Do You Know Your Brain Care Score?

Medscape

12-06-2025

Despite most strokes being preventable, someone in the US experiences a stroke every 40 seconds.
Noor F. Shaik, MD, PhD
Could a new risk score focused on the brain help change that? The McCance Brain Care Score (BCS) aims to empower patients and practitioners to better care for their brains.
We already have the American Heart Association's (AHA) PREVENT online calculator for predicting the 10- and 30-year risk for heart attack, stroke, and heart failure, as well as the Framingham Risk Calculator that estimates 10-year risk for atherosclerotic cardiovascular disease, including strokes and heart attacks. While they incorporate variations of the known modifiable risk factors, the BCS takes a more holistic, patient-forward approach and addresses dementia and late-life depression. Here are some aspects that make it stand out to me.
1. Intuitive scoring system. The BCS incorporates well-known modifiable risk factors (eg, hypertension, hyperlipidemia, smoking, alcohol use) into a 21-point score rather than a risk percentage. Each risk factor gets a number. For hypertension, the biggest modifiable contributor to stroke risk, this ranges from 0 to 3, with more points for better blood pressure control.
The McCance Brain Care Score
2. Gamification of health. Adding the points across several modifiable risk factors yields a score of up to 21, with higher scores linked to better neurologic outcomes. A 5-point higher BCS was associated with an approximate 50% lower risk for stroke in those under 60 years of age.
This scoring system capitalizes on the gamification of health, a concept that is increasingly popular because of health apps and wearables such as the Apple Watch and FitBit. Nearly 1 in 3 US adults use health wearables that may nudge them toward health-promoting behaviors such as hitting benchmarks for daily steps or weekly physical activity. Gamification tactics have been shown to improve medication adherence; whether they can lead to sustained behavioral changes remains to be seen. I like the idea of improving people's health while making it a fun challenge to get a 'high' score.
3. Practicality. The BCS presents the modifiable risk factors as opportunities for change and capitalizes on this by giving people goals. For example, the score provides multiple ways to get points for a healthier diet, such as eating 4.5 servings of fruit and vegetables per day or less than 36 oz of sweetened beverages (such as juice and soda) per week. The targets are specific, measurable, and realistic.
4. Widespread applicability and generalizability. Another highlight of the BCS is that it can be used by anyone, even those who have already had a stroke. The score also incorporates risk factors tied to dementia and late-life depression. Given that dementia cases are expected to double by 2060, this has broad application. The BCS shares risk factors with cardiovascular disease and multiple cancers, allowing people to use it to reduce their chances of multiple diseases. For example, in UK adults aged 40-69 years, a 5-point higher BCS was associated with a 43% lower risk of developing cardiovascular disease and a 31% lower risk for leading cancers (specifically, a 66% lower risk for lung cancer, 21% lower risk for colorectal cancer, and 16% lower risk for breast cancer).
5. Increasing popularity. The score is very new. The first validation study was published less than 2 years ago. But since then, there have been at least five other papers on the score's utility, and the questionnaire has even been adapted by The New York Times .
Have you or any of your patients taken the BCS? It might be a fun poster to have in your doctor's office or waiting room, and it could serve as a focal point to discuss positive habits and opportunities for change. With these strategies, we can empower our patients to proactively reduce their risk for stroke, heart disease, and cancer, and help them live longer, healthier lives.