{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T08:45:04Z","timestamp":1780994704091,"version":"3.54.1"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T00:00:00Z","timestamp":1716422400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>To determine the burden of disease among subjects at risk of developing stroke or dementia, brain health indexes (BHI) tend to rely on anatomical features. Recent definitions emphasize the need of a broader perspective that encompasses cardiovascular risk factors (CVRFS) and lifestyle components which can be considered partial contributors to optimal brain health. In this study, we aimed to establish the association and risk detected by a Brain Health Index and the risk of possible vascular dementia (PVD) using data from the Mexican Health and Aging Study (MHAS) 2012\u20132015. The MHAS is a longitudinal study of adults aged \u2265 50 years. We analyzed the data obtained between 2012 and 2015. CVRFS included in the index were diabetes mellitus, hypertension, myocardial infarction, depression, obesity, physical inactivity, and smoking history. A PVD diagnosis was established when scores in the Cross-Cultural Cognitive Examination were below reference norms and limitations in \u22651 instrumental activities of daily living and a history of stroke were present. A multinomial regression model was developed to determine the association between BHI scores and PVD. In 2015, 75 PVD cases were identified. Mean age was 67.1 \u00b113.2 years, 35.8% were female, and the mean educational level was 5.8 \u00b15.5 years. In cases with a higher score in the BHI, the model revealed a hazards ratio of 1.63 (95% CI: 1.63\u20131.64, p&lt; 0.001) for PVD. In this longitudinal study, with the use of a feasible multifactorial BHI in the Mexican population, a greater score was associated with a 1.63-fold risk of developing PVD during the 3-year follow-up, while the risk for stroke was 1.75. This index could potentially be used to predict the risk of PVD in adults with modifiable CVRFS.<\/jats:p>","DOI":"10.1371\/journal.pone.0304234","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T17:30:50Z","timestamp":1716485450000},"page":"e0304234","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Brain health index as a predictor of possible vascular dementia in the Mexican health and aging study 2012\u20132015"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2323-7644","authenticated-orcid":true,"given":"Sara G.","family":"Aguilar-Navarro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara G.","family":"Yeverino-Castro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Mej\u00eda-Arango","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0547-397X","authenticated-orcid":true,"given":"Rogelio","family":"Moctezuma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9442-3471","authenticated-orcid":true,"given":"Teresa","family":"Ju\u00e1rez-Cedillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto Jos\u00e9","family":"Mimenza-Alvarado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,5,23]]},"reference":[{"key":"pone.0304234.ref001","first-page":"1","article-title":"Vascular cognitive impairment","volume":"4","author":"WM van Der Flier","year":"2018","journal-title":"Nat Rev Dis Prim [Internet]."},{"issue":"10004","key":"pone.0304234.ref002","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1016\/S0140-6736(15)00463-8","article-title":"Vascular dementia.","volume":"386","author":"JT O\u2019Brien","year":"2015","journal-title":"Lancet [Internet]."},{"key":"pone.0304234.ref003","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/S0022-510X(02)00257-5","article-title":"The costs of vascular dementia: A comparison with Alzheimer\u2019s disease","volume":"203\u2013204","author":"H Fillit","year":"2002","journal-title":"J Neurol Sci [Internet]."},{"key":"pone.0304234.ref004","unstructured":"Patterson C. World Alzheimer Report 2018 The state of the art of dementia research: New frontiers [Internet]. London; 2018. Available from: https:\/\/www.alzint.org\/u\/WorldAlzheimerReport2018.pdf"},{"issue":"4","key":"pone.0304234.ref005","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1159\/000366471","article-title":"Vascular cognitive disorders and depression after first-ever stroke: The Fogarty-Mexico stroke cohort","volume":"38","author":"A Arauz","year":"2014","journal-title":"Cerebrovasc Dis"},{"issue":"7 July","key":"pone.0304234.ref006","first-page":"1","article-title":"Prevalence and incidence of possible vascular dementia among Mexican older adults: Analysis of the Mexican Health and Aging Study.","volume":"16","author":"SG Yeverino-Castro","year":"2021","journal-title":"PLoS One."},{"key":"pone.0304234.ref007","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.jalz.2017.09.007","article-title":"Progress toward standardized diagnosis of vascular cognitive impairment: Guidelines from the Vascular Impairment of Cognition Classification Consensus Study.","volume":"14","author":"OA Skrobot","year":"2018","journal-title":"Alzheimer\u2019s Dement [Internet]."},{"issue":"10","key":"pone.0304234.ref008","first-page":"e284","article-title":"Defining Optimal Brain Health in Adults: A Presidential Advisory From the American Heart Association\/American Stroke Association","volume":"48","author":"PB Gorelick","year":"2017","journal-title":"Stroke [Internet]."},{"issue":"January","key":"pone.0304234.ref009","first-page":"1","article-title":"Dementia Risk Scores and Their Role in the Implementation of Risk Reduction Guidelines.","volume":"12","author":"KJ Anstey","year":"2022","journal-title":"Front Neurol."},{"issue":"10248","key":"pone.0304234.ref010","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/S0140-6736(20)30367-6","article-title":"Dementia prevention, intervention, and care: 2020 report of the Lancet Commission","volume":"396","author":"G Livingston","year":"2020","journal-title":"Lancet"},{"issue":"3","key":"pone.0304234.ref011","article-title":"The American Heart Association Life\u2019s Simple 7 and Incident Cognitive Impairment: The Reasons for Geographic And Racial Differences in Stroke (REGARDS) Study.","volume":"3","author":"EL Thacker","year":"2014","journal-title":"J Am Hear Assoc Cardiovasc Cerebrovasc Dis [Internet]."},{"issue":"9","key":"pone.0304234.ref012","doi-asserted-by":"crossref","first-page":"2672","DOI":"10.1161\/STR.0b013e3182299496","article-title":"Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the american heart association\/american stroke association","volume":"42","author":"PB Gorelick","year":"2011","journal-title":"Stroke [Internet]."},{"key":"pone.0304234.ref013","doi-asserted-by":"crossref","first-page":"e1300","DOI":"10.1212\/WNL.0000000000012572","article-title":"Associations of the Lifestyle for Brain Health Index With Structural Brain Changes and Cognition Results From the Maastricht Study","volume":"97","author":"IS Heger","year":"2021","journal-title":"Neurology"},{"issue":"1","key":"pone.0304234.ref014","doi-asserted-by":"crossref","first-page":"373","DOI":"10.3233\/JAD-170731","article-title":"Utility of the LIBRA Index in Relation to Cognitive Functioning in a Clinical Health Seeking Sample","volume":"62","author":"A Pons","year":"2018","journal-title":"J Alzheimer\u2019s Dis [Internet]."},{"issue":"8","key":"pone.0304234.ref015","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1177\/1747493018770222","article-title":"The brain health index: Towards a combined measure of neurovascular and neurodegenerative structural brain injury","volume":"13","author":"DA Dickie","year":"2018","journal-title":"Int J Stroke"},{"issue":"18","key":"pone.0304234.ref016","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1212\/WNL.0000000000002090","article-title":"Availability, accessibility, and affordability of neurodiagnostic tests in 37 countries","volume":"85","author":"HC Mclane","year":"2015","journal-title":"Neurology [Internet]."},{"key":"pone.0304234.ref017","doi-asserted-by":"crossref","first-page":"641754","DOI":"10.3389\/fpubh.2021.641754","article-title":"A Novel BrainHealth Index Prototype Improved by Telehealth-Delivered Training During COVID-19","volume":"9","author":"SB Chapman","year":"2021","journal-title":"Front Public Heal [Internet]."},{"issue":"2","key":"pone.0304234.ref018","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ije\/dyu263","article-title":"Cohort profile: The Mexican Health and aging study (MHAS).","volume":"46","author":"R Wong","year":"2017","journal-title":"Int J Epidemiol."},{"issue":"9","key":"pone.0304234.ref019","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1111\/j.1532-5415.1993.tb06758.x","article-title":"Cross\u2010Cultural Cognitive Examination: Validation of a Dementia Screening Instrument for Neuroepidemiological Research.","volume":"41","author":"G Glosser","year":"1993","journal-title":"J Am Geriatr Soc."},{"key":"pone.0304234.ref020","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/978-1-4471-2452-8_8","volume-title":"In: Cognitive Screening Instruments [Internet]","author":"N Cherbuin","year":"2013"},{"key":"pone.0304234.ref021","author":"MHAS Working Group","year":"2021","journal-title":"Imputation of Cognitive Function Variables in the Mexican Health and Aging Study 2001\u20132018 Version 1mputation of Cognitive Function Variables in the Mexican Health and Aging Study 2001\u20132018 Version 1"},{"issue":"3","key":"pone.0304234.ref022","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jalz.2011.03.005","article-title":"The diagnosis of dementia due to Alzheimer\u2019s disease: Recommendations from the National Institute on Aging-Alzheimer\u2019s Association workgroups on diagnostic guidelines for Alzheimer\u2019s disease","volume":"7","author":"GM McKhann","year":"2011","journal-title":"Alzheimer\u2019s Dement [Internet]."},{"issue":"1","key":"pone.0304234.ref023","first-page":"90","article-title":"Normative and standardized data for cognitive measures in the Mexican Health and Aging Study","volume":"57","author":"S Mej\u00eda-Arango","year":"2015","journal-title":"Salud P\u00fab [Internet]."},{"issue":"3","key":"pone.0304234.ref024","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/WAD.0000000000000034","article-title":"Diagnostic criteria for vascular cognitive disorders: a VASCOG statement","volume":"28","author":"P Sachdev","year":"2014","journal-title":"Alzheimer Dis Assoc Disord [Internet]."},{"issue":"12","key":"pone.0304234.ref025","article-title":"Cardiovascular health metrics from mid- to late-life and risk of dementia: A population-based cohort study in Finland","volume":"17","author":"Y Liang","year":"2020","journal-title":"PLoS Med [Internet]."},{"issue":"4","key":"pone.0304234.ref026","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1590\/S0036-36342007000400005","article-title":"Validez y confiabilidad del cuestionario del ENASEM para la depresi\u00f3n en adultos mayores.","volume":"49","author":"SG Aguilar-Navarro","year":"2007","journal-title":"Salud Publica Mex"},{"issue":"2","key":"pone.0304234.ref027","first-page":"90","article-title":"Imputation Procedures for Cognitive Variables in the Mexican Health and Aging Study: Evaluating the Bias from Excluding Participants with Missing Data","volume":"12","author":"B Downer","year":"2021","journal-title":"Real Datos y Espac Rev Int Estad y Geogr [Internet]."},{"issue":"5","key":"pone.0304234.ref028","doi-asserted-by":"crossref","first-page":"e596","DOI":"10.1016\/S2214-109X(19)30074-9","article-title":"Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data","volume":"7","author":"N Mukadam","year":"2019","journal-title":"Lancet Glob Health"},{"key":"pone.0304234.ref029","volume-title":"BMC Medicine","author":"S Anand","year":"2020"},{"issue":"3","key":"pone.0304234.ref030","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1002\/gps.4245","article-title":"Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies","volume":"30","author":"K Deckers","year":"2015","journal-title":"Int J Geriatr Psychiatry [Internet]."},{"issue":"5","key":"pone.0304234.ref031","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1161\/STROKEAHA.115.012608","article-title":"Association of Ideal Cardiovascular Health With Vascular Brain Injury and Incident Dementia","volume":"47","author":"MP Pase","year":"2016","journal-title":"Stroke [Internet]."},{"issue":"NOV","key":"pone.0304234.ref032","doi-asserted-by":"crossref","first-page":"352","DOI":"10.3389\/fpubh.2018.00352","article-title":"Ideal cardiovascular health and cognitive test performance: Testing a modified index of life\u2019s simple 7 among older Chinese adults.","volume":"6","author":"TE Gildner","year":"2018","journal-title":"Front Public Heal."},{"issue":"3","key":"pone.0304234.ref033","doi-asserted-by":"crossref","first-page":"955","DOI":"10.3233\/JAD-151125","article-title":"Life\u2019s Simple 7\u2019s Cardiovascular Health Metrics are Associated with Hispanic\/Latino Neurocognitive Function: HCHS\/SOL Results.","volume":"53","author":"HM Gonz\u00e1lez","year":"2016","journal-title":"J Alzheimer\u2019s Dis [Internet]."},{"key":"pone.0304234.ref034","doi-asserted-by":"crossref","first-page":"s475","DOI":"10.1590\/S0036-36342007001000006","article-title":"Deterioro cognoscitivo y factores asociados en adultos mayores en M\u00e9xico","volume":"49","author":"S Mej\u00eda-Arango","year":"2007","journal-title":"Salud Publica Mex [Internet]."},{"issue":"4","key":"pone.0304234.ref035","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1017\/S1355617721000539","article-title":"Midlife Vascular Factors and Prevalence of Mild Cognitive Impairment in Late-Life in Mexico","volume":"28","author":"M Arce Renter\u00eda","year":"2022","journal-title":"J Int Neuropsychol Soc [Internet]."},{"issue":"2","key":"pone.0304234.ref036","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1159\/000443649","article-title":"Higher Education Is Associated with a Lower Risk of Dementia after a Stroke or TIA. The Rotterdam Study","volume":"46","author":"SS Mirza","year":"2016","journal-title":"Neuroepidemiology [Internet]."},{"issue":"6","key":"pone.0304234.ref037","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1212\/WNL.45.6.1161","article-title":"Incidence and risk factors of vascular dementia and Alzheimer\u2019s disease in a defined elderly Japanese population: The Hisayama Study","volume":"45","author":"T Yoshitake","year":"1995","journal-title":"Neurology"},{"issue":"3","key":"pone.0304234.ref038","doi-asserted-by":"crossref","first-page":"565","DOI":"10.3233\/JAD-121819","article-title":"Epidemiology, co-morbidities, and medication use of patients with alzheimer\u2019s disease or vascular dementia in the UK.","volume":"35","author":"P Imfeld","year":"2013","journal-title":"J Alzheimer\u2019s Dis."},{"issue":"6","key":"pone.0304234.ref039","first-page":"e000369","article-title":"Cardiovascular Disease and Cognitive Decline in Postmenopausal Women: Results From the Women\u2019s Health Initiative Memory Study","volume":"2","author":"B Haring","year":"2013","journal-title":"J Am Hear Assoc Cardiovasc Cerebrovasc Dis [Internet]."},{"issue":"11","key":"pone.0304234.ref040","doi-asserted-by":"crossref","first-page":"2332","DOI":"10.1111\/jgs.13794","article-title":"Midlife and Late-Life Smoking and Risk of Dementia in the Community: The Hisayama Study","volume":"63","author":"T Ohara","year":"2015","journal-title":"J Am Geriatr Soc [Internet]."},{"issue":"24","key":"pone.0304234.ref041","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1212\/WNL.0000000000004741","article-title":"Blood pressure from mid\u2010 to late life and risk of incident dementia","volume":"89","author":"ER McGrath","year":"2017","journal-title":"Neurology [Internet]."},{"issue":"7","key":"pone.0304234.ref042","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1016\/j.jalz.2019.06.001","article-title":"Preventing dementia by preventing stroke: The Berlin Manifesto.","volume":"15","author":"V Hachinski","year":"2019","journal-title":"Alzheimer\u2019s Dement [Internet]."},{"issue":"6","key":"pone.0304234.ref043","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1161\/STROKEAHA.116.012658","article-title":"Blood pressure and risk of vascular dementia: evidence from 4.3 million adults and a cohort study of TIA and stroke","volume":"47","author":"CA Emdin","year":"2016","journal-title":"Stroke [Internet]."},{"issue":"2","key":"pone.0304234.ref044","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.maturitas.2014.05.009","article-title":"Depression and dementia: cause, consequence or coincidence?","volume":"79","author":"S Bennett","year":"2014","journal-title":"Maturitas [Internet]."},{"issue":"6","key":"pone.0304234.ref045","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1002\/gps.4368","article-title":"White matter microstructural damage and depressive symptoms in patients with mild cognitive impairment and cerebral small vessel disease: The VMCI-Tuscany Study.","volume":"31","author":"M Pasi","year":"2016","journal-title":"Int J Geriatr Psychiatry"},{"key":"pone.0304234.ref046","article-title":"Diabetes mellitus and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 144 prospective studies.","volume":"55","author":"M Xue","year":"2019","journal-title":"Ageing Res Rev [Internet]."},{"issue":"1","key":"pone.0304234.ref047","article-title":"Effect of poor glycemic control in cognitive performance in the elderly with type 2 diabetes mellitus: The Mexican Health and Aging Study.","volume":"20","author":"AJ Mimenza-Alvarado","year":"2020","journal-title":"BMC Geriatr [Internet]."},{"issue":"13","key":"pone.0304234.ref048","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1212\/WNL.0b013e3181f4d7f8","article-title":"Diabetes, Alzheimer disease, and vascular dementia: a population-based neuropathologic study.","volume":"75","author":"S Ahtiluoto","year":"2010","journal-title":"Neurology [Internet]."},{"key":"pone.0304234.ref049","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.arr.2015.11.005","article-title":"The effect of physical activity on cognitive function in patients with dementia: A meta-analysis of randomized control trials","volume":"25","author":"C Groot","year":"2016","journal-title":"Ageing Res Rev [Internet]."},{"issue":"1","key":"pone.0304234.ref050","article-title":"Midlife physical activity is associated with lower incidence of vascular dementia but not Alzheimer\u2019s disease","volume":"11","author":"O Hansson","year":"2019","journal-title":"Alzheimers Res Ther [Internet]."},{"issue":"1","key":"pone.0304234.ref051","first-page":"1","article-title":"Association between ApoE \u03b54 Carrier Status and Cardiovascular Risk Factors on Mild Cognitive Impairment among Mexican Older Adults","volume":"11","author":"SG Aguilar-Navarro","year":"2021","journal-title":"Brain Sci [Internet]."},{"issue":"8","key":"pone.0304234.ref052","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1016\/S1474-4422(13)70124-8","article-title":"Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration","volume":"12","author":"JM Wardlaw","year":"2013","journal-title":"Lancet Neurol [Internet]."},{"issue":"2","key":"pone.0304234.ref053","first-page":"404","article-title":"Mild Cognitive Impairment.","volume":"22","author":"RC Petersen","year":"2016","journal-title":"Continuum (N Y) [Internet]."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0304234","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T17:31:35Z","timestamp":1716485495000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0304234"}},"subtitle":[],"editor":[{"given":"Victor Manuel","family":"Mendoza-Nu\u00f1ez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,5,23]]},"references-count":53,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,5,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0304234","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,23]]}}}