Neighborhood disadvantage reduces cognitive reserve independent of neuropathologic change

Abstract

Introduction: Individuals in socioeconomically disadvantaged neighborhoods exhibit increased risk for impaired cognitive function. Whether this association relates to the major dementia-related neuropathologies is unknown.

Methods: This cross-sectional study included 469 autopsy cases from 2011 to 2023. The relationships between neighborhood disadvantage measured by Area Deprivation Index (ADI) percentiles categorized into tertiles, cognition evaluated by the last Mini-Mental State Examination (MMSE) scores before death, and 10 dementia-associated proteinopathies and cerebrovascular disease were assessed using regression analyses.

Results: Higher ADI was significantly associated with lower MMSE score. This was mitigated by increasing years of education. ADI was not associated with an increase in dementia-associated neuropathologic change. Moreover, the significant association between ADI and cognition remained even after controlling for changes in major dementia-associated proteinopathies or cerebrovascular disease.

Discussion: Neighborhood disadvantage appears to be associated with decreased cognitive reserve. This association is modified by education but is independent of the major dementia-associated neuropathologies.

Keywords: Alzheimer's disease; Area Deprivation Index; cerebrovascular disease; cognitive reserve; proteinopathies; socioeconomic status.

FIGURE 1

Distribution of neighborhood disadvantage by ADI in the study cohort. Bars show the number of individuals within each range of national ADI percentile rankings. The number (N) and proportion (%) of individuals are indicated for each bar. ADI, Area Deprivation Index.