# Predicting cognitive decline: Comparative analysis of ANU-ADRI, CAIDE, CogDrisk, LIBRA, LIBRA2, UKBDRS and Lancet based dementia risk scores in the HUNT study

## TL;DR

This study compared eight dementia risk scores to see how well they predict cognitive decline over time in older adults.

## Contribution

The study provides a longitudinal comparison of dementia risk scores in predicting cognitive decline, highlighting their limitations compared to basic demographics.

## Key findings

- UKBDRS, LIBRA, and ANU-ADRI best predicted cognition 11 years after risk assessment.
- No risk score outperformed age and education alone in predicting cognitive decline.
- High-risk groups showed steeper cognitive decline for UKBDRS-APOE, Lancet, and LIBRA.

## Abstract

•Eight dementia risk scores and a demographics model were compared longitudinally.•UKBDRS, LIBRA, ANU-ADRI best predicted cognition 11 years after risk assessment.•Lancet, UKBDRS, ANU-ADRI best predicted 4-year cognitive decline.•UKBDRS, CogDrisk, Lancet best predicted who would get significant cognitive decline.•No risk score outperformed age and education alone in predicting cognitive decline.

Eight dementia risk scores and a demographics model were compared longitudinally.

UKBDRS, LIBRA, ANU-ADRI best predicted cognition 11 years after risk assessment.

Lancet, UKBDRS, ANU-ADRI best predicted 4-year cognitive decline.

UKBDRS, CogDrisk, Lancet best predicted who would get significant cognitive decline.

No risk score outperformed age and education alone in predicting cognitive decline.

To evaluate and compare the predictive value of eight dementia risk scores for late-life cognitive function and cognitive decline; ANU-ADRI, CAIDE, CogDrisk, LIBRA, LIBRA2, UKBDRS(-APOE), and a Lancet commission-based risk score.

Using Norwegian Trøndelag Health Study (HUNT) data, we calculated risk scores from lifestyle and health data of 7221 dementia-free participants (mean age: 76.8 years, 54.1% female) collected in HUNT3 (2006–2008). Cognitive function was assessed using the Montreal Cognitive Assessment scale (MoCA) 11 years later in HUNT4 70+, and reassessed in 4716 participants 4 years thereafter. Associations between continuous risk scores or risk score tertiles, cognition and cognitive decline were examined using linear mixed-effects models. Logistic regression models were used to test associations between risk scores and a ≥ 3-point decline in MoCA scores.

All risk scores were significantly associated with cognitive function and cognitive decline. Associations with cognitive function ranged from UKBDRS β per 1SD=-1.61(95%CI:-1.72,-1.51) to CAIDE (β=-0.74;95%CI:-0.82,-0.67), and with yearly cognitive decline from Lancet (β=-0.23;95%CI:-0.27,-0.18) to CAIDE (β=-0.04;95%CI:-0.07,-0.02). High-low risk group differences in cognitive function were largest for CogDrisk (β=-3.04;95%CI:-3.27,-2.81), LIBRA (β=-3.04;95%CI:-3.27,-2.80) and lowest for CAIDE (β=-1.65;95%CI:-1.86,-1.44). High-risk groups showed the steepest decline for UKBDRS-APOE (β=-0.43;95%CI:-0.52,-0.34), Lancet (β=-0.39;95%CI:-0.48,-0.30), and LIBRA (β=-0.38;95%CI:-0.47,-0.28). All scores predicted ≥3-point decline modestly: AUCs were highest for UKBDRS (AUC=0.61;95%CI:0.60,0.63), UKBDRS-APOE (0.61;95%CI:0.60,0.63), CogDrisk (0.60;95%CI:0.58,0.62), and Lancet (0.60;95%CI:0.58,0.61), but none outperformed a model including age and education alone (0.61;95%CI:0.60,0.63).

Risk scores captured meaningful gradients in cognition and decline but offered limited discriminatory accuracy beyond demographics, supporting their use for prevention-oriented risk profiling rather than prediction.