A tool that assesses a dozen modifiable risk factors across physical, lifestyle, and social-emotional domains to estimate risk for neurological disorders was a good predictor of stroke risk among different racial groups in the US, new research showed. 

The Brain Care Score (BCS) is a 21-point scale that predicts risk for neurological disorders. A higher score indicates better overall brain health and lower disease risk. 

This new analysis of scores from nearly 11,000 adults revealed a 5-point improvement in BCS was associated with a 53% lower risk of stroke in Black individuals compared to a 25% lower risk in White individuals.

The larger effect size in Black participants suggests improving brain health may offer an outsized benefit in this population, investigators said. That’s important because stroke incidence is significantly higher in Black individuals, and 80% of those cerebrovascular events are attributable to modifiable risk factors. 

“Our findings show that the Brain Care Score provides a practical framework to better understand and address this disparity — by identifying modifiable behavior that lower stroke risk,” study author Sanjula Dhillon Singh, MD, PhD, a principal investigator in the Brain Care Labs, Department of Neurology, Massachusetts General Brigham, Boston, said in a press release.

The findings were published December 18 in Neurology. 

The BCS addresses 12 modifiable risk factors across three domains: physical (blood pressure, blood sugar, cholesterol, and BMI); lifestyle (nutrition, alcohol consumption, smoking, physical activity, and sleep); and social-emotional (stress, social relationships, and meaning in life).

Scores range from 0-21 points, with a higher score indicating healthier behaviors, lower stroke risk, reduced burden of cerebral small vessel disease, and decreased risk of other age-related brain diseases, including dementia and late-life depression.

The new study included 10,861 participants (mean age, 63 years; 57% female; 31% Black) from the Reasons for Geographic and Racial Differences in Stroke cohort who were stroke-free and had complete BCS data.

Black participants had significantly lower baseline BCS compared with White participants (13.8 vs 14.7; P < .001). Investigators said this reflects a higher burden of vascular risk factors, which can include hypertension, diabetes, and smoking.

The primary outcome was incident stroke. Researchers calculated hazard ratios (HRs) and 95% confidence intervals for a 5-point higher BCS, which is considered clinically relevant. They adjusted for age, sex, socioeconomic factors (income, education, insurance), and living situation (urban vs rural).

Over a median follow-up of 15.9 years, 696 incident strokes were documented. A 5-point increase in BCS was associated with a 53% lower risk of stroke in Black individuals (HR, 0.47; 95% CI, 0.36-0.61) and a 25% lower risk in White participants (HR, 0.75; 95% CI, 0.62-0.92.)

The magnitude of the association was significantly stronger among Blacks (P = .0045).

Confirming the predictive power of the BSC in diverse populations “is essential if we are to make progress in ensuring that everyone everywhere has an opportunity to protect their brain health,” study co-author Jonathan Rosand, MD, director of the Brain Care Labs at Massachusetts General Brigham, and founder of the Global Brain Care Coalition, said in a release. 

Participants without complete BCS data were excluded, possibly introducing selection bias. Other limitations were that not all BCS components were available at baseline, and residual confounding or genetic factors may have influenced the results even after adjustments for demographic differences and socioeconomic factors linked to stroke disparities.

The study received funding from the National Institutes of Health and the American Heart Association. The authors have no relevant conflicts of interest.