The structural and social determinants of Alzheimer's disease related dementias

Abstract

Introduction The projected growth of Alzheimer's disease (AD) and AD‐related dementia (ADRD) cases by midcentury has expanded the research field and impelled new lines of inquiry into structural and social determinants of health (S/SDOH) as fundamental drivers of disparities in AD/ADRD. Methods In this review, we employ Bronfenbrenner's ecological systems theory as a framework to posit how S/SDOH impact AD/ADRD risk and outcomes. Results Bronfenbrenner defined the “macrosystem” as the realm of power (structural) systems that drive S/SDOH and that are the root cause of health disparities. These root causes have been discussed little to date in relation to AD/ADRD, and thus, macrosystem influences, such as racism, classism, sexism, and homophobia, are the emphasis in this paper. Discussion Under Bronfenbrenner's macrosystem framework, we highlight key quantitative and qualitative studies linking S/SDOH with AD/ADRD, identify scientific gaps in the literature, and propose guidance for future research. Highlights Ecological systems theory links structural/social determinants to AD/ADRD. Structural/social determinants accrue and interact over the life course to impact AD/ADRD. Macrosystem is made up of societal norms, beliefs, values, and practices (e.g., laws). Most macro‐level determinants have been understudied in the AD/ADRD literature.

The (in)visible Brazilians: A perspective review on the need for brain health and dementia research with Brazilian immigrants in the United States

“…These ethnoracial inequities persist following statistical adjustment for socioeconomic indicators, suggesting that race/ethnicity may independently affect health outcomes in Brazil, particularly the worse outcomes for the Black Brazilian population 59 . These observations highlight the need to consider ethnoracial inequities and systemic factors and biases (e.g., structural racism, ageism, and sexism/genderism) when investigating Brazilian immigrants in the United States, as these factors have been recognized increasingly in health research in Brazil and the United States 7,60 . In the context of dementia research in Brazil, the prevalence of dementia risk factors based on ethnoracial status seems variable.…”

Authors’ response to: A new dementia prevention approach requires new language

“…Ishtar Govia 2 Ruth Peters 3 Edo Richard 4,5 Blossom CM Stephan 6 Nikki-Anne Wilson 3,7 Lindsay Wallace 1 Kaarin J Anstey 3,7 Carol Brayne 1 1 Cambridge Public Health, University of Cambridge, Cambridge,…”

“…We agree that this represents an insufficient perspective from which to approach dementia risk reduction, and it is pleasing to see increasing attention being paid to the social, structural, and commercial determinants of dementia and poor neurological health. 2,3 Dr. Daly suggests replacing the term "risk factor" with a word like "determinant." We consider that there are some barriers to implementing this suggestion.…”

Neighborhood greenspace and neighborhood income associated with white matter grade worsening: Cardiovascular Health Study

“…Given the importance of racialization as a social determinant of ADRD, 48 we attempted to subset multivariable models to assess whether exposures had a stronger influence on MRI outcomes among Black participants. Models did not converge due to insufficient sam- As a first sensitivity analysis, we omitted race from multivariable analyses to examine whether this social construct and marker of experienced discrimination was a significant confounder.…”