Higher scores on a dementia risk score are suggestive of a less brain-healthy lifestyle and the associated greater risk of cognitive impairment, according to a new research published in the journal Neurology.

Cross-sectional data from the observational population-based cohort of The Maastricht Study was used. In this study, 4164 persons, average age 59 years, undertook the LIfestyle for BRAin health (LIBRA) index test. The study aimed to examine if the LIBRA index had any association with cognitive function and impairment, and abnormalities on brain MRI scans.

Eleven out of the 12 factors in the LIBRA index were considered to calculate the LIBRA score, which included protective factors like low to moderate alcohol use and adherence to a Mediterranean diet and risk factors such as physical inactivity, smoking, obesity, depression, type 2 diabetes, high blood pressure, high cholesterol levels, heart disease and chronic kidney disease. The score range for this study was -2.7 to +12.7.

Based on their level of risk of dementia, the study subjects were grouped into three: low risk (average score of -1.47), medium risk (average score of 1.20) and high risk (average score of 4.6). The overall average score was 1.19.

The volumes of white matter, grey matter, cerebrospinal fluid and white matter hyperintensities were measured on MRI to detect structural changes in the brain. Presence of lacunar infarcts and/or presence of cerebral microbleeds were taken as signs of cerebral small vessel disease indicative of vascular brain damage. Researchers also evaluated the participants for cognitive functioning. The participants were tested for their memory, information processing speed and executive function and attention. Values ≤1.5 SD below the average were considered as cognitive impairment. 

The study found that individuals with higher LIBRA scores had higher volumes of white matter hyperintensities (1.27 ml vs 0.48 ml in the lowest risk group). They also had lower scores on information processing speed and executive function and attention. The association between lower grey matter volume, memory and higher LIBRA scores were evident only in men.

This study has shown a significant association between higher LIBRA scores and higher risk of cognitive impairment and that many of the changes in brain, as observed in this study, are possibly due to risk factors that can be modified.

Hence, the LIBRA index, which is a compound score based on modifiable lifestyle-related risk factors, can also be considered as an index of brain health and serve as a useful means to identify individuals at increased risk of future cognitive decline and dementia and also to monitor compliance to treatment. Early intervention by improving lifestyle factors such as eating a healthy diet, increasing physical activity, quitting smoking, limiting alcohol intake etc. may improve brain health thus delaying onset of dementia.

(Source: American Academy of Neurology Press Release, August 25, 2021; Heger IS, et al. Associations of the lifestyle for brain health index with structural brain changes and cognition: Results from the Maastricht Study. Neurology. 2021 Aug 25;10.1212/WNL.0000000000012572. doi: 10.1212/WNL.0000000000012572)

Dr A.V. Srinivasan,

Emeritus Prof., The Tamil Nadu Dr. M.G.R. Medical University; Former President, Indian Academy Of Neurology