Predicting Cognitive Decline: Comparative Analysis of ANU-ADRI, CAIDE, CogDrisk, LIBRA, LIBRA2, UKBDRS and Lancet Based Dementia Risk Scores in the HUNT Study - 24/02/26

Doi : 10.1016/j.tjpad.2026.100524

Josephine Stubs ^a,^b,^c,^⁎ , Geir Selbæk ^a,^b,^c, Bjørn Heine Strand ^a,^b,^d, Gill Livingston ^e,^f, Kaarin J. Anstey ^g,^h,ⁱ, Kay Deckers ^j, Mika Kivimäki ^e,^k, Steinar Krokstad ^l,^m, Fiona E. Mathews ⁿ, Ellen Melbye Langballe ^a,^b

^a Norwegian National Centre for Aging and Health, Vestfold Hospital Trust, Tønsberg, Aldring og helse, 103 Tønsberg, Norway

^b Department of Geriatric Medicine, Oslo University Hospital, Oslo, Kirkeveien 166, 0450 Oslo Norway

^c Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway

^d Department of Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway

^e Division of Psychiatry, 149 Tottenham Court Rd, University College London, London, W1W 7EJ UK

^f North London NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE UK

^g School of Psychology, University of New South Wales, Sydney, Australia

^h Neuroscience Research Australia, Sydney, Australia

ⁱ UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia

^j Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands

^k Department of Public Health, Faculty of Medicine, University of Helsinki, Tukholmankatu 8 B, FI-00014, Finland

^l Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway

^m Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway

ⁿ Institute for Clinical and Applied Health Research, University of Hull, Cottingham Road, Hull, HU6 7RX, UK

^⁎ Corresponding author.

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Highlights

•	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.

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Abstract

Objective

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.

Methods

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.

Results

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).

Conclusion

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.

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Keywords : Dementia Risk Index, Modifiable risk factors, HUNT, Lifestyle Risk, Ageing, Cognitive Decline