Focus on Risk Factors: Exploring the Relationship Between Cognitive Performance (ACE-III) and Lifestyle Risk Factors (LIBRA Index) Within a Case-Finding Strategy

Dementia represents a major global health challenge, yet a substantial proportion of cases may be preventable through the modification of lifestyle and vascular risk factors. The present study forms part of the Ricor-Dare project, an Italian initiative designed to evaluate case-finding strategies for the early detection of cognitive impairment in community and clinical settings. The aim of this thesis was to investigate the relationship between cognitive functioning, assessed with the Addenbrooke’s Cognitive Examination–III (ACE-III), and lifestyle risk factors, by the LIfestyle for BRAin Health (LIBRA) score, within a sample of older adults participating in case-finding assessments. Data collection was conducted across multiple case-finding settings, including the Dementia Operations Center (COD) information desk, and community “Open Day” events. All participants were evaluated with the ACE-III, the LIBRA index, and complementary measures, with individuals scoring in borderline or pathological ranges referred for second-level neuropsychological assessment. The results highlighted several key associations. Older participants tended to report fewer years of formal education and higher LIBRA scores, reflecting generational differences in access to schooling and cumulative lifestyle risk exposure. Higher education was associated with lower LIBRA scores and better ACE-III performance, consistent with the protective role of cognitive reserve. Importantly, lower ACE-III scores were linked with higher LIBRA scores, suggesting that greater lifestyle risk factors corresponds to poorer cognitive functioning. While group comparisons across diagnostic categories (subjective cognitive decline, mild cognitive impairment, dementia) did not reveal statistically significant differences in overall LIBRA scores likely due to small sample sizes; item level analyses indicated that chronic kidney disease (risk factor) and low to moderate alcohol consumption (protective factor) were meaningfully related to diagnostic outcomes. These findings underscore the potential value of integrating lifestyle risk assessment into case-finding protocols. Although the evidence for case-finding effectiveness in dementia remains mixed, this study demonstrates its feasibility in community settings and highlights the relevance of lifestyle factors for understanding cognitive decline. Future work within the Ricor-Dare project will expand sample sizes, strengthen follow up, and refine case-finding protocols to maximize opportunities for early detection and targeted prevention.