CogDrisk, ANU-ADRI, CAIDE, and LIBRA Risk Scores for Estimating Dementia Risk

Abstract

ImportanceWhile the Australian National University–Alzheimer Disease Risk Index (ANU-ADRI), Cardiovascular Risk Factors, Aging, and Dementia (CAIDE), and Lifestyle for Brain Health (LIBRA) dementia risk tools have been widely used, a large body of new evidence has emerged since their publication. Recently, Cognitive Health and Dementia Risk Index (CogDrisk) and CogDrisk for Alzheimer disease (CogDrisk-AD) risk tools have been developed for the assessment of dementia and AD risk, respectively, using contemporary evidence; comparison of the relative performance of these risk tools is limited.ObjectiveTo evaluate the performance of CogDrisk, ANU-ADRI, CAIDE, LIBRA, and modified LIBRA (LIBRA with age and sex estimates from ANU-ADRI) in estimating dementia and AD risks (with CogDrisk-AD and ANU-ADRI).Design, Setting, and ParticipantsThis population-based cohort study obtained data from the Rush Memory and Aging Project (MAP), the Cardiovascular Health Study Cognition Study (CHS-CS), and the Health and Retirement Study–Aging, Demographics and Memory Study (HRS-ADAMS). Participants who were free of dementia at baseline were included. The factors were component variables in the risk tools that included self-reported baseline demographics, medical risk factors, and lifestyle habits. The study was conducted between November 2021 and March 2023, and statistical analysis was performed from January to June 2023.Main outcomes and measuresRisk scores were calculated based on available factors in each of these cohorts. Area under the receiver operating characteristic curve (AUC) was calculated to measure the performance of each risk score. Multiple imputation was used to assess whether missing data may have affected estimates for dementia risk.ResultsAmong the 6107 participants in 3 validation cohorts included for this study, 2184 participants without dementia at baseline were available from MAP (mean [SD] age, 80.0 [7.6] years; 1606 [73.5%] female), 548 participants without dementia at baseline were available from HRS-ADAMS (mean [SD] age, 79.5 [6.3] years; 288 [52.5%] female), and 3375 participants without dementia at baseline were available from CHS-CS (mean [SD] age, 74.8 [4.9] years; 1994 [59.1%] female). In all 3 cohorts, a similar AUC for dementia was obtained using CogDrisk, ANU-ADRI, and modified LIBRA (MAP cohort: CogDrisk AUC, 0.65 [95% CI, 0.61-0.69]; ANU-ADRI AUC, 0.65 [95% CI, 0.61-0.69]; modified LIBRA AUC, 0.65 [95% CI, 0.61-0.69]; HRS-ADAMS cohort: CogDrisk AUC, 0.75 [95% CI, 0.71-0.79]; ANU-ADRI AUC, 0.74 [95% CI, 0.70-0.78]; modified LIBRA AUC, 0.75 [95% CI, 0.71-0.79]; CHS-CS cohort: CogDrisk AUC, 0.70 [95% CI, 0.67-0.72]; ANU-ADRI AUC, 0.69 [95% CI, 0.66-0.72]; modified LIBRA AUC, 0.70 [95% CI, 0.68-0.73]). The CAIDE and LIBRA also provided similar but lower AUCs than the 3 aforementioned tools (eg, MAP cohort: CAIDE AUC, 0.50 [95% CI, 0.46-0.54]; LIBRA AUC, 0.53 [95% CI, 0.48-0.57]). The performance of CogDrisk-AD and ANU-ADRI in estimating AD risks was also similar.Conclusions and relevanceCogDrisk and CogDrisk-AD performed similarly to ANU-ADRI in estimating dementia and AD risks. These results suggest that CogDrisk and CogDrisk-AD, with a greater range of modifiable risk factors compared with other risk tools in this study, may be more informative for risk reduction.

Adaptation of the Australian National University Alzheimer's Disease Risk Index‐Short Form (ANU‐ADRI‐SF) into Turkish

“…In a study examining the performance of four measurement tools, including ANU‐ADRI, which are widely used in predicting dementia risk, the area under the receiver operating characteristic curve (AUC) was calculated. In three cohort studies in the United States, the AUC for ANU‐ADRI ranged from 0.65 to 0.74, performing similar to one of the instruments and better than the others (Huque et al., 2023).…”

Lifestyle for brain health and cognitive functioning in midlife to early late‐life New Zealanders: Utility of the LIBRA index

“…41 It has been suggested, for example, that the LIBRA score may underestimate dementia risk and that scores with a greater range of modifiable risk factors could be more informative. 42 Notably, a recent revision suggested the addition of three more factors (hearing impairment, social contact, and sleep) to the LIBRA index, which is currently undergoing validation studies. 43 factor in an index.…”

Lifestyle and incident dementia: A COSMIC individual participant data meta‐analysis

“…In the case of dementia, composite modifiable risk scores such as the LIfestyle for BRAin Health (LIBRA) index 8 , 17 or the Australian National University Alzheimer's Disease Risk Index (ANU‐ADRI 18 ) are also relevant to consider due to the syndrome's multifactor etiology. 19 , 20 These composite risk scores combine the presence or absence of multiple factors into one numeric value that expresses dementia risk. They are especially valuable as they can aid in the identification of individuals at high risk and may facilitate the implementation of dementia risk reduction guidelines into practice.…”

“… 8 , 17 The score has been well validated for predicting incident dementia in cohorts located in Western, high‐income countries. 9 , 16 , 17 , 18 , 19 , 20 , 21 However, its predictive validity has not been explored in populations living in other regions. The current study aims to assess whether the association between the LIBRA index and incident dementia is moderated by sociodemographic characteristics, including age, sex, education, and SEP, or by geographical location.…”

“…Therefore, risk personalization for all known modifiable risk and protective factors needs to be further investigated. In the case of dementia, composite modifiable risk scores such as the LIfestyle for BRAin Health (LIBRA) index 8,17 or the Australian National University Alzheimer's Disease Risk Index (ANU‐ADRI 18 ) are also relevant to consider due to the syndrome's multifactor etiology 19,20 . These composite risk scores combine the presence or absence of multiple factors into one numeric value that expresses dementia risk.…”