The predictive validity of a Brain Care Score for dementia and stroke: data from the UK Biobank cohort
Sanjula Singh, Tin Orešković, Sinclair Carr, Keren Papier, Megan Conroy, Jasper R. Senff, Zeina Chemali, Leidys Gutiérrez-Martínez, Livia Parodi, Ernst Mayerhofer, Sandro Marini, Courtney Nunley, Amy Newhouse, An Ouyang, H. Bart Brouwers, M. Brandon Westover, Cyprien Rivier, Guido J. Falcone, Virginia J. Howard, George Howard, Aleksandra Pikula, Sarah Ibrahim, Kevin N. Sheth, Nirupama Yechoor, Ronald M. Lazar, Christopher D. Anderson, Rudolph E. Tanzi, Gregory L. Fricchione, Thomas J. Littlejohns, Jonathan Rosand
Abstract
Introduction: The 21-point Brain Care Score (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. We aimed to assess the associations of the BCS with risk of incident dementia and stroke. Methods: The BCS was derived from the United Kingdom 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% (95%CI: 40-72%) lower risk of dementia among participants aged <50. Among those aged 50-59, the figure was 32% (95%CI: 20-42%) and 8% (95%CI: 2-14%) for those aged >59 years. A five-point higher BCS was associated with a 48% (95%CI: 39-56%) lower risk of stroke among participants aged <50, 52% (95%CI, 47-56%) among those aged 50-59, and 33% (95%CI, 29-37%) among those aged >59. Discussion: 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.