Mass General Brigham Researchers Reveal 17 Modifiable Risk Factors Shared by Stroke, Dementia, and Late-Life Depression
Age-related brain diseases such as stroke, dementia, and late-life depression are a debilitating part of growing older, but people can lower their risk of these diseases through behavioral and lifestyle changes. In a new extensive systematic review, Mass General Brigham researchers identified 17 modifiable risk factors that are shared by stroke, dementia, and late-life depression. Modifying any one of them can reduce your risk of all three conditions. The findings, which provide evidence to inform novel tools, such as the Brain Care Score, are published in the Journal of Neurology, Neurosurgery, and Psychiatry.
“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.
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 engaging in physical and cognitive leisure activities.
“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.
Authorship: In addition to Singh and Senff, Mass General Brigham researchers include Reinier W.P. Tack, Akashleena Mallick, Leidys Gutierrez-Martinez, Jonathan Duskin, Tamara N. Kimball, Benjamin YQ Tan, Zeina N. Chemali, Amy Newhouse, Christina Kourkoulis, Rudolph E. Tanzi, Gregory L. Fricchione, Nirupama Yechoor, Jonathan Rosand, and Christopher D. Anderson. Additional researchers include Cyprien Rivier, Guido J Falcone, Kevin N Sheth, Ronald M Lazar, Sarah Ibrahim, Aleksandra Pikula, H. Bart Brouwers, and Gabriël J.E. Rinkel.
Disclosures: There are no competing interests. Grants, consulting fees, and leadership roles are detailed in the disclosures section of the Journal of Neurology, Neurosurgery, and Psychiatry.
Funding: None.
Paper cited: Senff, J et al. “Modifiable Risk Factors for Stroke, Dementia, and Late-Life Depression: A Systematic Review and DALY Weighted Risk Factors for a Composite Outcome” Journal of Neurology, Neurosurgery, and Psychiatry DOI: 10.1136/jnnp-2024-3344925
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