From the Department of Neurology (C.A.R., S.C.-T., S.H., D.R., K.N.S., G.J.F.), Yale School of Medicine, New Haven, CT; Yale Center for Brain and Mind Health (C.A.R., S.C.-T., S.H., D.R., S.P., K.N.S., G.J.F.); Henry and Allison McCance Center for Brain Health (S.S., J.S., R.W.T., S.M., Z.C., C.K., M.B.W., G.F., R.E.T., N.Y., C.D.A., J.R.); Departments of Neurology (S.S., J.S., R.W.T., S.M., Z.C., C.K., M.B.W., N.Y., C.D.A., J.R.), Psychiatry (A.N.), and Medicine (A.N.), Massachusetts General Hospital, Boston; Broad Institute of MIT and Harvard (S.S., J.S., R.W.T., S.M., C.K., N.Y., C.D.A., J.R.), Cambridge, MA; Department of Neurology (S.S., J.S., R.W.T., H.B.B.), Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, the Netherlands; Cancer Epidemiology Unit (K.P.), Nuffield Department of Population Health (M.C., T.J.L., C.M.V.D.), Big Data Institute, University of Oxford, United Kingdom; UAB McKnight Brain Institute (R.M.L.), Department of Neurology, UAB Heersink School of Medicine, University of Alabama at Birmingham; Department of Medicine (Neurology) (A.P.), University of Toronto; Krembil Brain Institute (A.P.), Toronto, Ontario, Canada; Program for Health System and Technology Evaluation (S.I.); Toronto General Hospital Research Institute; The Jay and Sari Sonshine Centre for Stroke Prevention & Cerebrovascular Brain Health (A.P., S.I.), University Health Network, Toronto; Centre for Advancing Collaborative Healthcare & Education (CACHE) and Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health (S.I.), University of Toronto, Ontario, Canada; Departments of Epidemiology (V.J.H.) and Biostatistics (G.H.), School of Public Health, University of Alabama at Birmingham; Department of Neurosurgery (H.B.B.), Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Benson-Henry Institute for Mind Body Medicine (G.F.), Massachusetts General Hospital; and Department of Neurology (C.D.A.), Brigham and Women's Hospital, Boston, MA.
Neurology. 2024 Aug 27;103(4):e209687. doi: 10.1212/WNL.0000000000209687. Epub 2024 Jul 25.
To investigate associations between health-related behaviors as measured using the Brain Care Score (BCS) and neuroimaging markers of white matter injury.
This prospective cohort study in the UK Biobank assessed the BCS, a novel tool designed to empower patients to address 12 dementia and stroke risk factors. The BCS ranges from 0 to 21, with higher scores suggesting better brain care. Outcomes included white matter hyperintensities (WMH) volume, fractional anisotropy (FA), and mean diffusivity (MD) obtained during 2 imaging assessments, as well as their progression between assessments, using multivariable linear regression adjusted for age and sex.
We included 34,509 participants (average age 55 years, 53% female) with no stroke or dementia history. At first and repeat imaging assessments, every 5-point increase in baseline BCS was linked to significantly lower WMH volumes (25% 95% CI [23%-27%] first, 33% [27%-39%] repeat) and higher FA (18% [16%-20%] first, 22% [15%-28%] repeat), with a decrease in MD (9% [7%-11%] first, 10% [4%-16%] repeat). In addition, a higher baseline BCS was associated with a 10% [3%-17%] reduction in WMH progression and FA decline over time.
This study extends the impact of the BCS to neuroimaging markers of clinically silent cerebrovascular disease. Our results suggest that improving one's BCS could be a valuable intervention to prevent early brain health decline.
研究使用 Brain Care Score（BCS）衡量的健康相关行为与白质损伤的神经影像学标志物之间的关联。
这项在英国生物库进行的前瞻性队列研究评估了 BCS，这是一种旨在增强患者解决 12 种痴呆症和中风风险因素能力的新工具。BCS 的范围为 0 到 21，得分越高表示大脑护理越好。结果包括在两次影像学评估中获得的脑白质高信号（WMH）体积、各向异性分数（FA）和平均弥散度（MD），以及两次评估之间的进展情况，采用多变量线性回归模型调整年龄和性别因素。
我们纳入了 34509 名参与者（平均年龄 55 岁，53%为女性），他们没有中风或痴呆病史。在首次和重复影像学评估中，BCS 基线每增加 5 分，WMH 体积显著降低（首次评估时降低 25%[95%CI：23%-27%]，重复评估时降低 33%[27%-39%]），FA 升高（首次评估时升高 18%[16%-20%]，重复评估时升高 22%[15%-28%]），MD 降低（首次评估时降低 9%[7%-11%]，重复评估时降低 10%[4%-16%]）。此外，较高的基线 BCS 与 WMH 进展和 FA 随时间下降相关，其降低 10%[3%-17%]。
这项研究将 BCS 的影响扩展到了临床无症状脑血管疾病的神经影像学标志物。我们的研究结果表明，改善 BCS 可能是预防早期大脑健康下降的一种有价值的干预措施。
