Applications and implicit assumptions in dementia risk scores: A scoping review of the LIBRA score

Dementia risk scores are commonly used tools to estimate the risk of developing Alzheimer's disease and dementia. We lack an overview of what risk scores are used for, what is claimed they ought to be used for, and whether they are suitable for these applications. To address this, we use the 'Lifestyle for Brain Health' (LIBRA) score as a representative example risk score and conduct a literature review to study its applications. The goals of this study are (1) to create an overview of how the LIBRA score has been utilized in scientific articles, (2) to record other applications that these same articles mention, and (3) to critically assess whether LIBRA is suitable for these applications. Of the 66 articles included in our review, 36 involved analyzing associations of LIBRA with dementia, cognition, or other outcomes. We also identified several other applications, with 32 articles mentioning LIBRA as an estimate of 'dementia prevention potential', 6 articles used LIBRA as a surrogate outcome for their trial or intervention, and 7 articles mentioned that it could help support clinician decisions in practice. Although there is a clear need for tools that can be used for these applications, the amount of evidence supporting the suitability of dementia risk scores for many of these applications is limited. We recommend that researchers transparently report the purposes of these dementia risk scores, which may include causal tasks, and that research is done to evaluate whether it is valid to use these scores in this way.