Associations Between the Brain Care Score and Structural Brain Changes and Cognitive Impairment Using Data From the Hamburg City Health Study
Jenna Schellin, Susanne Sehner, Marie Neumann, Marvin Petersen, Felix Leonard Nägele, Sanjula D. Singh, Jonathan Rosand, Nils Schumacher, Birgit‐Christiane Zyriax, Raphael Twerenbold, Bastian Cheng, Götz Thomalla, Märit JensenABSTRACT
Background
The Brain Care Score (BCS) was designed to engage patients in behavior change targeting modifiable risk factors for dementia, stroke, and depression. We investigated its associations with structural brain changes and cognitive function to evaluate its utility for early prevention.
Methods
We analyzed data from the population‐based Hamburg City Health Study (participants aged 45–74 years). A modified BCS (range 0–18) was derived from physiological, lifestyle, and social factors. Brain MRI including diffusion tensor imaging provided markers of neurodegeneration, vascular brain damage, and structural brain network organization. Cognitive function was assessed using the MMSE and CERAD‐Plus subtests.
Results
Among 2453 participants (mean age 63.8 years, 44% women, median BCS 11), a higher BCS was associated with less vascular brain damage: a 5‐point‐increase was associated with lower white matter hyperintensity burden (relative increase 0.81; 95% CI [0.75, 0.87]) and lower Peak Width of Skeletonized Mean Diffusivity (relative increase 0.97; 95% CI [0.96, 0.98]). A higher BCS was also associated with better structural connectivity (higher global efficiency, lower clustering coefficient). Regarding cognition, a 5‐point‐increase was associated with faster processing speed (relative increase 0.96, 95% CI [0.94, 0.98]), better executive function (relative increase 0.94, 95% CI [0.91, 0.97]), and improved verbal fluency (absolute increase 0.57, 95% CI [0.05, 1.10]).
Conclusion
The BCS represents a simple score capturing modifiable risk factors for common age‐related brain disease, adaptable to large population‐based cohorts. Higher scores are associated with healthier brain structure, network organization, and better cognitive function, supporting its role in guiding preventive interventions.
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