Age-related brain diseases, including stroke, dementia, and late-life depression, can significantly impact quality of life in older adults. However, many of these conditions are preventable. A comprehensive systematic review by researchers at Mass General Brigham has identified 17 modifiable risk factors that are common to all three conditions.
The study shows that addressing even one of these factors can reduce the risk of developing stroke, dementia, and late-life depression. These findings, published in the Journal of Neurology, Neurosurgery, and Psychiatry, support the development of new prevention tools, such as the Brain Care Score.
“Our study identified 17 modifiable risk factors shared between stroke, dementia, and/or late-life depression, emphasizing that there are many different steps individuals can take to lower their risks for these age-related brain diseases,” said senior author Sanjula Singh, MD, PhD, MSc (Oxon), principal investigator at the Brain Care Labs at Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham healthcare system.
The researchers systematically searched the scientific literature for previously published meta-analyses of risk factors associated with stroke, dementia, and late-life depression. Then, they combined these data to identify modifiable risk factors (i.e., those that can be altered through behavioral change) shared amongst at least two out of the three diseases. They also estimated the relative impact of each risk factor on measures of quality of life and early death.
The Top 17 Modifiable Risk Factors
Altogether, the researchers identified 17 risk factors shared by at least two of the diseases, including blood pressure, kidney disease, fasting plasma glucose, total cholesterol, alcohol use, diet, hearing loss, pain, physical activity, purpose in life, sleep, smoking, social engagement, and stress. Of these, high blood pressure and severe kidney disease had the biggest impact on the incidence and burden of stroke, dementia, and late-life depression. In contrast, physical activity and engagement in leisure activities with a cognitive aspect (e.g., puzzles) were associated with a lower risk of disease, though the researchers suspect that these associations may be symptomatic rather than causal, since individuals with brain disease may be less capable of
“Dementia, stroke, and late-life depression are connected and intertwined, so if you develop one of them, there’s a substantial chance you may develop another one in the future,” said first author Jasper Senff, MD, post-doctoral fellow at the Singh Lab at the Brain Care Labs at MGH. “And because they share these overlapping risk factors, preventive efforts could lead to a reduction in the incidence of more than one of these diseases, which provides an opportunity to simultaneously reduce the burden of age-related brain diseases.”
Mass General Brigham researchers developed and validated the Brain Care Score to measure efforts to protect brain health and offer guidance on how to improve it. The researchers have updated the Brain Care Score to reflect the latest scientific updates. They emphasize the need for more studies on modifiable risk factors of late-life depression and call for a randomized controlled trial to test an intervention using the Brain Care Score.
“Healthcare is increasingly complex. But these findings remind us that preventing disease can be very simple. Why? Because many of the most common diseases share the same risk factors,” said Jonathan Rosand MD MSc, Founder of the Global Brain Care Coalition and the JP Kistler Endowed Chair in Neurology at MGH.
