A Brain Care Score for Dementia and Stroke: Data from the UK Biobank Cohort
Sanjula Singh1, Tin Oreskovic5, Sinclair Carr8, Keren Papier6, Megan Conroy7, Jasper Senff9, Zeina Chemali4, Leidys Gutierrez-Martinez4, Livia Parodi10, Ernst Mayerhofer4, Sandro Marini2, Courtney Nunley1, Amy Newhouse4, An Ouyang1, Bart Brouwers11, Brandon Westover3, Cyprien Rivier13, Guido Falcone14, Virgina Howard15, George Howard16, Aleksandra Pikula12, Sarah Ibrahim12, Kevin Sheth17, Nirupama Yechoor18, Ronald Lazar19, Christopher Anderson20, Gregory Fricchione1, Thomas Littlejohns6, Jonathan Rosand4
1Henry and Allison McCance Center for Brain Health, 2Herny and Allison McCance Center for Brian Health, 3Department of Neurology, Massachusetts General Hospital, 4Massachusetts General Hospital, 5Nuffield Department of Population Health, Medical Sciences Division, 6Nuffield Department of Population Health, 7Nuffield Department of Population Healt, University of Oxford, 8Institute for Health Metrics and Evaluation, University of Washington, 9McCance Center for Brain Health, 10Mass General Hospital, 11Department of Neurology and Neurosurgery, University Medical Center Utrecht, 12University Medical Center Utrecht, 13Yale University, 14Yale School of Medicine, 15Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 16UAB School of Public Hlth, 17Yale UniversityDivision of Neuro and Critical Care, 18MassGeneral Brigham, 19University of Alabama At Birmingham, 20Brigham and Women's Hospital
Objective:
We aimed to assess the associations of the Brain Care Score (BCS) with risk of incident dementia and stroke.
Background:
The 21-point BCS was developed through a modified Delphi process in partnership with practitioners and patients to promote behavior changes and lifestyle choices in order to sustainably reduce the risk of dementia and stroke.
Design/Methods:
The BCS was derived from the UK Biobank (UKB) baseline evaluation for participants aged 40–69 years, recruited between 2006–2010. Associations of BCS and risk of subsequent incident dementia and stroke were estimated using Cox proportional hazard regressions, adjusted for sex assigned at birth and stratified by age groups at baseline.
Results:
The BCS (median: 12; IQR:11–14) was derived for 398,990 UKB participants (mean age: 57; females: 54%). There were 5,354 incident cases of dementia and 7,259 incident cases of stroke recorded during a median follow-up of 12.5 years. A five-point higher BCS at baseline was associated with a 59% (HR: 0.41, 95%CI: 0.28–0.60) lower risk of dementia among participants aged <50. Among those aged 50–59, the figure was 32% (HR: 0.68, 95%CI: 0.58–0.80) and 8% (HR: 0.92, 95%CI: 0.86–0.98) for those aged >59 years. A five-point higher BCS was associated with a 48% (HR: 0.52, 95%CI: 0.44–0.61) lower risk of stroke among participants aged <50, 52% (HR: 0.48, 95%CI: 0.44–0.53) among those aged 50–59, and 33% (HR: 0.67, 95%CI: 0.63–0.71) among those aged >59.
Conclusions:
The BCS has clinically relevant and statistically significant associations with risk of dementia and stroke in approximately 0.4 million UK people. Future research includes investigating the feasibility, adaptability and implementation of the BCS for patients and providers worldwide.