Association of Environmental Features and the Risk of Alzheimer’s Dementia in Older Adults: A Nationwide Longitudinal Case-Control Study

Abstract

Little is known about the association between environmental features and the risk of Alzheimer’s dementia (AD). This study aims to investigate the association of physical and social environments with the incidence of AD. We identified 12,401 newly diagnosed AD cases aged ≥65 years in 2010, with the same no. of matched controls from National Health Insurance claims in Taiwan. Environmental data were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was conducted to calculate the odds ratios (OR) of AD in association with environmental features at the township level. Results showed that living in the areas with higher availability of playgrounds and sport venues was associated with a 3% decreased odds of AD (95% CI = 0.96–0.99), while higher density of elderly living alone was associated with a 5% increased odds of AD (95% CI = 1.01–1.11), after controlling for individual and other environmental factors. In further examination by urbanization level, the above relationships were found only in rural areas but not in urban areas. This study provides evidence that specific physical and social environmental features have different impacts on the risk of AD.

Operationalizing Social Environments in Cognitive Aging and Dementia Research: A Scoping Review

“…The most common demographic data measure was neighborhood socioeconomic status, using either single indicators (e.g., median income; n = 8), or indices of area deprivation (n = 19). Other demographic data measures included income inequality calculated at the U.S. state or metropolitan statistical area [ 114 , 125 ]; racial/ethnic residential composition [ 116 ]; and the density of older adults living alone [ 120 ]. Six studies aggregated study participant responses to define area-level social activity participation [ 80 ] and social support/cohesion [ 50 , 68 , 123 , 124 , 143 ].…”

Rural-urban Disparities in the Prevalence of Mild Cognitive Impairment and Dementia in Taiwan: A Door-to-door Nationwide Study

“…The urbanization classification was proposed by Huang et al 18 They categorized all 358 cities and townships of Taiwan into five ordered levels of urbanization based on different indicators, including the number of residents, population density, and the percentage of people working in secondary and tertiary industries. 18,32,33…”

Long-Term Exposure to Residential Greenness and Neurodegenerative Disease Mortality Among the Elderly: A 13-Year Follow-Up Cohort Study

“…However, studies evaluating the effect of green spaces on AD alone have shown contradictory ndings [18][19][20][21]. Moreover, we are not aware of prior studies evaluating the association between green spaces and vascular dementia.…”

“…Hypothesized mechanisms include inducing stress restoration, providing opportunities for physical activity and social cohesion, and mitigating environmental hazards [8]. However, the available evidence on the association between green spaces and neurodegenerative diseases among the elderly is mixed and inconclusive, and studies have so far primarily focused on dementia or its precursor, cognitive decline [9,10,[19][20][21][11][12][13][14][15][16][17][18]. As far as we are aware, only one ecological and three longitudinal studies investigated the relationship between exposure to green spaces and neurodegenerative disease mortality: two longitudinal studies reported no association [22,23], while the other two observed a bene cial association [24,25].…”