LIBRA and LIBRA2 Operationalization (WRAP)
The Lifestyle for Brain Health (LIBRA) score is a weighted sum score with lower scores indicating healthier lifestyle choices. All components are based on clinical measures and/or self-reported questionnaire answers.
There are 12 modifiable factors that make up the LIBRA score: coronary artery disease, physical inactivity, renal dysfunction, diabetes, high cholesterol, smoking, obesity, hypertension, depression, low-to-moderate alcohol use, high cognitive activity, and a healthy Mediterranean diet. The latter 3 factors are protective and thus decrease the overall score.
The LIBRA2 score is an updated version with three new modifiable factors: sleep, social contact, and hearing impairment. Additionally, the protective factor of low-to-moderate alcohol use has been reversed to a high alcohol use risk factor, and physical inactivity is now a protective factor of high physical activity. See Rosenau, et. al (2023) and Rosenau, et. al (2024) for more information.
Note: See the LIBRA and LIBRA2 Imputation (WRAP) KB article for information on imputation and inclusion of diet.
Possible Ranges:
LIBRA: -4.2 to 12.7 (without diet); -5.9 to 12.7 (with diet).
LIBRA2: -4.9 to 25.7 (without diet); -6.1 to 25.7 (with diet).
The following table and component descriptions detail how factors are weighted and how variables are utilized in calculations.
| Modifiable Factor | Definition | LIBRA Score | LIBRA2 Score |
|---|---|---|---|
| Low/moderate Alcohol Use | Self-reported frequency of alcohol use defined as 2 drinks or less per day for men and 1 drink or less per day for women, including non-drinkers. Additionally, women who report a range of 1-2 drinks per day (multi-choice option) with no further information. [1] | - 1.0 | - |
| High Alcohol Use | Self-reported frequency of alcohol use defined as more than 2 drinks per day for men and more than 1 drink per day for women. Women who report a range of 1-2 drinks per day (multi-choice option) with no further information are not included. [1] | - | + 1.0 |
| Coronary Artery Disease | Self-reported medical history of heart attack (myocardial infarction) or cardiac surgery (e.g. angioplasty, stenting, or coronary bypass surgery). [2] | + 1.0 | + 2.6 |
| Physical Inactivity | Self-reported physical activity < 150 minutes of moderate exercise per week (or < 7.5 MET hours per week). [3] | + 1.1 | - |
| High Physical Activity | Self-reported physical activity of ≥ 150 minutes of moderate exercise per week (or ≥ 7.5 MET hours per week). [3] | - | - 1.9 |
| Renal Dysfunction | The CKD-EPI equation was used to estimate GFR from serum creatinine and other clinical parameters. GFR< 60 mL/min/1.73m2; if not available, self-reported kidney disease. [4] | + 1.1 | + 1.8 |
| Diabetes | Fasting blood glucose ≥ 126 mg/dL; if not available, self-reported diabetes. [5] | + 1.3 | + 2.2 |
| High Cholesterol | Total serum cholesterol ≥ 240mg/dL; if not available, self-reported high cholesterol. [6,7] | + 1.4 | + 2.6 |
| Smoking | Self-reported history of smoking at least once in the past month. | + 1.5 | + 2.5 |
| Obesity | BMI ≥ 30 kg/m2; if not available, waist circumference for men > 102 cm and women > 88 cm. [8] | + 1.6 | + 2.2 |
| Hypertension | Mean systolic blood pressure ≥ 130mmHg or mean diastolic blood pressure ≥ 80mmHg; if not available, self-reported hypertension. [9] | + 1.6 | + 1.1 |
| Depression | The CES-D sum score ≥ 16; if not available, self-reported depression. [10,11] | + 2.1 | + 4.1 |
| High Cognitive Activity | Games frequency of "every day or about every day" on CAS; if not available, Chess, Checkers, or Puzzles frequency of "every day" on FCAS. [12] | - 3.2 | - 3.0 |
| Poor Sleep | ISI sleep satisfaction of "dissatisfied" or "very dissatisfied" [13] or Epworth Sleepiness Scale total score of ≥ 11 [14]; if not available, sleep duration outside of 6-9 hours [15]. | - | + 1.1 |
| Social Isolation | Phone, Social Clubs, and Church score of "never did this activity" to "1-4 times per month" on the FCAS (i.e. no responses of "5 or more times per month, but not every day" or "every day") [16]. | - | + 2.1 |
| Hearing Impairment | Self-reported hearing loss or use of hearing devices. [17] | - | + 2.4 |
| Mediterranean Diet | MIND Diet total score > 8. [18] | - 1.7 | - 1.2 |
Abbreviations: LIBRA Lifestyle for Brain health, MET metabolic equivalent, CKD-EPI Chronic Kidney Disease Epidemiology Collaboration, GFR glomerular filtration rate, BMI body mass index, CES-D Center for Epidemiologic Studies-Depression, CAS Cognitive Activities Scale, FCAS Florida Cognitive Activities Scale, ISI Insomnia Severity Index, MIND Mediterranean-DASH Intervention for Neurodegenerative Delay.
Papers on WRAP LIBRA data:
| Version Date | Change Reason | Primary Author |
|---|---|---|
| August 2, 2023 | Original | Rachel Studer |
| June 17, 2025 | Updated to include LIBRA2 and removal of extra information | Rachel Studer |