To examine the relationship between brain health-related behaviors/risk factors measured by Brain Care Score (BCS) and self-reported disability in a post-traumatic brain injury (TBI) clinic cohort.

TBI is a prevalent, chronic disease with heterogenous recovery trajectories and dementia risk. Mechanisms of chronic TBI disability and dementia are unknown. Poor brain health is associated with increased stroke, dementia, and white matter hyperintensity risk, but brain health has not been investigated in TBI. BCS, a 21-point tool measuring brain health by reported physical components, lifestyle elements, and social factors, has not been used in TBI.

Retrospective cohort study of sequential TBI-clinic visits in the University of California, Irvine-NTBIC database (9/2022-8/2024). Inclusion criteria: ≥18yo, self-reported TBI per 2023-ACRM criteria, BCS, and functional outcomes. Disability defined as Glasgow-Outcome-Extended Scale (GOSE) score <7. Exploratory analysis dichotomized BCS as “optimal” (≥19/21) or “suboptimal” (<19/21). Descriptive statistics and multivariable logistic regression were performed.

Among 119 patients evaluated (median age 48yo, 44% women, 80% mild TBI, 45.4% non-white race, 14.3% non-white Hispanic ethnicity, 5-months median-time from TBI to clinic), 61% were disabled (Mean GOSE 5.1, standard deviation 0.73). Disabled TBI patients had lower BCS (14.97) compared to non-disabled (BCS 16.85, p=.002). Suboptimal BCS accounted for 83% of patients, were older (48 yo vs 37 yo, p=.008), and more likely to report previous TBI (36% vs 10%, p=.041). In multivariable analysis (accounting for age, sex, race, TBI type, time to visit), higher BCS predicted lower odds of poor outcome (Odds ratio=0.756; 95% CI: 0.634-0.880; p=.0008).

We demonstrate the feasibility of measuring brain health with BCS in a TBI clinic cohort. Most post-TBI patients had BCS <20. Lower/suboptimal BCS is associated with higher disability risk. This suggests brain health is a potential intervenable, modifiable risk factor for long-term disability in TBI survivors.