Brain Care Score Can Predict Stroke Risk Across Racial Groups, New Long-Term U.S. Study Finds

A new large-scale U.S. study suggests that a simple scoring system known as the Brain Care Score (BCS) can strongly predict a person’s risk of stroke—and that it works consistently across racial groups. Even more importantly, the findings indicate that improving this score may offer especially meaningful protection for Black adults, who historically face a much higher risk of stroke than white adults in the United States.

The research was conducted by scientists at Mass General Brigham and published in the medical journal Neurology in 2025. It adds to a growing body of evidence that everyday, modifiable behaviors play a critical role in long-term brain health and stroke prevention.

Understanding the Stroke Disparity in the U.S.

Stroke remains one of the leading causes of death and long-term disability worldwide, and the burden is not evenly distributed. In the United States, Black adults experience a two- to three-fold higher risk of stroke compared to white adults. This disparity has persisted for decades and is influenced by a combination of medical, social, economic, and environmental factors.

The researchers behind this study wanted to explore whether the Brain Care Score—a tool designed to summarize multiple aspects of brain health—could help explain and potentially address these differences in stroke risk.

What Exactly Is the Brain Care Score?

The Brain Care Score was originally developed at the McCance Center for Brain Health as a practical way to measure brain health using factors that people and clinicians can actually change. Instead of focusing on a single risk factor, the BCS combines physical, lifestyle, and social-emotional components into one overall score.

The score ranges from 0 to 21 points, with higher scores reflecting healthier behaviors and lower risk of age-related brain diseases.

The twelve components that make up the Brain Care Score include:

• Blood pressure
• Blood sugar levels
• Nutrition and diet quality
• Alcohol consumption
• Smoking status
• Physical activity
• Sleep habits
• Body weight
• Stress levels
• Social relationships
• Sense of purpose
• Emotional well-being

By summarizing all of these areas into a single number, the BCS provides a snapshot of overall brain health rather than focusing on isolated medical metrics.

Inside the Study: Who Was Included and How It Was Done

To test how well the Brain Care Score predicts stroke risk, researchers analyzed data from 10,861 adults who participated in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. REGARDS is one of the largest and most well-known long-term stroke studies in the U.S.

Key details about the study population include:

• Participants were Black and white adults aged 45 and older
• None had experienced a stroke at the beginning of the study
• All participants had complete data for the twelve Brain Care Score factors
• The cohort was followed for a median of 15.9 years, making this a true long-term analysis

During this follow-up period, researchers tracked who went on to experience a stroke and compared those outcomes to participants’ baseline Brain Care Scores.

The Key Findings: Higher Scores, Lower Stroke Risk

The results were clear and consistent. Higher Brain Care Scores were associated with significantly lower stroke risk in both Black and white participants.

One of the most striking findings was the difference in how strongly the score predicted stroke risk between racial groups:

• A five-point increase in the Brain Care Score was linked to a 53% lower risk of stroke among Black participants
• The same five-point increase was associated with a 25% lower risk of stroke among white participants

These associations remained strong even after researchers adjusted for age, sex, income, education, and other socioeconomic factors.

This means that the Brain Care Score was not simply reflecting differences in wealth or access to healthcare—it was capturing meaningful behavioral and health-related factors that independently influenced stroke risk.

Why the Brain Care Score Matters for Health Equity

One of the most important implications of this study is its potential role in addressing racial disparities in stroke outcomes. Because Black adults face higher baseline stroke risk, improvements in modifiable behaviors may result in larger relative benefits.

The findings suggest that focusing on everyday health behaviors—such as managing blood pressure, improving diet, reducing stress, and strengthening social connections—could have a disproportionate positive impact in high-risk populations.

Rather than relying solely on medications or specialized interventions, the Brain Care Score offers a practical framework for prevention that can be applied broadly across communities.

Important Limitations to Keep in Mind

While the findings are compelling, the researchers emphasized that this was an observational study. That means it can show strong associations, but it cannot prove that improving the Brain Care Score directly causes stroke risk to decrease.

In other words, raising a person’s BCS does not guarantee they will avoid a stroke. However, the consistent relationship between higher scores and lower risk strongly supports the idea that these modifiable factors matter.

How This Fits Into Broader Brain Health Research

The Brain Care Score is not only linked to stroke. Previous research has shown that higher BCS values are associated with lower risk of dementia, depression, and other age-related brain conditions.

This makes the score particularly appealing as a holistic brain health tool, rather than a disease-specific checklist. It aligns with a growing scientific consensus that brain health is shaped by long-term patterns of behavior, environment, and social connection—not just genetics or acute medical events.

Practical Implications for Patients and Clinicians

From a clinical perspective, the Brain Care Score could serve as a screening and counseling tool. Because it focuses on modifiable behaviors, it provides a clear roadmap for conversations between healthcare providers and patients.

Instead of abstract risk estimates, clinicians can point to specific areas—such as sleep, stress, or blood pressure—and explain how improvements may translate into real reductions in stroke risk over time.

For individuals, the score reinforces an encouraging message: small, consistent changes across multiple areas of life can add up to meaningful brain protection.

Why This Study Stands Out

Several factors make this research particularly notable:

• A large, diverse national cohort
• Nearly 16 years of follow-up
• Clear demonstration of predictive power across racial groups
• Focus on modifiable, real-world behaviors
• Publication in a leading neurology journal

Together, these strengths make the findings highly relevant for public health, preventive medicine, and future research on reducing stroke disparities.

Research Paper Reference

Association of Modifiable Risk Factors Measured with the Brain Care Score and Incident Stroke in the REGARDS Cohort, Neurology (2025)
https://doi.org/10.1212/WNL.0000000000214488