Key takeaways

• The Brain Care Score ranges from 0 to 21 points across 12 modifiable health factors. Higher scores significantly reduce the risks of dementia (up to 59%), stroke (up to 52%), and late-life depression
• The tool assesses physical health, lifestyle choices, and social-emotional well-being. A five-point higher BCS is associated with a significant reduction in the risk of dementia, stroke, and late-life depression.
• Benefits extend beyond brain health to help reduce the risk of severe health conditions like cardiovascular disease and cancer.

Overview

Have you ever wondered if there’s a simple way to assess your brain health and reduce your risk of dementia, stroke, and depression? The groundbreaking Brain Care Score offers exactly that — a scientifically validated tool that transforms how we approach brain wellness.

Dementia affects millions worldwide and is one of the leading causes of human suffering as people age. Developed by researchers at Harvard’s Massachusetts General Hospital, this revolutionary assessment doesn’t just measure your current brain health status.

It empowers you with actionable insights to protect your most valuable asset: your mind. Mental health is a key component of optimal brain health, playing a crucial role in stress management, social connections, and overall well-being. Whether you’re 40 or 70, this comprehensive scoring system can help you take control of your cognitive future.

What is the brain care score?

The Brain Care Score (BCS) represents a paradigm shift from reactive brain disease treatment to proactive brain care prevention. This evidence-based assessment tool, known as the McCance Brain Care Score, was developed at the McCance Center for Brain Health in partnership with patients to serve as a pragmatic instrument that engages people in behavior change toward risk factor modification. The development process included input from patient advocacy groups and extensive patient engagement, such as qualitative interviews and feedback sessions, to ensure the tool is patient-centered and motivating.

Unlike traditional risk assessment tools that simply predict disease probability, the Brain Care Score was designed with a different purpose: to motivate meaningful lifestyle changes. The BCS represents a significant paradigm shift from treating brain disease reactively to actively promoting brain health. The research team, including Mass General Brigham researchers, designed and validated the McCance Brain Care Score, emphasizing its scientific rigor and collaborative foundation.

The scoring system addresses a critical gap in preventive healthcare. While we routinely screen for heart disease and cancer, brain care has historically been overlooked in preventive medicine. The BCS focuses on common modifiable risk factors—lifestyle, physical, and social elements that individuals can change to reduce their risk of dementia and stroke. 

Family history, a non-modifiable risk factor, is not included in the BCS, as the score is designed to empower individuals to act on factors they can control. According to the CDC, only about a quarter of American adults with high blood pressure have it under control, despite blood pressure management being one of the most effective ways to prevent both stroke and dementia.

Brain Care Score validation was conducted through an extensive study involving nearly 400,000 adults aged 40-69 from the UK Biobank, who were followed for an average of 12.5 years. The research found that people who scored higher at the start of the study had lower risks of developing strokes or dementia over time.

12 components that shape your brain care score

Physical health metrics 

• Your brain care score begins with four critical physical components—measurable health factors that directly impact brain function and are essential for assessing your risk of brain diseases:
• Blood pressure control emerges as the most potent single factor, earning up to 3 points. Maintaining a blood pressure below 120/80 mmHg is among the most powerful protective factors, earning three points on the Brain Care Score. Lowering blood pressure is crucial for maintaining a healthy brain and significantly reduces the risk of cerebrovascular diseases such as stroke, as well as cognitive decline. This makes sense because your brain requires precise blood flow regulation every second.
• Blood sugar management through hemoglobin A1c levels reflects how well you’re controlling diabetes risk. High blood sugar damages the tiny vessels in your brain, leading to cognitive decline over time.
• Cholesterol levels affect the health of the blood vessels feeding your brain. Optimal cholesterol levels ensure your brain receives the nutrients and oxygen it needs to function at peak performance.
• Body Mass Index (BMI) reflects overall metabolic health. Maintaining a healthy weight helps reduce inflammation throughout your body, including in your brain tissue.

Lifestyle factors

Your daily choices create the foundation for long-term brain health. Making positive lifestyle choices can improve brain health and make your brain healthier, reducing the risk of serious health problems such as dementia, stroke, and depression:

• Nutrition quality focuses on brain-protective foods. The scoring system emphasizes vegetables, fruits, whole grains, and healthy fats, while limiting consumption of processed foods and red meat. The red meat score is based on consumption of beef, pork, and lamb, with optimal scores awarded to those who eat these foods less than once a week.
• Alcohol consumption follows a clear pattern: moderation protects, excess destroys. The scoring rewards limited alcohol intake while penalizing heavy drinking that damages brain cells.
• Smoking status offers the clearest choice for brain protection. Not smoking nets three points on the Brain Care Score, making it one of the most potent protective factors.
• Physical activity keeps your brain supplied with fresh blood and nutrients. Regular aerobic exercise stimulates the growth of new brain cells and strengthens connections between them.
• Sleep quality allows your brain to clear toxins and consolidate memories. Poor sleep accelerates brain aging and increases dementia risk.

Social-emotional well-being

• The brain care score acknowledges that emotional health has a direct impact on brain function. Social-emotional well-being is essential for mental well-being and can help prevent conditions such as a major depressive episode.
• Stress management addresses how chronic stress hormones can damage brain tissue over time. These components include the management of stress, which is critical to assessing our brain health.
• Social relationships reflect the protective power of human connection. Strong social bonds reduce inflammation and provide cognitive stimulation that keeps your brain sharp.
• Meaning and purpose in life contribute to resilience against brain disease. Having clear goals and values appears to protect against cognitive decline, even when brain changes occur.

How does the brain care score protect against disease?

Dementia prevention through multiple pathways

The Brain Care Score’s effectiveness against dementia stems from its ability to address multiple disease mechanisms simultaneously. Damage to small brain vessels leaves them prone to injury and deterioration, known as cerebral small vessel disease, which is the most common precursor to vascular dementia. Alzheimer’s disease is a significant form of dementia, and individuals with increased genetic risk for Alzheimer’s and other brain conditions can benefit from lifestyle changes that improve their Brain Care Score.

Research published in Neurology demonstrates measurable brain protection. In a study of more than 34,000 middle-aged adults without a history of stroke or dementia who had brain MRI scans, a higher Brain Care Score was associated with less visible damage from cerebral small vessel disease. These findings demonstrated statistically significant associations and were clinically relevant for predicting future neurological health outcomes.

The protection is substantial and age-dependent. Each five-point increase in the BCS was associated with a 59% lower risk of developing dementia among adults younger than 50 years old at enrollment, with similar estimates for participants aged 50–59 years, showing a 32% lower risk of dementia.

Stroke risk reduction

Brain Care Score components directly target the most preventable risk factors for stroke. At least 60% of strokes are preventable by changing behaviors, habits, and other risk factors that contribute to stroke. These findings are based on an extensive prospective cohort study that tracked participants over time to assess the development of health outcomes.

The stroke protection parallels dementia benefits. Results were analyzed by age group and across different age groups to show differences in risk reduction. A five-point higher Brain Care Score was associated with a 48% lower risk of experiencing a stroke among adults younger than 50 years old, and a 52% lower risk of stroke for participants aged 50–59 years.

Depression prevention

Recent research reveals the Brain Care Score’s power against late-life depression. A study published in Frontiers in Psychiatry showed that a higher BCS score is associated with a lower risk of late-life depression. This connection makes biological sense because depression often shares risk factors with dementia and stroke, including inflammation and poor vascular health. Late-life depression can cause severe impairment in daily functioning, highlighting the importance of prevention and early intervention.

Beyond brain health: Cardiovascular and cancer benefits

Heart disease protection

The Brain Care Score offers remarkable versatility by protecting multiple organ systems simultaneously. The BCS components are also modifiable risk factors for cardiovascular disease, as they encompass all the elements of the AHA’s Life’s Essential Eight.

Among 416,370 UK Biobank participants, 33,944 cases of cardiovascular disease (8.8%) were identified over a median follow-up of 12.5 years. A 5-point higher BCS at baseline was associated with a lower incidence of cardiovascular disease, with a hazard ratio of 0.57.

Cancer risk reduction

The Brain Care Score’s impact extends to cancer prevention. Among the same study participants, 16,090 cases of cancer (4.0%) were identified. A 5-point higher BCS was associated with a lower incidence of the three most common cancer types (lung, colorectal, and breast cancer), with a hazard ratio of 0.69.

This multi-disease protection makes the Brain Care Score incredibly valuable for overall health optimization. The BCS components are modifiable risk factors for most cancers, rendering the BCS an attractive choice for a single instrument to use routinely in primary care.

Practical implementation advantages

Healthcare providers appreciate the Brain Care Score’s comprehensive yet simple approach. An advantage of the Brain Care Score is its holistic approach, which eliminates the need for separate tools to prevent a range of chronic, non-communicable diseases.

Can you improve your brain care score over time?

Starting at any age

The encouraging news about the Brain Care Score improvement is that it’s never too late to start. The findings support earlier evidence showing that it’s never too late to raise your Brain Care Score. While the impact may be greater when you’re younger, it remains substantial even when you’re older.

Even if you’ve already experienced brain health challenges, improvement remains valuable. If you’ve already had a stroke or have early cognitive decline, raising your score is likely to reduce your risk of another stroke and might even slow the rate of your cognitive decline.

Practical improvement strategies

The Brain Care Score was designed for real-world implementation. Tallying up your Brain Care Score helps you identify what you’re doing right and pinpoint the areas you can improve. “It doesn’t matter where you start — just pick one area that seems the easiest,” says Dr. Rosand.

Small changes create meaningful progress. One successful experience often leads people to try other changes. For example, a patient who rarely ate vegetables but liked broccoli and ate it about once a week was encouraged to eat it three times a week.

The 5-point improvement goal

Researchers identified a specific target for meaningful change. A five-point increase in total BCS (e.g., from 0–5 or 10–15) is considered to reflect a substantial yet achievable improvement in someone’s brain care. Hence, an improvement of 5 points in the BCS could be used as an initial goal for patients and providers.

This goal provides flexibility in how you achieve improvement, allowing you to focus on the areas that feel most manageable in your current situation.

How does the brain care score compare to other health assessments?

Unique focus on prevention

Traditional risk scores predict future disease probability, but the Brain Care Score takes a different approach. In contrast to conventional risk scores, which are designed to provide risk stratification for the development of future disease, the BCS was created as a simple tool to motivate patients and their practitioners to modify risk factors.

Comprehensive disease prevention

The Brain Care Score’s strength lies in its ability to prevent multiple conditions simultaneously. While the BCS may not have optimized components for individual brain diseases, this avoids the creation of separate disease-specific scores. Implementing multiple such scores in routine care would be cumbersome in real-life settings.

Patient-centered development

Unlike many medical assessments created purely by researchers, the Brain Care Score involved patients in its development. The Brain Care Score was developed at the McCance Center for Brain Health in partnership with patients to serve as an evidence-based and pragmatic instrument to engage patients in behavior change.

Baseline independence

The Brain Care Score doesn’t require existing brain health measurements to be useful. A further attribute of the BCS is that it does not depend on the individual’s baseline brain health status. This means anyone can start using it regardless of their current brain health condition.

What are the current limitations of brain care score research?

Single time point assessment

Current research has primarily evaluated the Brain Care Score at one point in time. The study only assessed the BCS at a single time point in people’s lives. Additional research is needed to determine whether a person can reduce their risk by improving their BCS over time through behavior changes.

Age-related effectiveness variations

The protective effects appear strongest in younger participants. Those brain disease benefits appeared to diminish for those older than 59 at the study’s start. This group experienced only 8% lower odds of dementia and a 33% lower risk of stroke with each five-point higher score.

Researchers theorize this may reflect undetected early-stage dementia in some older participants, which could mask the score’s protective effects.

Component availability limitations

Some studies couldn’t capture all the Brain Care Score components. The UK Biobank fell just short of collecting all the components of the BCS in its dataset, lacking questions on the meaning of life. So its scores ranged from 0 to 19, not up to 21.

Despite these limitations, the research provides compelling evidence for the Brain Care Score’s effectiveness across multiple health outcomes.

Bottom line

The Brain Care Score represents a revolutionary approach to brain health that puts the power of prevention directly in your hands. This scientifically validated tool transforms abstract brain health concepts into concrete, actionable steps you can take today.

Whether your current score is 5 or 15, the evidence is clear: improvement is possible at any age, and the benefits extend far beyond brain health to protect your heart and reduce cancer risk. What’s good for the brain is good for the heart and the rest of the body.

Take the brain care score assessment at the McCance Center website to establish your baseline. Then choose one area for improvement — perhaps adding more vegetables to your diet or taking a daily walk. Remember, minor changes compound into significant brain protection over time.

The goal isn’t perfection; it’s progress. Your brain will thank you for every positive change you make, no matter how small.

Frequently asked questions (FAQs)

1. How is the Brain Care Score calculated? 

The BCS was calculated as the sum of the assigned scores of all quantified components for each person. Each component receives a score of 0, 1, 2, or 3 points, depending on the factor, with a total possible score of 21 points.

2. Can I improve my Brain Care Score if I’m over 60 years old? 

Yes, improvement is beneficial at any age. While the impact may be greater when you’re younger, it remains substantial even when you’re older. Even if you’ve already had a stroke or have early cognitive decline, raising your score is likely to reduce your risk of another stroke.

3. How much improvement in the Brain Care Score makes a difference? 

A five-point increase in total BCS reflects a substantial yet achievable improvement in someone’s brain care and could be used as an initial goal for patients and providers.

4. Is the Brain Care Score only for brain health?

No, the benefits extend to overall health. Research shows that a higher Brain Care Score is associated with a lower incidence of cardiovascular disease and reduced risk of lung, colorectal, and breast cancers.

5. Where can I take the Brain Care Score assessment?

 To determine a Brain Care Score for yourself, all you need to do is fill out a questionnaire, which is available at the McCance Center webpage.

References

1. Lloyd-Jones, D. M., Allen, N. B., Anderson, C. A. M., Black, T., Brewer, L. C., Foraker, R. E., Grandner, M. A., Lavretsky, H., Perak, A. M., Sharma, G., & Rosamond, W. (2022). Life’s essential 8: Updating and enhancing the American Heart Association’s construct of cardiovascular health: A presidential advisory from the American Heart Association. Circulation, 146(5), e18-e43.
2. Rivier, C. A., Singh, S., Senff, J., Oreskovic, T., Gutierrez-Martinez, L., Newhouse, A., Fricchione, G., Tanzi, R. E., Yechoor, N., Chemali, Z., Anderson, C. D., Rosand, J., & Singh, S. D. (2024). Brain Care Score and neuroimaging markers of brain health in asymptomatic middle-age persons. Neurology, 103(3), e209687. 
3. Senff, J. R., Rivier, C. A., Tack, R., Tan, B. Y. Q., Kimball, T. N., Brouwers, H. B., Newhouse, A., Fricchione, G., Tanzi, R. E., Yechoor, N., Chemali, Z., Anderson, C. D., Rosand, J., Falcone, G. J., & Singh, S. (2025). The Brain Care Score and its associations with cardiovascular disease and cancer. Family Practice, 42(4), cmaf034.
4. Singh, S., Oreskovic, T., Carr, S., Gutierrez-Martinez, L., Newhouse, A., Fricchione, G., Tanzi, R. E., Yechoor, N., Chemali, Z., Anderson, C. D., Rosand, J., & Singh, S. D. (2023). The predictive validity of a Brain Care Score for dementia and stroke: Data from the UK Biobank cohort. Frontiers in Neurology, 14, 1291020.
5. Singh, S. D., Gutierrez-Martinez, L., Newhouse, A., Fricchione, G., Tanzi, R. E., Yechoor, N., Chemali, Z., Anderson, C. D., & Rosand, J. (2022). Brain health begins with brain care. The Lancet Neurology, 21(11), 961-962. 
6. Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., Commodore-Mensah, Y., Elkind, M. S. V., Evenson, K. R., Eze-Nliam, C., Fugar, S., Generoso, G., Heard, D. G., Hiremath, S., Ho, J. E., … Wilkins, J. T. (2023). Heart disease and stroke statistics—2023 update: A report from the American Heart Association. Circulation, 147(8), e93-e621.