Brain health begins with brain care

The brain health crisis demands a rapid response. In the USA alone, one in ten people aged 65 years and older has dementia, a stroke-related death occurs every 4 minutes, and 21 million adults had at least one major depressive episode in 2020. Primary prevention strategies have led to a decline of at least 20% in deaths from heart disease and cancer over the past 30 years.1Ford ES Ajani UA Croft JB et al.Explaining the decrease in U.S. deaths from coronary disease, 1980–2000.N Engl J Med. 2007; 356: 2388-2398Crossref PubMed Scopus (2255) Google Scholar, 2Weir HK Anderson RN Coleman King SM et al.Heart disease and cancer deaths—trends and projections in the United States, 1969–2020.Prev Chronic Dis. 2016; 13160211Crossref Google Scholar Although prevention of brain disease is yet to be a focus of primary care medicine, a crucial opportunity exists to leverage the global acceptance that more than 40% of dementia, stroke, and depression cases are attributable to modifiable risk factors.3Livingston G Huntley J Sommerlad A et al.Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.Lancet. 2020; 396: 413-446Summary Full Text Full Text PDF PubMed Scopus (3659) Google Scholar, 4Pandian JD Gall SL Kate MP et al.Prevention of stroke: a global perspective.Lancet. 2018; 392: 1269-1278Summary Full Text Full Text PDF PubMed Scopus (214) Google Scholar, 5Herrman H Patel V Kieling C et al.Time for united action on depression: a Lancet-World Psychiatric Association Commission.Lancet. 2022; 399: 957-1022Summary Full Text Full Text PDF PubMed Scopus (189) Google Scholar We and our colleagues at the McCance Center for Brain Health have developed and tested a prototype Brain Care Score as a straightforward, motivational, and multidimensional tool for use in primary care. Designed for simplicity, the Brain Care Score is a comprehensive tool for brain care and is composed of 12 components, each a modifiable risk factor for at least one of the three most common non-communicable diseases: dementia, stroke, and depression. Four are physical components (blood pressure, haemoglobin A1c, cholesterol, and body-mass index), five are lifestyle elements (nutrition, alcohol intake, smoking, physical activity, and sleep), and three are social factors (stress, relationships, and meaning in life; see appendix). Patients are encouraged to increase their score, focusing sequentially on the components for which they are most motivated. Applicability of the Brain Care Score further extends to cardiovascular health, as it incorporates all of the Life's Essential Eight, the American Heart Association's key measures for improving and maintaining cardiovascular health. Many components are also risk factors for a range of cancers. As such, an advantage of the Brain Care Score is its holistic approach, eliminating the need for separate tools for the prevention of a range of chronic, non-communicable diseases. The Brain Care Score is a crucial first step to motivate anyone—individuals who do not have brain disease as well as those who do—to take the steps that physicians worldwide generally agree will help to prevent brain diseases. Rather than focusing on an individual's brain health in itself, or on how well their brain is functioning, the Brain Care Score facilitates discussions on what an individual is already doing and on identifying additional ways to enhance brain care. This prototype Brain Care Score is just that: a prototype. It will no doubt require refinement as investigators pursue essential research to answer questions such as the following: does improvement in the Brain Care Score over time lead to a reduction in disease risk? Is the Brain Care Score approach acceptable to, and adopted by, patients and health-care providers? Will different forms be required for different populations? Can implementation of the Brain Care Score be made sustainable? Can its use help to reduce health-care disparities? Novel medicines could one day markedly reduce the huge burden of age-associated brain diseases, but we cannot afford to wait for that day to arrive without acting. The time to introduce the Brain Care Score into primary care is now. All its components are uncontroversial. Let us embrace the Brain Care Score as a first step towards routine brain care, and, in parallel, launch the important work of showing its effectiveness. JR receives research funding from the National Institutes of Health and the American Heart Association.