The Resilience Index: A Quantifiable Measure of Brain Health and Risk of Cognitive Impairment and Dementia

Article type: Research Article

Authors: Galvin, James E.^{; *} | Kleiman, Michael J. | Chrisphonte, Stephanie | Cohen, Iris | Disla, Shanell | Galvin, Conor B. | Greenfield, Keri K. | Moore, Claudia | Rawn, Susan | Riccio, Mary Lou | Rosenfeld, Amie | Simon, Judith | Walker, Marcia | Tolea, Magdalena I.

Affiliations: Comprehensive Center for Brain Health, Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA

Correspondence: [*] Correspondence to: James E. Galvin, MD, MPH, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL 33136, USA. Tel.: +1 305 243 1664; E-mail: [email protected].

Abstract: Background:There is increasing interest in lifestyle modification and integrative medicine approaches to treat and/or prevent mild cognitive impairment (MCI) and Alzheimer’s disease and related dementias (ADRD). Objective:To address the need for a quantifiable measure of brain health, we created the Resilience Index (RI). Methods:This cross-sectional study analyzed 241 participants undergoing a comprehensive evaluation including the Clinical Dementia Rating and neuropsychological testing. Six lifestyle factors including physical activity, cognitive activity, social engagements, dietary patterns, mindfulness, and cognitive reserve were combined to derive the RI (possible range of scores: 1–378). Psychometric properties were determined. Results:The participants (39 controls, 75 MCI, 127 ADRD) had a mean age of 74.6±9.5 years and a mean education of 15.8±2.6 years. The mean RI score was 138.2±35.6. The RI provided estimates of resilience across participant characteristics, cognitive staging, and ADRD etiologies. The RI showed moderate-to-strong correlations with clinical and cognitive measures and very good discrimination (AUC: 0.836; 95% CI: 0.774–0.897) between individuals with and without cognitive impairment (diagnostic odds ratio = 8.9). Individuals with high RI scores (> 143) had better cognitive, functional, and behavioral ratings than individuals with low RI scores. Within group analyses supported that controls, MCI, and mild ADRD cases with high RI had better cognitive, functional, and global outcomes than those with low RI. Conclusion:The RI is a brief, easy to administer, score and interpret assessment of brain health that incorporates six modifiable protective factors. Results from the RI could provide clinicians and researchers with a guide to develop personalized prevention plans to support brain health.

Keywords: Alzheimer’s disease, brain health, cognitive activity, cognitive reserve, dementia, diet, lifestyle, mild cognitive impairment, mindfulness, physical activity, resilience, risk factors

DOI: 10.3233/JAD-215077

Journal: Journal of Alzheimer's Disease, vol. 84, no. 4, pp. 1729-1746, 2021