Prevention of dementia in midlife using the Lifestyle for Brain Health (LIBRA) score
The LIfestyle for BRAin health (LIBRA) score was developed to assess an individual’s room for prevention of dementia in midlife. The dementia risk score is defined based on empirical evidence from the existing literature and expert consensus.
Research authors: Olga J.G. Schiepers, Sebastian Köhler, Kay Deckers , Kate Irving, Catherine A. O'Donnell, Marjan van den Akker, Frans R.J. Verhey, Stephanie J.B. Vos, Marjolein de Vugt, Martin P.J. van Boxtel
Details Formula Study characteristics Files & References
★★★
Model author
Model ID
1041
Version
1.31
Revision date
2017-12-07
Specialty
MeSH terms
  • Dementia
  • Elderly
  • Geriatrics
  • Brain
  • Cognitive Decline
  • Primary Prevention
  • Model type
    Linear model (Calculation)
    Status
    public
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    Formula
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    Condition Formula

    Additional information

    Original study:
    The LIfestyle for BRAin health (LIBRA) score was developed to assess an individual’s room for prevention of dementia in midlife.1 The LIBRA index was calculated following a previously applied approach based on the relative risk (RR) of all risk factors separately as recently reported. Briefly, the natural logarithm (ln) of the RR was calculated for each factor. Next, these were standardized by taking the lowest ln (RR) as a reference value (score 1) and dividing all other values by this value. Finally, summing the scores of the risk factors resulted in the total LIBRA index. A higher LIBRA score indicates a higher risk for dementia.

    External validation:
    In 2017, an external validation regarding the LIBRA model was published by Vos et al.2 A total of 9,387 participants were included with a mean age of 72.9 (SD 7.3, 55–97) years, of whom 5141 (55%) were female. 31% of the cases had data on APOE genotype available. The average LIBRA index was 2.9 (SD 2.0, range –1.0 to 10.5). After an average follow-up of 7.2 years (SD 3.6, range 1 to 16), 1120 (12%) individuals progressed to dementia. The dementia incidence rate was 16.8 (95% CI 16.0–17.6) per 1000 person-years. In midlife (55–69 y), and late life (70–79 y), the risk for dementia increased with higher LIBRA scores. Individuals in the intermediate- and high-risk groups had a higher risk of dementia than those in the low-risk group. In the oldest-old (80–97 y), higher LIBRA scores did not increase the risk for dementia.

    Sources:
    1. Schiepers OJ, Köhler S, Deckers K, et al. Lifestyle for Brain Health (LIBRA): a new model for dementia prevention. Int J Geriatr Psychiatry. 2017 Feb 28. doi: 10.1002/gps.4700. [Epub ahead of print].
    2. Vos SJ, van Boxtel MP, Schiepers OJ, et al.  Modifiable Risk Factors for Prevention of Dementia in Midlife, Late Life and the Oldest-Old: Validation of the LIBRA Index. J Alzheimers Dis. 2017;58(2):537-547.

    Study Population

    Total population size: 949
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Continuous characteristics

    Name Mean SD Unit
    Age 65 8.7 years

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Gender Female 466
    Male 483
    Level of education Low 200
    Medium/high 749
    Alcohol consumption Low/moderate 516
    None or high 433
    Cardiovascular disease Yes 173
    No 776
    Psysical activity Yes 365
    No 584
    Renal dysfunction Yes 50
    No 899
    Diabetes Yes 66
    No 883
    High cholesterol Yes 139
    No 810
    Smoking Yes 217
    No 732
    Obesity Yes 223
    No 726
    Hypertension Yes 545
    No 404
    Depression Yes 233
    No 716
    High cognitive activity Yes 331
    No 618
    Prevention of dementia in midlife using the Lifestyle for Brain Health (LIBRA) score
    V-1.31-1041.17.12.07
    Refer to Intended Use for instructions before use
    Evidencio B.V., Irenesingel 19, 7481 GJ, Haaksbergen, the Netherlands
    Result
    Note
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    Calculated LIBRA score: points

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    Outcome stratification

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    Conditional information

    Result interpretation

    How this model should be used:
    Recent evidence suggests that one in three up to one in two Alzheimer’s disease cases are potentially attributable to modifiable risk factors. The LIBRA score was developed as a useful tool to identify individuals for primary prevention interventions of dementia and monitor individuals risk-change over time.

    Context information:
    The LIBRA index is unique in that it reflects an individual’s prevention potential for dementia. The predictive accuracy of the LIBRA index for dementia is somewhat lower compared to that of other prediction indices.1 This is not unexpected, given that previous indices were maximized for risk prediction by including major predictors for dementia such as age, gender, education, and APOE genotype that are not amenable to change.

    Important note:
    Notably, the current model lacks three of the original LIBRA factors (i.e., cognitive activity, renal dysfunction, and adherence to a Mediterranean diet), because these factors were not available upon external validation. This might have influenced the predictive validity of the LIBRA index.

    Sources:

    1. Schiepers OJ, Köhler S, Deckers K, et al. Lifestyle for Brain Health (LIBRA): a new model for dementia prevention. Int J Geriatr Psychiatry. 2017 Feb 28. doi: 10.1002/gps.4700. [Epub ahead of print].
    2. Tang EY , Harrison SL , Errington L , et al. Current developments in dementia risk prediction modelling: An updated systematic review. PLoS One. 2015;10(9):e0136181.
    3. Vos SJ, van Boxtel MP, Schiepers OJ, et al.  Modifiable Risk Factors for Prevention of Dementia in Midlife, Late Life and the Oldest-Old: Validation of the LIBRA Index. J Alzheimers Dis. 2017;58(2):537-547.

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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