Modifiable Risk Factors for Prevention of Dementia in Midlife, Late Life and the Oldest-Old: Validation of the LIBRA Index

Article type: Research Article

Authors: Vos, Stephanie J.B.^{a; *} | van Boxtel, Martin P.J.^a | Schiepers, Olga J.G.^a | Deckers, Kay^a | de Vugt, Marjolein^a | Carrière, Isabelle^{b; c} | Dartigues, Jean-François^{d; e} | Peres, Karine^{d; e} | Artero, Sylvaine^{b; c} | Ritchie, Karen^{b; c; f} | Galluzzo, Lucia^g | Scafato, Emanuele^g | Frisoni, Giovanni B.^{h; i} | Huisman, Martijn^{j; k} | Comijs, Hannie C.^l | Sacuiu, Simona F.^m | Skoog, Ingmarⁿ | Irving, Kate^o | O’Donnell, Catherine A.^p | Verhey, Frans R.J.^a | Visser, Pieter Jelle^{a; q} | Köhler, Sebastian^a

Affiliations: [a] Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands | [b] Inserm, U1061, Montpellier, France | [c] University Montpellier, U1061, Montpellier, France | [d] University Bordeaux, ISPED, Centre INSERM U1219 – Bordeaux Population Health Research Center, Bordeaux, France | [e] INSERM, ISPED, Centre INSERM U1219 – Bordeaux Population Health Research Center, Bordeaux, France | [f] Faculty of Medicine, Imperial College, London, UK | [g] Population Health and Health Determinants Unit, National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy | [h] University Hospitals and University of Geneva, Geneva, Switzerland | [i] IRCCS Fatebenefratelli, Brescia, Italy | [j] Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands | [k] Department of Sociology, VU University, Amsterdam, The Netherlands | [l] Department Psychiatry and EMGO Institute for Health and Care Research VU University Medical Center, GGZinGeest, Amsterdam, The Netherlands | [m] Institute of Neuroscience and Physiology, Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, Sahlgrenska University Hospital, Sweden | [n] Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden | [o] School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland | [p] General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK | [q] Department of Neurology and Alzheimer Center, Neuroscience Campus, VU University Medical Center, Amsterdam, The Netherlands

Correspondence: [*] Correspondence to: Stephanie J.B. Vos, PhD, Alzheimer Center Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Tel.: +31 43 38 81036; Fax: +31 43 38 84092; E-mail: [email protected].

Abstract: Background: Recently, the LIfestyle for BRAin health (LIBRA) index was developed to assess an individual’s prevention potential for dementia. Objective: We investigated the predictive validity of the LIBRA index for incident dementia in midlife, late life, and the oldest-old. Methods: 9,387 non-demented individuals were recruited from the European population-based DESCRIPA study. An individual’s LIBRA index was calculated solely based on modifiable risk factors: depression, diabetes, physical activity, hypertension, obesity, smoking, hypercholesterolemia, coronary heart disease, and mild/moderate alcohol use. Cox regression was used to test the predictive validity of LIBRA for dementia at follow-up (mean 7.2 y, range 1–16). Results: In midlife (55–69 y, n = 3,256) and late life (70–79 y, n = 4,320), 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, n = 1,811), higher LIBRA scores did not increase the risk for dementia. Conclusion: LIBRA might be a useful tool to identify individuals for primary prevention interventions of dementia in midlife, and maybe in late life, but not in the oldest-old.

Keywords: Aging, dementia, modifiable risk factors, prevention

DOI: 10.3233/JAD-161208

Journal: Journal of Alzheimer's Disease, vol. 58, no. 2, pp. 537-547, 2017