Effect of Social Determinants of Health on Cognition and Risk of Alzheimer Disease and Related Dementias

Abstract

Social determinants of health are the conditions in which people are born, work, live, and age and the wider set of forces and systems that shape the conditions of daily life. They affect every area of life, particularly health and health care. There is increasing focus on modifiable factors that affect cognition and risk of Alzheimer disease and related dementias (ADRDs). This article examines the impact of various social determinants of health, which are potentially reversible, on the incidence, prevalence, and risk of ADRDs and cognition. Various social determinants of health affect cognition and risk of ADRDs. Lower socioeconomic status (SES) and less education are associated with a higher incidence of ADRDs, whereas higher SES and education level appear to be protective, leading to a deceleration of time to diagnosis. In terms of employment, manual labor is associated with a higher risk of ADRDs. Higher body mass index in midlife and a decreasing body mass index in old age are associated with a higher risk of ADRDs. Furthermore, lower food security in early and late life is associated with a higher risk of ADRD diagnosis. Neighborhoods that are economically disadvantaged with fewer physical resources are associated with a higher risk of ADRDs. Higher levels of social engagement have a protective effect on diagnosis of ADRDs. Higher levels of stress are associated with a higher likelihood of developing ADRDs. Early-life adversity is associated with an increased risk of ADRDs, and further work in this area will be illuminating. Racial discrimination also leads to higher risk of ADRDs through the direct effect of discrimination and indirectly through lower SES, educational level, employment, and residential segregation. With an aim of reducing of ADRDs, future work in enhancing education, improving socioeconomic conditions, work, and neighborhood environments, and eliminating racial discrimination could potentially have a drastic impact.

Keywords: ADRDs; Alzheimer disease; cognition; social determinants of health.