The science is clear that healthy lifestyle choices can prevent or at least delay the onset of dementia. Now researchers are assessing whether a simple lifestyle scoring system could identify areas where people can make positive changes in their daily lives that can help them stay in good mental shape.

The test is called LIBRA.

Scientists have calculated that modifiable risk factors might account for between a third to one half of all Alzheimer’s cases worldwide. What’s more, they estimate that a risk factor reduction of ten to 25 percent might prevent up to three million cases of the disease.

With this large impact in mind, they designed a test called the LIfestyle for BRAin health index (LIBRA) featuring twelve risk factors to assess a middle-aged and older individual’s potential for preventing dementia through better lifestyle choices.

How does it work? Let’s take a closer look…

LIBRA’s Twelve Risk Factors 

The modifiable factors in the LIBRA index include:

  1. Excess alcohol consumption
  2. Smoking
  3. Physical inactivity
  4. Low cognitive activity
  5. Obesity
  6. Poor Diet
  7. Heart disease
  8. High blood pressure
  9. High cholesterol
  10. Diabetes (type 2)
  11. Chronic kidney disease
  12. Depression

Each factor in the index is weighted according to its importance to dementia risk.

For instance, positive factors such as performing regular cognitive activities like reading or solving puzzles is scored at -3.2, adherence to a Mediterranean diet, -1.7, and low to moderate alcohol intake, -1.0. Negative factors such as depression and obesity are scored at +2.1 and +1.6 respectively.

The overall score covering all 12 factors can range from -2.7 (extremely low risk of Alzheimer’s) to +12.7 (extremely high risk of Alzheimer’s).

Each Uptick Raises Dementia Risk 

Researchers published the results of the first study in 2017. The study included 949 participants aged 50 to 81. After a 12 to 16 year follow up, LIBRA was able to identify future risk of both dementia and cognitive impairment. More specifically, a one-point increase in the LIBRA score related to a 19 percent higher risk for dementia and a nine percent higher risk for cognitive impairment.

Later the same year a larger study included 9,387 dementia-free participants aged 55 to 97. Researchers followed this group for seven years. They found a higher LIBRA score led to a greater incidence of dementia for people aged up to 79. However, the LIBRA score made no difference once a person reached the age of 80.

Further studies followed that also confirmed the validity of LIBRA. The most recent study was published in the journal Neurology in September.

Poor Choices Harm the Brain – Especially in Men 

For this study the research team divided 4,164 participants with an average age of 59 into three groups: low risk (average score of -1.47); medium risk (average score of 1.20), and high risk (average score of 4.6).

Each participant took memory and thinking skill tests and had brain scans to look for signs of white matter lesions and small blood vessel disease, both of which are seen in patients who go on to develop dementia. They also measured brain volume in both white and gray matter.

The researchers found that people in the high-risk group had higher volumes of brain lesions, 1.27 ml compared to 0.48 ml for those in the lowest risk group.

The high-risk group also had lower scores on two tests of thinking: information processing speed and executive function and attention. Only in men, however, were associations found between higher LIBRA scores and lower volumes of grey matter, as well as lower scores on tests of memory.

Researchers Excited by Trial Results 

Senior author Dr. Sebastian Köhler of Maastricht University in the Netherlands has been involved in all of the LIBRA studies.

He explained the importance of the research, saying, “Dementia risk scores might be useful to help identify people at higher risk of dementia earlier, so that potential lifestyle factors can be addressed earlier and monitored more closely.

“Our study found that a substantial proportion of brain changes might be attributable to risk factors that can be modified. More research is needed to confirm these findings and determine why there were differences between men and women.” Dr. Köhler goes on to say, “It’s exciting that a simple test score may indeed be an index of brain health.”

If you’re interested in taking a version of the LIBRA dementia assessment test that’s available to the public, you can find it here.


  1. https://onlinelibrary.wiley.com/doi/10.1002/gps.4700
  2. https://pubmed.ncbi.nlm.nih.gov/28453475/ 
  3. https://www.aan.com/PressRoom/Home/PressRelease/4920 
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8480401/ 

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