McCance Brain Care Score Predicts Depression, Risk of Dementia and Stroke in Older Adults

July 30, 2024

Ruta Nonacs, MD PhD

The brain care score consists of 12 questions about modifiable risk factors can be used to help individuals estimate their risk of depression, dementia and stroke and to make changes that reduce risk.

The 21-point Brain Care Score (BCS) is a novel tool developed by a team of researchers from the McCance Center for Brain Health at Mass General Hospital. Designed to identify modifiable risk factors for dementia and stroke, the BCS can be used to motivate individuals and care providers to take action to improve brain health by encouraging lifestyle changes. Given that late-life depression appears to share risk factors with stroke and dementia, the research team examined whether the BCS could be used to predict risk of future depression.

The McCance Brain Care Score

The 21-point Brain Care Score (BCS) was conceptualized and developed by researchers from the McCance Center for Brain Health, including Zeina Chemali, MD, MPH, Director of Neuropsychiatry Clinics and Training in the Departments of Psychiatry and Neurology at Mass General. In order to maximize practitioner and patient engagement, the BCS was developed using a group consensus process that systematically and quantitatively combined patient feedback, expert opinion, and scientific evidence. The BCS includes common modifiable risk factors for dementia and stroke that are most widely endorsed by professional organizations and patient advocacy groups. A scoring system was designed to give more emphasis to factors hypothesized to have the strongest associations with risk for dementia and/or stroke. Risk factors such as age, family history, education level, and socioeconomic status were not included because the survey focuses only on factors that could realistically be modified by the patient or practitioner.

The BCS captures information on (1) physical, (2) lifestyle, and (3) social and emotional risk factors. The survey includes questions about blood pressure, hemoglobin A1c, cholesterol levels, Body Mass Index, and also gathers information on diet, use of alcohol, smoking, aerobic exercise, and sleep. Importantly, the BCS also asks about stress, social relationships, and meaning in life.

The questionnaire can be filled out by the patient and/or provider. Scores on the BCS range from 0 to 21, with higher scores reflecting lower burden of risk factors for dementia and stroke.

Validation of the Brain Care Score: Risk of Late-Life Depression

In a previous study, the research team performed the first validation of the BCS in a clinical sample, examining the association between the BCS and risk of dementia and stroke during follow-up in adults participating in the United Kingdom Biobank (UKB), a population-based, prospective cohort study of more than 500,000 participants living in the UK. In this study, the research team demonstrated that risk for stroke and/or dementia increased as the Brain Score decreased.

In a subsequent study using the same cohort, the researchers examined whether BCS could also be used to predict risk of future depression. The BCS was calculated for 363,323 UKB participants (mean age: 57; females: 54%). The median BCS at baseline was 12 (observed range: 1–19). There were 6,628 new cases of depression recorded during a median follow-up of 13 years.

The researchers observed a clinically relevant and statistically significant association between BCS and risk of depression. After adjusting for age, each five-point increase in baseline BCS was associated with a 33% lower risk of experiencing late-life depression. Among the youngest participants aged <50 years at baseline, each five-point higher BCS was associated with a 59% lower risk of late-life depression.

Next Steps

The current study demonstrates clinically relevant and statistically significant associations between the BCS at baseline and future risk of depression, dementia and stroke in nearly 400,000 individuals participating in the UK Biobank. Given that lower Brain Care scores were associated with a higher risk of depression, dementia and stroke across all age groups, the BSC is a tool that could be used to identify modifiable risk factors in middle-aged adults. This 12-item questionnaire is a tool that is inexpensive and easy to administer and score and thus could easily be incorporated into primary care settings in order to help the provider and patient identify risk factors that need to be addressed.

Rather than focusing on risk factors that are not modifiable, such as family history or socioeconomic status, the BCS emphasizes factors that can be managed or changed. Improving one’s BCS may require medical intervention (for example, medications to manage blood pressure or cholesterol levels), but the BCS also highlights behaviors that an individual may target in order to improve brain health, such as diet, exercise and use of alcohol.

The current study focuses only on Brain Care Scores at baseline; future studies are needed to determine how individual improvements in BCS, especially in younger adults, may modify subsequent risk for depression, dementia and stroke.

Other researchers involved in this study include Sanjula D. Singh, MD, PhD, MSc, Cyprien Rivier, MD, Keren Papier, PhD, Leidys Gutierrez-Martinez, MD, MSc, Livia Parodi, PhD, Ernst Mayerhofer, MD, Jasper R. Senff, MD, Santiago Clocchiatti-Tuozzo, PhD, Courtney Nunley, MSc, Amy Newhouse, MD, An Ouyang, PhD, Brandon Westover, MD, PhD, H. Bart Brouwers, MD PhD, Virginia Howard, PhD, George Howard, PhD, Aleksandra Pikula, MD, Sarah Ibrahim, RN, MN, Kevin N. Sheth, MD, PhD, Nirupama Yechoor, MD, Ronald M. Lazar, MD, PhD, Christopher D. Anderson, MD, MMSc, Rudolph E. Tanzi, PhD, Gregory Fricchione, MD, Thomas Littlejohns, PhD, MSc, Jonathan Rosand, MD, MSc, and Guido Falcone, MD, PhD,.

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Singh SD, Rivier CA, Papier K, Chemali Z, et al. The predictive validity of a Brain Care Score for late-life depression and a composite outcome of dementia, stroke, and late-life depression: data from the UK Biobank cohort. Front Psychiatry, July 2024.