Neighborhood disadvantage reduces cognitive reserve independent of neuropathologic change

Abstract

INTRODUCTIONIndividuals in socioeconomically disadvantaged neighborhoods exhibit increased risk for impaired cognitive function. Whether this association relates to the major dementia‐related neuropathologies is unknown.METHODSThis 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.RESULTSHigher 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.DISCUSSIONNeighborhood disadvantage appears to be associated with decreased cognitive reserve. This association is modified by education but is independent of the major dementia‐associated neuropathologies.

Identifying longitudinal cognitive resilience from cross-sectional amyloid, tau, and neurodegeneration

“…As such, the generalizability of these findings to more representative populations may be limited. For instance, in contrast to our findings, CR has been associated with lower neighborhood deprivation in cohorts with higher average levels of deprivation [ 41 ] and with higher educational attainment in cohorts with very low levels of education [ 84 ]. Finally, while we consider those in the Resilient subgroup to show CR to AD, we must acknowledge that many individuals in our sample had low levels of Aβ and tau at baseline and may not be on the AD continuum.…”

“…National ADI values range from 1–100 and reflect national percentiles of neighborhood disadvantage with lower values reflect lower level of disadvantage within the nation. We categorized ADI into tertiles (Lowest deprivation, intermediate deprivation, and highest deprivation) based on the distribution of national ADI values across the wider HABS cohort [ 41 ].…”