Neighborhood Socioeconomic Status and Cognitive Trajectories in a Diverse Longitudinal Cohort

Meyer, Oanh L.; Mungas, Dan M; King, Jackie; Hinton, W Ladson; Farias, Sarah E Tomaszewski; Reed, Bruce R; DeCarli, Charles; Geraghty, Estella M.; Beckett, Laurel A.

doi:10.1080/07317115.2017.1282911

Cited by 39 publications

(54 citation statements)

References 51 publications

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“…These findings indicated that older women had lower cognitive scores if they lived in an area classified in the bottom 20% of IMD when compared with those in the top (least deprived) quintile. 13 In contrast, Meyer et al 14 showed that neighborhood SES had limited effects on executive function, independent of personal characteristics such as education and ethnicity. They also showed that individuals with dementia living in neighborhoods with higher SES experienced faster rates of decline before further statistical adjustment for education and ethnicity.…”

Section: Introductionmentioning

confidence: 97%

Individual and Area-Based Socioeconomic Factors Associated With Dementia Incidence in England

et al. 2018

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Key PointsQuestionWhat is the association between various socioeconomic markers and dementia incidence?FindingsThis longitudinal cohort study found that lower wealth in late life, but not education, was associated with increased risk for dementia, suggesting that people with fewer financial resources were at higher risk. No substantive differences were identified in relation to the area of neighborhood deprivation; an age-cohort effect was observed, highlighting that socioeconomic inequalities were more robust among people born in later years.MeaningThe association between socioeconomic status and dementia incidence in a contemporary cohort of older adults may be driven by wealth rather than education.

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Section: Introductionmentioning

confidence: 97%

Individual and Area-Based Socioeconomic Factors Associated With Dementia Incidence in England

et al. 2018

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“…Indeed, in one model similar to our own, incorporating measures of reading ability, such as the Weschler Test of Adult Reading, a robust proxy of educational quality, eliminated ethnoracial disparities in neuropsychological testing . Additionally, neighborhood socioeconomic markers, such as median rent and household income, may suggest increased opportunity for individuals to learn outside the formal classroom . Twin studies demonstrate that higher socioeconomic status in childhood interacts with the apparent heritability of intelligence when measured in adulthood in a synergistic fashion .…”

Section: Discussionmentioning

confidence: 99%

Quality of education impacts late‐life cognition

Mantri

Nwadiogbu

Fitts

et al. 2019

Int J Geriat Psychiatry

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Objectives: Screening tests of global cognition detect racial differences in scores even after adjustment for educational attainment. Differential educational environments in adolescence may affect individual cognitive function. This study examines the impact of high school educational quality on late-life cognition among community-dwelling older adults. Methods/design: Data were collected from community-dwelling individuals from the Philadelphia Healthy Brain Aging (PHBA) cohort at the University of Pennsylvania Health System. The present analysis included subjects from the PHBA over the age of 55 years without a diagnosis of Parkinson's disease or dementia, who had attended high school in the City of Philadelphia. Cognition was assessed using the Montreal Cognitive Assessment (MoCA); clinical information was abstracted from the subject's electronic health record. High school information was obtained from the Philadelphia Board of Education. After univariable correlations were defined, we performed stepwise multiple linear regression models to determine the most significant predictors of late-life cognitive status. Results: A total of 130 subjects meeting inclusion criteria were included in the analysis. Years of education, race, educational level, school district, and financial status were all positively associated with MoCA. Significant negative associations included composite vascular risk, attendance at highly segregated schools, and historical poverty status. In stepwise multiple linear regression modeling, the impact of race on cognition remained significant when educational attainment was added to the model but was no longer significant once segregation status was added. Conclusions: This work suggests that academic and community factors beyond years of education have a marked impact on late-life cognition. KEYWORDS cognition, dementia, healthy aging, mild cognitive impairment, quality of education 1 | INTRODUCTION In an aging population, cognitive impairment is a major driver of both health-related quality of life (HRQOL) and health-care costs. Even before the diagnosis of dementia, individuals with subjective cognitive complaints report worse quality of life; 1-3 care partners of these individuals experience higher levels of anxiety and burnout. 4,5 As individuals progress from subjective complaints to mild cognitive impairment to dementia, health utilization and cost increase dramatically. In the United States alone, the monetary cost of dementia care, including both direct costs such as physician visits and medications, and also indirect costs such as informal care by spouses and children, was estimated at $236 billion in 2016. 6 Even conservative estimates assuming a plateau or decline in dementia prevalence acknowledge a doubling of inflation-adjusted care costs by 2040. 7 Additionally, on detailed neuropsychological testing and in advanced imaging studies,

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“…For example, policies aimed at reducing disparities in wealth or favoring access to educational or health resources for the most disadvantaged people. The understanding of how SES relates to cognitive function could help policy-makers to design strategies for prevention and intervention for older adults (Hackman et al, 2010;Meyer et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Impact of Individual and Neighborhood dimensions of Socioeconomic Status on the Prevalence of Mild Cognitive Impairment over Seven-Year Follow-Up

Fernández-Blázquez¹,

Noriega-Ruiz²,

Ávila-Villanueva³

et al. 2019

Preprint

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IMPORTANCE: There is strong evidence about the association between low socioeconomic status (SES) and higher risk of dementia. However, it has not been conveniently addressed so far the role of SES on the incidence of Mild Cognitive Impairment (MCI) which is considered a prodromal stage of latter dementia.OBJECTIVE: To examine the impact of individual and neighborhood dimensions of SES, as well as their interaction, on the risk of developing MCI in a sample of older adults that were followed-up for seven years.DESIGN, SETTING, AND PARTICIPANTS: Data from the Vallecas Project cohort, an ongoing community-based longitudinal study for early detection of cognitive impairment and dementia, were used to build two indices of SES namely individual and neighborhood, as well as a global SES as a combination of both, and to investigate their effects on MCI conversion by means of a multivariate-adjusted Cox proportional hazard model.MAIN OUTCOMES AND MEASURES: Based on data referred to as individual-level (one´s educational attainment, occupation, parent´s level of education) and neighborhood-level (district´s income, unemployment rate, housing price, percentage of people with no formal qualifications, with higher education, and with white-collar employs) different composite measures of SES were built and quartiles were considered for further analyses. MCI diagnoses were agreed between neurologists and neuropsychologists at consensus meetings.RESULTS: 1180 participants aged 70 years and older were enrolled in this study (mean age at baseline, 74.9 years; 63.5% females). Of these, 199 cases of MCI (16.9%) were diagnosed at any point of the follow-up. The individual and neighborhood dimensions of SES played different roles in the dynamics of the MCI occurrence through ageing. Most importantly, the risk of developing MCI was almost double for lower SES quartiles when compared to the highest one.CONCLUSIONS AND RELEVANCE: The incidence of MCI in older adults was related to both individual characteristics and socioeconomic context. Public health strategies should be holistic and focus not only on promoting the classical individual preventive measures, but also on reducing social inequalities as a means of fostering healthy ageing and reducing dementia burden.

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Neighborhood Socioeconomic Status and Cognitive Trajectories in a Diverse Longitudinal Cohort

Abstract: Clinical assessments of individuals who present with cognitive impairment might benefit from an understanding of the neighborhood context from which patients come.

Cited by 39 publications

References 51 publications

Individual and Area-Based Socioeconomic Factors Associated With Dementia Incidence in England

Individual and Area-Based Socioeconomic Factors Associated With Dementia Incidence in England

Quality of education impacts late‐life cognition

Impact of Individual and Neighborhood dimensions of Socioeconomic Status on the Prevalence of Mild Cognitive Impairment over Seven-Year Follow-Up

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