Brain Health and Traumatic Brain Injury (TBI): Relationship Between Brain Care Score and Disability in Subacute-Long Term TBI

Traumatic brain injury (TBI) is a prevalent, chronic disease with heterogenous recovery and dementia risk. Poor brain health is associated with increased dementia risk, but brain health remains unexplored in TBI. Brain Care Score (BCS), a tool measuring brain health with physical, lifestyle, and social factors, has not been used in TBI. Retrospective cohort study of TBI-clinic visits in the Neurology Traumatic Brain Injury and Concussion Clinic (9/2022-10/2025). Inclusion criteria: ≥18yo, self-reported TBI, BCS, functional outcomes. Disability defined as Glasgow Outcome Scale-Extended (GOSE) <7. Among 185 patients (median age 45yo, 55.1% men, 76.2% mild TBI), 64.9% were disabled (mean GOSE 5.11 [SD: 0.80]) whom had lower BCS vs non-disabled (14.9 vs 16.8, P < 0.001). In multivariable analysis adjusted for age, sex, insurance status, Injury Severity Score (ISS), higher ISS was associated with greater odds of disability (OR = 1.06, 95% CI: 1.02-1.10, P = 0.006). Higher BCS was associated with lower odds of disability (OR = 0.779, 95% CI: 0.677-0.883, P < 0.001). We demonstrate feasibility of measuring brain health with BCS in a TBI clinic. Higher BCS is associated with lower disability risk. Future studies will investigate brain health as potentially intervenable risk factors for long-term disability in TBI survivors.