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The BrainHealth Index A Holistic Measure for Optimizing Brain Health Across the Lifespan

July

2026

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For 25+ years, Center for BrainHealth has been advancing the science of brain health. We develop and research ways to measure it and strategies and interventions to improve it, driven by a simple belief: brain health is foundational to human development and global well-being. he concept of brain health is gaining wide traction around the world. In 2022, the World Health Organization (WHO) published its frst formal defnition of brain health, and in 2025, for the frst time, the key priorities at the United Nations General Assembly (UNGA) included brain health as a primary focus – marking a milestone in recognizing brain health as essential to human development and global well-being. Nationally, three of the U.S. Surgeon General’s fve current priorities – health worker burnout, workplace well-being and youth mental health – directly relate to brain health, reinforcing the growing consensus that brain health is foundational to public health. As laid out in Making BrainHealth Operational, Center for

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BrainHealth’s frst white paper, the ability to measure holistic brain health is key, because

what gets measured gets managed. Brain health management requires precision brainhealth – continuous, individualized tracking of multidimensional brain function, rather than just screening for impairment or disease. The BrainHealth Index (BHI), an empirically derived measure of holistic and precision brain health, o°ers a unique focus on the brain’s lifelong ability to improve.

THIS WHITE PA P ER Introduces the BHI and explores the scientifc research validating its e°cacy as a holistic measure of brain health. Demonstrates how the BHI meets the requirements for a meaningful brain health measure. Positions the BHI as the leading candidate for individuals and organizations seeking a precision brain health metric.

Why Brain Health Needs a 21st Century Measure Center for BrainHealth defnes brain health as the continual development of optimal neural health, cognitive function, well-being, and connectedness to people and purpose. Together, these domains work in tandem to contribute to thriving in daily life. Simply put, the brain is considered healthy when performance across these domains is maintained or improved over time, and at risk when losses appear. The human brain is a highly complex entity, and measuring brain health is not simple.

Precision brain health requires metrics capable of measuring and deciphering interdependencies across a broad spectrum of brain functions over time. Widely used measures generally detect signs of impairment or decline or focus on a single domain of brain health (e.g. lifestyle, cognition, depression). While these measures can be valuable in their intended contexts, they do not fulfll the higher standard of capturing and measuring the multidomain

functioning of the brain, especially upward and downward trajectories in generally healthy adults. Based on scientifc evidence, this paper contends that the BrainHealth Index, developed by Center for BrainHealth, is currently the most advanced measurement for capturing holistic brain health and its upward potential longitudinally.

Introducing the BrainHealth Index (BHI) What is the BHI? The BrainHealth Index is a holistic, multidimensional metric designed to measure and track brain health and performance longitudinally. Visualizing an individual’s brain performance as a whole, the BHI is designed for precision brain health, rather than as a diagnostic tool, with BHI scores refecting multiple paths that guide goal setting and behaviors to strengthen brain health over time. Averaging one hour to complete and accessible via web or mobile app, the BHI integrates measures of cognitive performance with both validated questionnaires and novel tasks developed and piloted in prior research at Center for BrainHealth. The novel or adapted cognitive tasks – such as Center for Updated 7/30/26

BrainHealth’s proprietary Test of Strategic Learning™ (TOSL) – measure complex thinking capacities such as reasoning, abstraction, mental fexibility and strategy. Rather than evaluating a single domain (such as attention), these measures are designed to capture the complex integrated mental functions refective of real-life demands. In addition, the BHI includes established and validated questionnaires to capture other aspects of daily life that relate to brain health, such as emotional well-being, lifestyle, purpose, happiness, resilience, social support systems and sleep. In total, the BHI uses more than 20 measures across domains. Rather than assuming decline or setting a fxed ceiling for brain performance, the BHI is designed to be taken periodically (at least annually) in order to assess change in brain health factors over time.

20+

VALIDATED MEASURES ACROSS COGNITIVE, EMOTIONAL, AND LIFESTYLE DOMAINS

A HOLISTIC VIEW OF BRAIN HEALTH. DESIGNED FOR LIFELONG INSIGHT.

NTS OF BR E N AIN PO M HE CO TH AL

Drawing on earlier research, in 2015 Center for BrainHealth began to focus on integrating multiple dimensions of brain health into a unifed assessment. In a randomized controlled trial, researchers found strategy-based cognitive training was associated with improvements in cognitive performance that corresponded with measurable brain changes in healthy older adults, such as elevated cerebral blood fow, stronger functional connectivity, and increased white matter integrity˝.

Development of the BHI

This research helped demonstrate that brain gains can be measured across multiple levels: how people think, how they function in daily life, and how the brain itself changes. Building on this work, BrainHealth researchers further organized components of brain health into neural and behavioral domains, including cognition, daily life, well-being and interaction. In 2020, Center for BrainHealth applied this domain framework to create an online version of their personalized performance-based brain health metric, the BrainHealth Index. Through the pilot phase of The BrainHealth Project, a longitudinal study seeking to fnd e°ective ways to measure, track and improve brain health throughout life, researchers started by analyzing hundreds of Updated 7/30/26

completed BHI assessments to understand how scores from more than 20 measures changed. From this analysis, researchers found that components of brain health (e.g. innovation, nutrition, social support) do not move in isolation.

Utilizing factor analysis, researchers derived highly interconnected multi-domain factors that collectively contribute to brain health and performance˙. These three factors form the basis for the BHI’s personalized scores.

Evidence shows measures across cognitive, daily life, well-being and social interaction domains are interconnected, so change on one measure relates to a change in another.

For example, an increase in sleep in the daily life domain tended to correspond with decreases in perceived stress in the well-being domain.

Understanding BHI Scores Performance on the BrainHealth Index is refected by four separate scores that highlight the interdependence of three contributing factors of brain health (that have been identifed so far). Each of these three multi-domain factors is derived from a

combination of brain health components: In this way, the BrainHealth Index is designed to both measure the status of brain health and help individuals understand what brain health means, how to track it, and why taking action today can strengthen it tomorrow.

Watch a visualization of how the BHI’s measurable factors are derived from components of brain health.

(click to play)

Composite BHI Score An overall score based on three empirically derived and multi-domain factors: clarity, connectedness and emotional balance

Clarity

Connectedness

Emotional Balance

Readiness to reason through complex situations and create new opportunities or solutions

To people and purpose: being driven by a bigger purpose through meaningful relationships and activities

Steadiness in the face of diˆcult situations, ability to handle adversity while remaining productive & capable

The BrainHealth Index, a proprietary measure of Center for BrainHealth, is already being deployed in a wide variety of contexts while continuing to be refned in the context of The BrainHealth Project, one of the largest longitudinal brain health research initiatives in the world.

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What Makes a Brain Health Measure Meaningful? A meaningful measure of brain health should meet six key criteria: multidimensionality, sensitivity to bidirectional change, actionability, personalization, ability to track change over time, and scientifc validation. The BrainHealth Index (BHI) is designed to address each of these criteria, as outlined below.

Multi-domain: The BHI operates as a holistic measure of brain performance, mirroring the multi-domain of brain health and correlating cognitive, emotional, and social domains with physical and functional brain biomarkers.

Brain health is more than the absence of disease. A growing collection of peer-reviewed research recognizes that – in addition to cognitive performance – emotional well-being, social connectedness, purpose, resilience, and sleep all

contribute to how e°ectively a person draws upon mental resources to carry out everyday life and responsibilities. Capturing the complexity of the brain’s output systems, the BHI integrates diverse measures of brain function

across domains of cognition, daily life, well-being and social interaction into one comprehensive and powerful assessment. Ongoing research also links physical biomarkers of the brain with changes in BHI scores.

Sensitivity to Bidirectional Change: By design, the BHI captures meaningful measurements of the dynamic nature of brain health, including signs of both gains and losses.

Brain health is dynamic – changing throughout life in response to aging, lifestyle, disease, interventions, medications, including chemotherapy or anesthesia, and other contexts. As a result, meaningful assessment requires a measure that detects change in either direction – capturing not only signs of decline, but also improvement. The BHI was built on decades of research demonstrating the science of neuroplasticity: the

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brain’s lifelong ability to adapt, strengthen and reorganize itself. Rather than simply classifying individuals according to a “normal” range, the BHI recognizes there is no known ceiling on brain health, and instead quantifes changes in brain health, allowing a person's unique trajectory to be measured over time. Traditional neuropsychological assessments typically function in an isolated vacuum, evaluating cognitive faculties like memory or processing speed. In contrast, the BHI

operates as an interconnected, multi-domain metric, capturing how a person's cognitive complaints are inextricably linked to daily, real-world stressors, sleep disruptions and emotional balance. By measuring the brain as a dynamic, integrated system rather than a collection of siloed parts, the BHI registers subtle, meaningful improvements in everyday functional capacity that traditional, defcit-focused tests completely miss.

Selected Evidence of Sensitivity to Bidirectional Change In the original validation study with healthy adults, approximately 75% of participants improved their BrainHealth Index scores following strategy training and coaching˙. A clinical study following postmenopausal women undergoing hormone replacement therapy, found that the BHI served as an outcome measure sensitive to non-cognitive interventionsˇ. A randomized clinical trial in breast cancer survivors experiencing brain fog found that the BHI was more sensitive to cognitive complaints than traditional assessments and detected meaningful improvements following cognitive training˘.

Together, these fndings suggest the BrainHealth Index is sensitive to both medical and non-drug-based interventions, enabling the detection of meaningful gains or losses in brain health across diverse populations.

Actionability: Accurately measuring an individual’s brain performance, the BHI informs actionable insights and personalized opportunities for supporting brain health.

A truly useful brain health measure should help individuals develop a personalized opportunity pathway. The BHI is organized into factors and subcomponents that translate score details and insights in order to guide personalized brain health strategies by identifying both strengths and growth opportunities across multiple aspects of brain health. While the pilot study demonstrated general improvement with cognitive training, individual experiences varied. For example, some participants improved their overall score by taking steps to reduce anxiety, while others improved through actions targeted to support cognitive fexibility, innovation or social engagement˙‚ . Research from workplace, community and clinical settings demonstrates that individuals can use these insights to guide behavior change and monitor the impact of interventions over time , .

Example in Practice Baseline BHI An individual experiencing high levels of stress sees this refected in the emotional balance score. The unique structure of the BHI also provides a clear, personal starting point: focus on steps to improve sleep – because better sleep has been shown to signifcantly decrease stress levels.

Follow-Up BHI The same individual sees improvement in two scores – emotional balance and also clarity – as sleep is a highly important to both factors.

Importantly, research using the BHI suggests that individuals with lower initial scores often show the largest improvements. These fndings challenge the belief that some people are beyond help and reinforce the reality that cognitive decline is not inevitable biology. At the same time, the BHI has also demonstrated sensitivity to changes in the highest performers, even tracking measurements of continued, high-level gain over three years .

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Personalization: The BHI o°ers a unique "you-against-you” approach through self-assessments that track individual change over time, relative to the user’s starting point.

The BHI compares individuals to themselves rather than population norms, with the goal of understanding how individual brain health and ftness can change and improve over time. The baseline BHI score serves as a personal benchmark and

than population comparisons, the BHI provides feedback that is personalized, actionable and meaningful to each individual.

Ability to Track Change Over Time: Tracking repeated change in brain health longitudinally, the BHI enables users to continually monitor brain health over time and gain new insights based on validated science.

The BrainHealth Index delivers its greatest benefts when used repeatedly over time to track trajectories of brain health. This capability has been demonstrated through The BrainHealth Project, a longitudinal study engaging participants from ages 19 to 94 in completing repeat assessments every six months

longitudinal starting point to identify strengths, act upon opportunities for growth, and monitor change. Research has shown that improvements measured by the BHI occur across adulthood and are not dependent on age, education or gender . By focusing on within-person change rather

over a three-year period, allowing researchers to examine how brain health changes across adulthood . Results show that brain health is highly dynamic. Participants demonstrated measurable improvements over time, reinforcing the concept that brain health can be strengthened throughout

adulthood. Findings also show that when participants experienced losses in brain health, they were able to apply targeted strategies to rebound. The digital, remotely administered format also allows for scalable monitoring in real-world settings.

Scientifc Validation: The BHI maintains scientifc rigor through validation in peer-reviewed research publications spanning varied populations.

Grounded in more than three decades of cognitive neuroscience research, the BHI has been evaluated across diverse populations and settings. Validation studies have demonstrated that the BHI is sensitive to meaningful change following intervention, can be administered remotely, and Updated 7/30/26

captures dimensions of brain health associated with everyday functioning ²,³, , , ‚ . It has been applied in studies involving healthy adults, workplace populations, postmenopausal women, and breast cancer survivors, providing evidence of its utility across a range of real-world contexts.

A future phase of validation will seek to expand to youth and diverse racial, socioeconomic, and international populations.

Toward Precision BrainHealth Research is now moving toward the next generation of precision brain health measurement. Emerging work being conducted by Center for BrainHealth and their research collaborators links BrainHealth Index scores with neuroimaging and physiological biomarkers. This research will help to establish better understanding of the biological mechanisms underlying changes in brain performance – and to develop even more individualized prediction models using machine learning algorithms ,¹ ,¹¹. Advances in predictive modeling are creating opportunities to accurately map an individual’s personalized brain health trajectory, enabling earlier risk detection and highly targeted recommendations, including intervention type and timing¹ . Decades of research and validation behind the BHI have assembled a unique longitudinal dataset that integrates cognitive, behavioral physiological, and

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neuroimaging data – making it accessible to an international network of collaborators who are all working toward the shared goal of advancing precision brain health. The BHI is also being studied across a wide range of populations and life contexts, including adults participating in The BrainHealth Project, working professionals, college students, and military and veteran populations. Studying brain health across diverse populations enables BrainHealth researchers and collaborators to continue refning the BHI while deepening scientifc understanding of the many pathways through which people can strengthen brain health and performance. Paired with predictive modeling capabilities. This growing body of evidence o°ers a remarkable opportunity for innovative researchers to help create personalized guidance and interventions. The future of humanity demands the implementation

of protocols to protect and preserve brain health – like those previously established to protect heart health through individualized monitoring and multidimensional panels of data. Promoting brain health can reduce risk of brain diseases, including dementias by 45%, while also improving outcomes for people living with mental health conditions or brain injuries ¹². These benefts can help individuals thrive in the context of their everyday lives, and this e°ort also serves to improve identifcation and timely treatment of brain disease and injury. The BrainHealth Index, Center for BrainHealth’s validated measure to track changes in brain health over time sensitive to improvement as well as early decline., flls a major void by providing an informative measure that shifts scientifc focus from detecting decline to a holistic shift toward optimizing brain health throughout life.

Sources ¹Chapman, S., et al. (2015). Neural Mechanisms of Brain Plasticity with Complex Cognitive Training in Healthy Seniors. Cerebral Cortex. ²Chapman, S., et al. (2021). A Novel Brainhealth Index Prototype Improved by Telehealth-Delivered Training During COVID-19. Frontiers in Public Health. ³Fratantoni, J., et al. (2025). Impact of Menopausal Hormone Therapy on Brain Health in Postmenopausal Women, a Pilot Study. Women’s Health Reports. Venza, E. (2025). E°ects Of Cognitive Training in Breast Cancer Survivors: A 3-Arm Randomized Controlled Trial. Doctoral Dissertation, The University of Texas at Dallas. Laane, S., et al. (2022). E°ects of Online Brain Training on Self-reported Mental Health Symptoms for Generally Healthy Adults During the Covid-19 Pandemic. Brain and Behavior. Zientz, J., et al. (2023). Exploring How Brain Health Strategy Training Informs the Future of Work. Frontiers in Psychology. Cook, L., et al. (2026). Measuring and Increasing the Brain Health Span Across Adulthood: A Public Health Imperative. [Nature] Scientifc Reports. Young, L. R., et al. (2025). Cognitive Training to Increase Resilience. Military Medicine. Ajith, M., Spence, J. S., Chapman, S. B., & Calhoun, V. D. (2025). Multimodal Predictive Modeling: Scalable Imaging-Informed Approaches to Predict Future Brain Health. [Preprint]. Journal of Neuroscience Methods. ¹ Spence, J. S., et al. (2024). Toward Precision Brain Health: Accurate Prediction of a Cognitive Index Trajectory Using Neuroimaging Metrics. Cerebral Cortex. ¹¹Honea, R., et al. (2026). Longitudinal Surface-Based Morphometry Reveals Potential MRI Biomarkers Correlated with Multidimensional Brain Health Measures. [Springer Nature] Brain Imaging and Behavior. ¹²Livingston, G., et al. (2024). Dementia Prevention, Intervention, and Care: 2024 Report of The Lancet Standing Commission. The Lancet.

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