Umbrella review and Delphi study on modifiable factors for dementia risk reduction

Colin Rosenau, Sebastian Köhler, Lion M. Soons, Kaarin J. Anstey, Carol Brayne, Henry Brodaty, Knut Engedal, Francesca R. Farina, Mary Ganguli, Gill Livingston, Constantine G. Lyketsos, Francesca Mangialasche, Laura E. Middleton, Marcel G.M.Olde Rikkert, Ruth Peters, Perminder S. Sachdev, Nikolaos Scarmeas, Geir Salbæk, Martin P.J. van Boxtel, Kay Deckers*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

5 Scopus citations


A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the “LIfestyle for BRAin health” (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta-analyses with a two-round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts. Highlights: An umbrella review was combined with opinions of 18 dementia experts. Various candidate targets for dementia risk reduction were identified. Experts prioritized hearing impairment, social contact, and sleep. Re-assessment of dementia risk scores is encouraged. Future work should evaluate the predictive validity of updated risk scores.

Original languageEnglish (US)
Pages (from-to)2223-2239
Number of pages17
JournalAlzheimer's and Dementia
Issue number3
StatePublished - Mar 2024


  • Delphi study
  • brain health
  • cognitive decline
  • cognitive impairment
  • dementia
  • etiological risk factors
  • hearing impairment
  • lifestyle
  • prevention
  • protective factors
  • risk prediction
  • risk reduction
  • sleep
  • social contact
  • umbrella review

ASJC Scopus subject areas

  • Clinical Neurology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Health Policy
  • Developmental Neuroscience
  • Epidemiology


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