The brain health index: Towards a combined measure of neurovascular and neurodegenerative structural brain injury

David Alexander Dickie (Corresponding Author), Maria del C Valdes Hernandez, Stephen D Makin, Julie Staals, Stewart J Wiseman, Mark E Bastin, Joanna M Wardlaw

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Background A structural magnetic resonance imaging measure of combined neurovascular and neurodegenerative burden may be useful as these features often coexist in older people, stroke and dementia. Aim We aimed to develop a new automated approach for quantifying visible brain injury from small vessel disease and brain atrophy in a single measure, the brain health index. Materials and methods We computed brain health index in N = 288 participants using voxel-based Gaussian mixture model cluster analysis of T1, T2, T2*, and FLAIR magnetic resonance imaging. We tested brain health index against a validated total small vessel disease visual score and white matter hyperintensity volumes in two patient groups (minor stroke, N = 157; lupus, N = 51) and against measures of brain atrophy in healthy participants (N = 80) using multiple regression. We evaluated associations with Addenbrooke's Cognitive Exam Revised in patients and with reaction time in healthy participants. Results The brain health index (standard beta = 0.20-0.59, P <0.05) was significantly and more strongly associated with Addenbrooke's Cognitive Exam Revised, including at one year follow-up, than white matter hyperintensity volume (standard beta = 0.04-0.08, P > 0.05) and small vessel disease score (standard beta = 0.02-0.27, P > 0.05) alone in both patient groups. Further, the brain health index (standard beta = 0.57-0.59, P <0.05) was more strongly associated with reaction time than measures of brain atrophy alone (standard beta = 0.04-0.13, P > 0.05) in healthy participants. Conclusions The brain health index is a new image analysis approach that may usefully capture combined visible brain damage in large-scale studies of ageing, neurovascular and neurodegenerative disease.
Original languageEnglish
Pages (from-to)849-856
Number of pages8
JournalInternational Journal of Stroke
Issue number8
Early online date19 Apr 2018
Publication statusPublished - 1 Oct 2018

Bibliographical note

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding from the Stroke Association (DAD), Technology Strategy Board/ Innovate UK (46917-348146), Wellcome Trust (WT088134/Z/09/A), Row Fogo Charitable Trust, Lupus UK, National Institutes of Health (R01 EB004155-03), European Union Horizon 2020 PHC-03-15, project No 666881, SVDs@Target, and Fondation Leducq (Transatlantic Network of Excellence for the Study of Perivascular Spaces in Small Vessel Disease, ref no. 16 CVD 05) is gratefully acknowledged.


  • Atrophy
  • cerebral small vessel diseases
  • cognition
  • computer-assisted image processing
  • stroke
  • magnetic resonance imaging


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