The tool assesses 12 modifiable physical, lifestyle and social factors that can help patients protect their brain health

Late-life depression, generally defined as depression that begins in people over the age of 60, can affect up to a third or more of people over 60 and can be disabling. But, as with other neurological disorders, individual risk can be influenced by lifestyle choices.

Researchers at Mass General Brigham previously developed and validated the Brain Care Score (BCS) to help patients and clinicians identify lifestyle changes that may reduce their risk of dementia and stroke.

Now, with the help of collaborators at Yale University, they have shown that a higher BCS score is also associated with a lower risk of depression in later life. The results, published in Frontiers in psychiatryprovide further evidence of shared biological risk factors for stroke, dementia, and depression and highlight the potential of BCS to help patients make lifestyle changes to better care for their brain health.

“The Brain Care Score is a simple tool designed to help anyone in the world answer the question, ‘What can I do to better care for my brain?’” said author Jonathan Rosand, MD, MSc, co-founder of the McCance Center for Brain Health at Massachusetts General Hospital and principal developer of the Brain Care Score.

“This paper provides compelling evidence that increasing your BCS not only may make your brain healthier and more resistant to diseases like dementia and stroke, but also offers hope of protection against depression.”

The new study represents a collaboration between researchers at Brigham and Women’s Hospital and Massachusetts General Hospital, founding members of the Mass General Brigham health system.

“Dementia, stroke and depression are leading causes of human suffering as we age,” said corresponding author Christopher D. Anderson, MD, MSc, chief of stroke and cerebrovascular disease in the Department of Neurology at BWH. “This study highlights an extraordinary opportunity to prevent the development of these diseases.”

The Brain Care Score was developed by McCance Center researchers and their collaborators to help patients and clinicians prevent the onset of brain disease by focusing on modifiable risk factors. These include four physical risk factors (blood pressure, hemoglobin A1c, cholesterol, and body mass index), five lifestyle items (nutrition, alcohol use, smoking, physical activity, and sleep), and three social/emotional items (stress, relationships, and purpose in life). A higher score on the 21-point scale indicates a lower risk of brain disease.

The research team, using data from more than 350,000 participants in the UK Biobank (UKB) study, demonstrated that a five-point increase in baseline BCS was associated with a 33% lower risk of late-life depression and a 27% lower composite risk of late-life depression, stroke and dementia over a median follow-up period of 13 years.

The UKB, which the researchers previously used to develop and validate the BCS, includes more than a decade of systematically collected medical information from participants across the UK, who were aged 40 to 69 during the study’s enrollment period from 2006 to 2010. In addition, the researchers verified their findings in a separate dataset of nearly 200,000 people from the UKB, whose primary care records were also accessible to the researchers.

Underdiagnosis and underdocumentation of depression is a known challenge for epidemiological research, but inclusion of primary care records may reduce the likelihood of missed diagnoses.

When stratifying the results by age, the researchers were surprised to find a substantial association between baseline BCS and depression risk in people under age 50.

While researchers expected that older adults might experience neurodegenerative and inflammatory processes that could contribute to late-life depression, stroke, and dementia, the neurobiological changes that lead to depression in younger people are less apparent.

Going forward, the researchers will conduct additional work to understand the relationship between BCS scores and depression risk in youth.

“There is still much to be learned about the pathways that contribute to depression, dementia and stroke in late life,” said first author Sanjula Singh, MD, PhD, MSc, of the McCance Center for Brain Health in the Department of Neurology at Massachusetts General Hospital and Harvard Medical School.

“Our results highlight the importance of a holistic view of the brain to better understand the underlying links between different brain diseases.”

Researchers are continuing to investigate whether people who increase their BSC score by five points or more over time have a reduced risk of stroke and dementia in the future, compared with those who did not experience a substantial increase in their score.

“There is growing evidence that the risk of a variety of noncommunicable diseases is to some extent influenced by modifiable lifestyle changes, if they are initiated early enough,” said Gregory Fricchione, MD, associate chief of psychiatry at Massachusetts General Hospital.

“This research is exciting and hopeful in its implications for combating common diseases such as depression, which is itself a risk factor for many other diseases. This research reminds us of the intertwining of the nervous system with psychosocial and immunological stress, and the potential to reduce vulnerabilities to downstream brain damage through improvements in the factors described in the BCS.”