Review

. 2023 Sep;19(9):4204-4225.

doi: 10.1002/alz.13104. Epub 2023 May 23.

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

Lisa Ann Kirk Wiese¹, Allison Gibson^{2

3}, Marc Aaron Guest⁴, Amy R Nelson⁵, Raven Weaver⁶, Aditi Gupta⁷, Owen Carmichael⁸, Jordan P Lewis⁹, Allison Lindauer¹⁰, Samantha Loi^{11

12}, Rachel Peterson¹³, Kylie Radford¹⁴, Elizabeth K Rhodus^{2

3

15

16}, Christina G Wong¹⁷, Megan Zuelsdorff^{18

19}, Ladan Ghazi Saidi²⁰, Esmeralda Valdivieso-Mora²¹, Sanne Franzen²², Caitlin N Pope²³, Timothy S Killian²⁴, Hom L Shrestha²⁵, Patricia C Heyn²⁶, Ted Kheng Siang Ng²⁷, Beth Prusaczyk²⁸, Samantha John²⁹, Ambar Kulshreshtha^{30

31}, Julia L Sheffler³², Lilah Besser³³, Valerie Daniel³³, Magdalena I Tolea³³, Justin Miller¹⁷, Christine Musyimi³⁴, Jon Corkey³⁵, Veronica Yank³⁶, Christine L Williams¹, Zahra Rahemi³⁷, JuYoung Park³⁸, Sheryl Magzamen³⁹, Robert L Newton Jr⁸, Candace Harrington⁴⁰, Jason D Flatt⁴¹, Sonakshi Arora¹⁷, Sarah Walter⁴², Percy Griffin⁴³, Ganesh M Babulal^{44

45

46}

Affiliations

¹ C.E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA.
² University of Kentucky College of Social Work, University of Kentucky, Lexington, Kentucky, USA.
³ Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA.
⁴ Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA.
⁵ Frederick P. Whiddon College of Medicine, Department of Physiology & Cell Biology, University of South Alabama, Mobile, Alabama, USA.
⁶ Department of Human Development, Washington State University, Pullman, Washington, USA.
⁷ Division of Nephrology and Hypertension, Department of Internal Medicine, Neurology, Alzheimer's Disease Research Center, University of Kansas, Kansas City, Kansas, USA.
⁸ Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
⁹ Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth, Minnesota, USA.
¹⁰ Oregon Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.
¹¹ Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.
¹² Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
¹³ University of Montana School of Public and Community Health Sciences, Missoula, Montana, USA.
¹⁴ School of Psychology, University of New South Wales, Sydney, Australia.
¹⁵ University of Kentucky Alzheimer's Disease Research Center, University of Kentucky, Lexington, Kentucky, USA.
¹⁶ University of Kentucky College of Medicine, for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, USA.
¹⁷ Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA.
¹⁸ School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA.
¹⁹ Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
²⁰ Department of Communication Disorders, Center for Brain Biology and Behavior (CB3), University of Nebraska at Kearney, and Lincoln, Nebraska, USA.
²¹ Department of Psychology and Public Health, Universidad Centroamericana José Simeón Cañas, El Salvador, El Salvador.
²² Department of Neurology and Alzheimer Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
²³ Department of Health, Behavior, & Society, University of Kentucky, Lexington, Kentucky, USA.
²⁴ Human Development and Family Sciences, University of Arkansas, Fayetteville, Arkansas, USA.
²⁵ School of Kinesiology and Health Sciences, Laurentian University, Sudbury, Ontario, Canada.
²⁶ Center for Optimal Aging, Department of Physical Therapy, Marymount University, Arlington, Virginia, USA.
²⁷ Department of Psychology, Arizona State University, Phoenix, Arizona, USA.
²⁸ Institute for Informatics (I2), Center for Population Health Informatics at I2, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
²⁹ Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, USA.
³⁰ Department of Family and Preventive Medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
³¹ Department of Epidemiology, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
³² Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida, USA.
³³ Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA.
³⁴ Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
³⁵ Amissa, Charlotte, North Carolina, USA.
³⁶ Department of Medicine, University of California, San Francisco, USA.
³⁷ Clemson School of Nursing, Clemson University, Clemson, South Carolina, USA.
³⁸ Sandler School of Social Work, College of Social Work and Criminal Justice, Florida Atlantic University, Boca Raton, Florida, USA.
³⁹ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA.
⁴⁰ School of Nursing, University of Louisville, Louisville, Kentucky, USA.
⁴¹ School of Public Health, Department of Social & Behavioral Health, University of Nevada, Las Vegas, USA.
⁴² Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
⁴³ Alzheimer's Therapeutic Research Institute, Alzheimer's Clinical Trials Consortium, University of Southern California, San Diego, California, USA.
⁴⁴ Scientific Engagement, Medical & Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA.
⁴⁵ Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.
⁴⁶ Department of Psychology, University of Johannesburg, Johannesburg, South Africa.

PMID: 37218539
PMCID: PMC10524180
DOI: 10.1002/alz.13104

Review

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

Lisa Ann Kirk Wiese et al. Alzheimers Dement. 2023 Sep.

. 2023 Sep;19(9):4204-4225.

doi: 10.1002/alz.13104. Epub 2023 May 23.

Authors

Affiliations

¹ C.E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA.
² University of Kentucky College of Social Work, University of Kentucky, Lexington, Kentucky, USA.
³ Sanders-Brown Center on Aging, University of Kentucky, Lexington, Kentucky, USA.
⁴ Center for Innovation in Healthy and Resilient Aging, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA.
⁵ Frederick P. Whiddon College of Medicine, Department of Physiology & Cell Biology, University of South Alabama, Mobile, Alabama, USA.
⁶ Department of Human Development, Washington State University, Pullman, Washington, USA.
⁷ Division of Nephrology and Hypertension, Department of Internal Medicine, Neurology, Alzheimer's Disease Research Center, University of Kansas, Kansas City, Kansas, USA.
⁸ Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
⁹ Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth, Minnesota, USA.
¹⁰ Oregon Alzheimer's Disease Research Center, Oregon Health & Science University, Portland, Oregon, USA.
¹¹ Neuropsychiatry, Royal Melbourne Hospital, Parkville, Victoria, Australia.
¹² Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
¹³ University of Montana School of Public and Community Health Sciences, Missoula, Montana, USA.
¹⁴ School of Psychology, University of New South Wales, Sydney, Australia.
¹⁵ University of Kentucky Alzheimer's Disease Research Center, University of Kentucky, Lexington, Kentucky, USA.
¹⁶ University of Kentucky College of Medicine, for Health Equity Transformation, University of Kentucky, Lexington, Kentucky, USA.
¹⁷ Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, Nevada, USA.
¹⁸ School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA.
¹⁹ Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
²⁰ Department of Communication Disorders, Center for Brain Biology and Behavior (CB3), University of Nebraska at Kearney, and Lincoln, Nebraska, USA.
²¹ Department of Psychology and Public Health, Universidad Centroamericana José Simeón Cañas, El Salvador, El Salvador.
²² Department of Neurology and Alzheimer Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
²³ Department of Health, Behavior, & Society, University of Kentucky, Lexington, Kentucky, USA.
²⁴ Human Development and Family Sciences, University of Arkansas, Fayetteville, Arkansas, USA.
²⁵ School of Kinesiology and Health Sciences, Laurentian University, Sudbury, Ontario, Canada.
²⁶ Center for Optimal Aging, Department of Physical Therapy, Marymount University, Arlington, Virginia, USA.
²⁷ Department of Psychology, Arizona State University, Phoenix, Arizona, USA.
²⁸ Institute for Informatics (I2), Center for Population Health Informatics at I2, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.
²⁹ Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, Nevada, USA.
³⁰ Department of Family and Preventive Medicine, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
³¹ Department of Epidemiology, Division of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
³² Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida, USA.
³³ Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Boca Raton, Florida, USA.
³⁴ Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
³⁵ Amissa, Charlotte, North Carolina, USA.
³⁶ Department of Medicine, University of California, San Francisco, USA.
³⁷ Clemson School of Nursing, Clemson University, Clemson, South Carolina, USA.
³⁸ Sandler School of Social Work, College of Social Work and Criminal Justice, Florida Atlantic University, Boca Raton, Florida, USA.
³⁹ Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA.
⁴⁰ School of Nursing, University of Louisville, Louisville, Kentucky, USA.
⁴¹ School of Public Health, Department of Social & Behavioral Health, University of Nevada, Las Vegas, USA.
⁴² Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
⁴³ Alzheimer's Therapeutic Research Institute, Alzheimer's Clinical Trials Consortium, University of Southern California, San Diego, California, USA.
⁴⁴ Scientific Engagement, Medical & Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA.
⁴⁵ Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.
⁴⁶ Department of Psychology, University of Johannesburg, Johannesburg, South Africa.

PMID: 37218539
PMCID: PMC10524180
DOI: 10.1002/alz.13104

Abstract

Introduction: Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators.

Methods: An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings.

Results: A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions.

Discussion: A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities.

Highlights: Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues.

Keywords: community engagement; community-based action; facilitators and barriers to ADRD diagnosis and treatment; global disparities; health disparities; location dynamics; modifiable ADRD risk factors; rural; rural culture; under-represented; underserved.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest:

There are no conflicts of interest by any of the authors on this manuscript.

Figures

**Figure 1.**
Barriers and Facilitators to Rural ADRD Disparities. Created with BioRender.com

**Figure 2.**
Location Dynamics Model to Address Rural ADRD Disparities. Created with BioRender.com

See this image and copyright information in PMC

References

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Global rural health disparities in Alzheimer's disease and related dementias: State of the science

Affiliations

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical