What's your Brain Care Score?

After someone receives the devastating diagnosis of stroke or dementia, family members inevitably have many questions. "But the one question I get all the time is, 'What can I do to take good care of my brain so I don't end up like this?'" says Dr. Jonathan Rosand, professor of neurology at Harvard Medical School. So he collaborated with patients and colleagues at Massachusetts General Hospital's McCance Center for Brain Health to create the McCance Brain Care Score.

The measurement — the first of its kind — tallies points from 12 physical, lifestyle, and social-emotional domains (see "What factors affect brain health?"). It was validated using data from nearly 400,000 adults ages 40 through 69 who were followed an average of 12.5 years. The study, published Nov. 30, 2023, by Frontiers in Neurology, found that people who scored higher at the start of the study had lower risks of developing strokes or dementia over time. Each year, more than 795,000 people suffer a stroke in the United States, and dementia affects one in seven Americans.

The results varied by age group, with more dramatic drops among people younger than 50 compared to those ages 59 and older. But the benefits were still evident for people in their 60s: a five-point higher score was linked to a 33% lower risk of stroke. A subsequent study found that higher scores were also associated with a lower risk of depression over time.

Benefits beyond the brain?

"The findings support earlier evidence showing that it's never too late to raise your Brain Care Score," says Dr. Rosand. While the impact may be greater when you're younger, it's still substantial when you're older. And if you've already had a stroke or have early cognitive decline, raising your score is likely to reduce your risk of another stroke and might even slow the rate of your cognitive decline.

Every four minutes, someone in the United States dies from a stroke-related cause. Yet at least 60% of strokes are preventable by changing behaviors, habits, and other risk factors that contribute to stroke. Among the most potent of these are (1) not smoking and (2) keeping your blood pressure below 120/80 mm Hg. Both factors net three points each on the Brain Care Score.

What's more, the same things that benefit your brain are also closely linked to lower risks for heart disease and heart failure, as well as many cancers, including those of the lung, breast, and colon. "As those of us who focus on brain health like to say, 'Take care of your brain, and the rest of your body will follow,'" says Dr. Rosand.

Decoding the dementia link

Heart attacks and strokes are two main examples of problems affecting the vascular system — the network of blood vessels in the body and brain. Another is vascular dementia, which stems from the degeneration of blood vessels in the brain, often from a series of tiny strokes. The symptoms include slowed thinking, confusion, and problems with attention, concentration, and organization. Vascular dementia differs from Alzheimer's disease, which results from brain cell degeneration, Dr. Rosand explains. However, the two conditions often occur together, and Alzheimer's disease is exacerbated by vascular dementia. In fact, it's often difficult to say for certain whether a person has Alzheimer's or vascular dementia. The good news is that a higher Brain Care Score appears to help prevent both types.

"The brain is a very metabolically active organ that demands rapid changes in blood supply from second to second," says Dr. Rosand. As a result, the brain's smallest vessels constantly dilate and contract to ensure that the regions of the brain that are active have the blood supply they need, while those that are at rest don't receive any more than they need. Over time, damage to these vessels leaves them prone to injury and deterioration. Known as cerebral small vessel disease, it's the most common precursor to vascular dementia.

In a study published Aug. 27, 2024, in Neurology, Dr. Rosand and colleagues found that a higher Brain Care Score was associated with less visible damage from cerebral small vessel disease. The study involved more than 34,000 middle-aged adults without a history of stroke or dementia who had brain MRI scans. The scans can reveal evidence of damage to small vessels — especially lesions in the brain's white matter, which consists of bundles of nerve fibers that connect brain cells.

"The findings provide a physical sign that you can measure in the brain that's correlated to your lifestyle and the degree to which you're modifying your risk factors," says Dr. Rosand.

How to use the Brain Care Score

Tallying up your Brain Care Score helps you identify what you're doing right and pinpoint the areas you can improve. "It doesn't matter where you start — just pick one area that seems the easiest," says Dr. Rosand. One successful experience often leads people to try other changes, he says.

Where people live, what they have access to, and their unique lifestyles all influence what they're able to start changing. Dr. Rosand chats with his patients to help them figure out about what solutions might work best for them. For example, a patient who rarely ate vegetables acknowledged liking broccoli and eating it about once a week. "Why not eat it three times a week?" Dr. Rosand suggested. It's not that much extra effort to buy and cook a few extra servings.

A different person whose job demanded long stretches of sitting realized he could add informal exercise to his daily routine by climbing the six flights of stairs to his apartment at least twice a day. "You don't have to wear fancy exercise gear and go to a gym to meet the recommended exercise goals," says Dr. Rosand. Another man, who was recently divorced, didn't have many social relationships outside of work and his immediate family. "We started talking about his old friends, which reminded him of his artistic aspirations during high school," says Dr. Rosand. Within six months, the man was taking painting lessons and meeting new people.

"Each of us can find ways to improve our Brain Care Score over time. The key is deciding that you really don't want to develop dementia or stroke and are eager to do something about it," he says.

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