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the brain care score: unlocking the connection between your brain and body
9 minute read
while the brain care score aims to address diseases that often develop as people age, it’s most beneficial at any age. data from the u.k. biobank research showed that people under 50 may experience the most benefit from using it.
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taking care of your brain is, for lack of a better term, a no-brainer, right? not necessarily—many people are unaware of the various facets of health that can do a number on their brain health as they age into their golden years.
everything you do and don’t do, from lifestyle factors such as diet, exercise, and sleep to social factors such as stress, relationships, and life purpose, will play a role in how healthy your brain is.
that’s why researchers at mass general brigham developed what is known as the mccance brain care score™️ (bcs), a tool that the general public can use to protect and foster better brain health through actionable advice based on where their current score stands.
dr. jonathan rosand, co-founder of the mccance centre for brain health at massachusetts general hospital and neurologist specializing in intensive care and vascular neurology, sees first-hand repercussions of what can happen to the brain due to modifiable risk factors.
“we have focused on dementia, stroke, and depression because they’re the most common conditions of the brain, and they’re age-related, and they’re preventable,” he said. “there’s so much that one can do to actually reduce one’s risk.”
together with patients, families, healthcare providers, and “a whole lot of science,” dr. rosand and his colleagues worked to create a brain care tool that could change the way people approach brain health now and into their futures.
the prevalence of preventable brain health declines
roughly 771,939 canadians are living with some form of dementia. annual stroke rates have also increased in recent years, and currently, that number sits at 108,707. for depression, one in five canadians are currently affected.
as people age, depression continues to be an issue, with between 10 and 20 per cent of the older adult population having the condition. dementia, in particular, is predicted to afflict more and more people in the coming years.
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“the main reason for the rising number of cases of dementia is that the average age of our population is growing,” said dr. rosand. “in addition, we’ve become more and more attuned to detecting it, and in many cultures, dementia wasn’t recognized. it was thought to be part of aging, and so the world is becoming more attuned to the fact that that isn’t normal aging and dementia is separate.”
dr. rosand notes that 40 per cent of dementias are “theoretically preventable” based on the steps people take in their younger years, as well as depression at 35 per cent and stroke at 70 per cent.
this puts the power of brain health into the hands of the patient, but only if they know where they stand and what to do to change the trajectory of where they’re headed when it comes to their brain health.
using the data on risk factors to better the health of patients
research has continuously investigated various aspects of health and lifestyle that lead to the development of chronic diseases later in life. physical, lifestyle, and social or emotional factors all play their own roles in the development of diseases. for example, a lack of exercise and social isolation can drive depression, but it can also increase the risk of developing heart disease, stroke, and early death.
to create the bcs, dr. rosand and researchers wanted to simplify things because knowing the risk factors and being told how to reduce them isn’t always enough for patients.
“we would share this information with patients (but) what we found was that patients couldn’t easily take a next step. it often didn’t stick,” he said. “so, we concluded that we were just not communicating effectively, and we started to develop a score that was simple.”
dr. rosand notes that to ensure that the score would positively affect others, it had to be created in a way that taps into the universal human experience by being engaging, informative, and solution-driven instead of just pointing out problems.
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“that’s the key connection that we try to make at the individual level,” he said.
the bcs aims to benefit from these facts, and the data states that if you do x, you’re more at risk for developing y in a way that truly benefits people in the long run.
the score looks at 12 tweakable factors, all of which affect brain health. the physical factors are blood pressure, hemoglobin a1c, cholesterol, and body mass index (bmi). nutrition, alcohol intake, smoking, physical activity, and sleep comprise the lifestyle factors. stress levels and management, relationships, and life purpose account for the three remaining factors, which are considered social or emotional.
each factor that goes into overall well-being and good health works together to ensure that the human body and brain continue to be a well-oiled machine. because once one part of that machine falters, the rest follow suit. that’s why so many conditions co-exist.
after people find out their score, which will be given in a points system, they’ll see all the areas where they’re doing well and those that need attention. but people can’t tackle everything at once. the good news is that, even if they address only one aspect of their health at a time, they’ll still be better off because, as mentioned above, everything works together.
“they’re all interconnected. it’s like a series of 12 levels. if you move one, the others will move in the right direction as well,” said dr. rosand. “so, it’s further reassurance that it doesn’t matter where you start, just start somewhere.”
as an example, blood pressure is a commonly known risk factor for stroke, but many people globally aren’t receiving adequate treatment. however, if exercise is something they know they can improve on their bcs list of risk factors, it will indirectly improve blood pressure. this will improve their health now, but also in the future by lowering their risk for stroke.
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this baby-step approach makes improving a person’s bcs doable, regardless of their current health status. each person chooses the factor they want to work on first, and the process only gets easier from there.
“we want you to feel good about the brain care score. we don’t want you to feel like it’s tyrannical,” said dr. rosand, later continuing. “it’s very important to help people not feel anxious and see this as a lifelong journey.”
bcs research shows health improvements
to ensure that the bcs could be effective in practice, researchers analyzed data from a u.k. biobank study involving 350,000 participants. the data showed that after 13 years of participating in and acting on the bcs, people experienced a 27 per cent lower risk of late-life depression, stroke, dementia, and even some forms of cancer if they increased their score by five points.
“for the last 15 or 20 years, (these people) have been followed as part of research, and what we did is we took the baseline visit for each participant, extracted the data, calculated their brain care score, and then asked the question, is the brain care score at the time you enter the u.k. biobank associated with your risk of ultimately developing dementia, stroke, and depression,” said dr. rosand. “what we found was the higher brain care score, the lower your risk of dementia, stroke, depression, as well as heart disease, lung cancer, breast cancer, and colorectal cancer.”
in new research, the efficacy of the bcs was further confirmed, with a five-point increase being associated with a reduced risk of stroke by 30 per cent, late-life depression by 35 per cent, and dementia by 18 per cent.
this study also included those with an unmodifiable genetic predisposition to these diseases, yet it yielded the same results. it shows that even people with unchangeable risk factors for certain brain diseases can benefit from the bcs.
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the score is also designed to be ever-changing to include even more risk factors for an even more accurate assessment as more research unfolds.
“we have a large international process where we’re involving experts to do that (improve the score), and i can already tell you that the next version, when it becomes available, will include at least one addition, which is assessing for hearing impairment,” said dr. rosand.
the importance of hearing impairment stems from its commonality in aging, as well as its ability to increase the risk of developing dementia, depression, or stroke because it affects a person’s social connectedness with others.
accessing the bcs as a part of your general health checklist
while the bcs aims to address diseases that often develop as people age, it’s most beneficial at any age. data from the u.k. biobank research showed that people under 50 may experience the most benefit from using it.
“participants who are under 50 at the time of enrollment in the u.k. biobank, for every five-point rise in their brain care score, baseline had a 59 per cent reduction in risk, ultimately of dementia. so, it’s an incredible association,” said dr. rosand.
however, he also notes that just because those under the age of 50 saw a significant reduction in risk doesn’t mean that once you’re past a certain age, it’s not worthwhile.
“i want to reassure people that that doesn’t mean that … you shouldn’t use it when you’re 75 or 80 because there’s still a benefit,” he said. “i think every adult can benefit from using it, and our goal, we’ve launched what we’re calling the global brain care coalition to achieve this.”
dr. rosand and colleagues within the brain care coalition aim to make the bcs accessible to everyone, regardless of their culture, in a way that aligns with their unique lived experiences. it’s also worth noting that the assessment is completely free.
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when it’s accessible to everyone and used as a viable and effective preventative health literacy tool, that’s when they’ll believe it has reached its intended success.
“this is really a movement among colleagues like me, professors who’ve had very successful careers in research and patient care and really are not ready to actually do something that we think is practically going to make a difference in the world much faster than the discoveries you make will have an impact,” he said.
self-care for your brain without guilt and shame
while the bcs will tell people where they’re going wrong, the focus on the score is to show them the positive side of things in terms of where they could be going.
dr. rosand notes that if a person needs to get more exercise, meeting them where they are at is the best way to address that so that they don’t feel guilty for not making time.
that’s where understanding their life comes into play.
“one of our goals is to help people see opportunities to increase their physical activity, even if they think they can’t go to the gym every day,” he said. “often folks will have these elevated expectations of what exercise has to be. it has to be the right outfit in the right gym, doing the right stuff, and really it doesn’t at all. it just can be climbing the stairs every day at work.”
he recalls speaking with people who worked as taxi drivers with busy schedules who wanted to get more time in for exercise and how difficult that could be with their lifestyle. his, along with the bcs’s, suggestions for solving the problem aren’t bogged down in negatives that force people to burn the wick at both ends to get more movement but rather incorporate it into their everyday.
“i always talk to the taxi drivers whenever i travel, and one taxi driver, this was in germany, was very concerned about strokes because his sister had one, and he told me he just didn’t have time to exercise. so, we talked for the whole ride about his daily routines, and it turns out that he’s sitting in a queue in his taxi quite a bit, and there’s lots he can do to exercise by getting out of the car, walking, stepping up and down from the curb,” he said. “that’s part of our job is to help people open up the sense of possibility of how they can take good care of their brains.”
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ultimately, the bcs isn’t designed to scare people into making changes. it’s there to lead with hope rather than fear, giving people a picture of a brighter future rather than a dull right now.
“we want to give people the agency over their own health care,” said dr. rosand.
if you are interested in trying out the brain care score for yourself, you can find it here.
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