The LIBRA Index in Relation to Cognitive Function, Functional Independence, and Psycho-Behavioral Symptoms in a Sample of Non-Institutionalized Seniors at Risk of Dementia

Article type: Research Article

Authors: Franchini, Flaminia^{a; b} | Musicco, Massimo^{c; †} | Ratto, Federica^a | Storti, Gabriele^d | Shofany, Jacob^a | Caltagirone, Carlo^{a; b} | Di Santo, Simona Gabriella^{a; b; *}

Affiliations: [a] Department of Clinical and Behavioral Neurology, Santa Lucia Foundation IRCCS, Rome, Italy | [b] Department of Neuroscience, University of Rome “Tor Vergata”, Rome, Italy | [c] Institute of Biomedical Technologies, National Research Council, Milan, Italy | [d] Department of Surgical Sciences, University of Rome “Tor Vergata”, Rome, Italy

Correspondence: [*] Correspondence to: Dr. Simona Gabriella Di Santo, Santa Lucia Foundation IRCCS, Ed. G, Floor 1, Room 133, Via Ardeatina 306, 00179 Rome, Italy. E-mail: s.disanto@hsantalucia.it.

Abstract: Background:Alzheimer’s disease is the principal cause of dementia and is determined, in at least one third cases, by modifiable risk factors (MRF). The “Lifestyle for Brain Health (LIBRA)” index was recently developed to quantify the individual risk of progression to dementia ascribable to MRF. Objective:The aim of this study was to investigate the association between LIBRA scores and markers of cognitive performance, functional independence, and psycho-behavioral symptoms in a community-based sample of Italian elders. Methods:308 senior participants with mild cognitive impairment (MCI) or subjective cognitive decline (SCD) were evaluated with a complete neuropsychological battery and semi-structured interviews for the assessment of depression, apathy, and functional autonomy. All the 12 LIBRA MRF were available for the calculation of LIBRA scores. A modified version of the index (LIBRA-2) was calculated by removing depression weight from the LIBRA index. Partial correlation analyses, controlling for age and education, assessed the association between LIBRA indices and cognitive, functional, and behavioral outcomes. Separate analyses were repeated in the MCI and SCD subgroups. Results:In participants with SCD (SCDp), significant correlations existed between LIBRA and markers of impairment in global cognition, visuo-spatial attention, and semantic fluency. LIBRA-2 associated with psycho-behavioral symptoms in the whole sample and in SCDp. LIBRA-2 only associated with apathy in the MCI subgroup. Conclusions:The LIBRA index might be useful to determine the lifestyle-attributable risk of cognitive and psycho-behavioral decline in Italian seniors at risk, while in those with overt cognitive impairment, these outcomes are presumably mainly associated with non-modifiable factors.

Keywords: Alzheimer’s disease, apathy, depression, LIBRA Index, modifiable risk factors, mild cognitive impairment, neuropsychological tests, subjective cognitive decline

DOI: 10.3233/JAD-190495

Journal: Journal of Alzheimer's Disease, vol. 72, no. 3, pp. 717-731, 2019