The Resilience Index: A Quantifiable Measure of Brain Health and Risk of Cognitive Impairment and Dementia

James E. Galvin, Michael J. Kleiman, Stephanie Chrisphonte, Iris Cohen, Shanell DIsla, Conor B. Galvin, Keri K. Greenfield, Claudia Moore, Susan Rawn, Mary Lou Riccio, Amie Rosenfeld, Judith Simon, Marcia Walker, Magdalena I. Tolea

Research output: Contribution to journalArticlepeer-review


Background: There is increasing interest in lifestyle modification and integrative medicine approaches to treat and/or prevent mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD). Objective: To address the need for a quantifiable measure of brain health, we created the Resilience Index (RI). Methods: This cross-sectional study analyzed 241 participants undergoing a comprehensive evaluation including the Clinical Dementia Rating and neuropsychological testing. Six lifestyle factors including physical activity, cognitive activity, social engagements, dietary patterns, mindfulness, and cognitive reserve were combined to derive the RI (possible range of scores: 1-378). Psychometric properties were determined. Results: The participants (39 controls, 75 MCI, 127 ADRD) had a mean age of 74.6±9.5 years and a mean education of 15.8±2.6 years. The mean RI score was 138.2±35.6. The RI provided estimates of resilience across participant characteristics, cognitive staging, and ADRD etiologies. The RI showed moderate-to-strong correlations with clinical and cognitive measures and very good discrimination (AUC: 0.836; 95% CI: 0.774-0.897) between individuals with and without cognitive impairment (diagnostic odds ratio = 8.9). Individuals with high RI scores (> 143) had better cognitive, functional, and behavioral ratings than individuals with low RI scores. Within group analyses supported that controls, MCI, and mild ADRD cases with high RI had better cognitive, functional, and global outcomes than those with low RI. Conclusion: The RI is a brief, easy to administer, score and interpret assessment of brain health that incorporates six modifiable protective factors. Results from the RI could provide clinicians and researchers with a guide to develop personalized prevention plans to support brain health.

Original languageEnglish (US)
Pages (from-to)1729-1746
Number of pages18
JournalJournal of Alzheimer's Disease
Issue number4
StatePublished - 2021
Externally publishedYes


  • Alzheimer's disease
  • brain health
  • cognitive activity
  • cognitive reserve
  • dementia
  • diet
  • lifestyle
  • mild cognitive impairment
  • mindfulness
  • physical activity
  • resilience
  • risk factors

ASJC Scopus subject areas

  • Neuroscience(all)
  • Clinical Psychology
  • Geriatrics and Gerontology
  • Psychiatry and Mental health


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