New Tool Helps Assess Cognitive Impairment Risk in People Without Symptoms

Evidence has grown over the past decade showing that specific lifestyle factors and choices can play a significant role in the risk of Alzheimer’s disease and other neurodegenerative diseases. A recent study analyzed 12 sociodemographic, medical, and functional factors that can actively identify asymptomatic individuals at high risk for dementia and cognitive impairment, and do so earlier rather than later.

In this exclusive MedPage Today video, study co-author James E. Galvin, MD, the director of the Center for Brain Health at Miami University Miller School of Medicine, takes us through the assessment tool, the “Vulnerability Index,” (VI) that he and a colleague developed.

Following is a transcript of his remarks:

So our research projects have largely focused on understanding the risks of developing neurodegenerative diseases like Alzheimer’s disease, and then how we could use that information to develop primary, secondary, and tertiary prevention programs. So to understand how people might be at higher risk for [neurodegenerative] disease, we need to understand what makes people more resilient — that is being able to resist the effects of diseases like Alzheimer’s disease — and what puts their brain at a higher risk of developing those diseases.

So, over the last several years, we’ve develop several tools that will help us capture this. One tool we created was called the “Resilience Index” to understand what makes the brain more resistant to the ravages of aging and disease, and that gives us a measure of brain health. After that we then develop something called the VI which looks at the other spectrum; what factors increase the risk of developing a disease like Alzheimer’s disease or Parkinson’s disease.

And so the VI allows us to look at things that are modifiable and non-modifiable, and apply a quantitative score. So if we can understand each person as an individual…how they fit onto the spectrum of vulnerability, we can then better understand what we can do to change that risk and develop prevention measures.

So what we did was we created a scale that has 12 factors that can be easily extracted from electronic health records. Four are not modifiable — so their age, education, sex, and race, and ethnicity. And then eight factors, which are potentially modifiable, that includes heart disease, diabetes, stroke, frailty, obesity, hypertension, hypercholesterolemia, and depression. And each of these things have a weighted score so that some factors, like frailty and diabetes, contribute to the risk of Alzheimer’s disease to a greater extent than other factors like depression or heart disease. And understanding what the vulnerability of the brain is, can then, at the time that a physician is first seeing their patient just walking through the door, it can quickly get a sense of how vulnerable that person is, and that vulnerability tells you what the likelihood is that they have an underlying brain disease.

So it runs on a scale of 2 to 20 with a threshold of 8. So people below scores of 8 are more likely to have a healthy brain and people with scores greater than eight are at a 17-fold increase risk of having some form of a brain disease like Alzheimer’s, Parkinson’s, stroke, et cetera. So a very simple measure that could be done, and again, using factors that we are already collect in the process of medical care, and so I think that really makes the utility of it [the VI]. So we can use this to screen people who are asymptomatic to understand their risk of brain disease.