Dementia, dementia's risk factors and premorbid brain structure are concentrated in disadvantaged areas: National register and birth-cohort geographic analyses

Aaron Reuben; Leah S Richmond-Rakerd; Barry Milne; Devesh Shah; Amber Pearson; Sean Hogan; David Ireland; Ross Keenan; Annchen R Knodt; Tracy Melzer; Richie Poulton; Sandhya Ramrakha; Ethan T Whitman; Ahmad R Hariri; Terrie E Moffitt; Avshalom Caspi

doi:10.1002/alz.13727

Dementia, dementia's risk factors and premorbid brain structure are concentrated in disadvantaged areas: National register and birth-cohort geographic analyses

Alzheimers Dement. 2024 Mar 14. doi: 10.1002/alz.13727. Online ahead of print.

Authors

Aaron Reuben^{1

2}, Leah S Richmond-Rakerd³, Barry Milne⁴, Devesh Shah¹, Amber Pearson^{5

6}, Sean Hogan⁷, David Ireland⁸, Ross Keenan⁸, Annchen R Knodt¹, Tracy Melzer⁹, Richie Poulton⁷, Sandhya Ramrakha⁷, Ethan T Whitman¹, Ahmad R Hariri¹, Terrie E Moffitt^{1

10

11

12}, Avshalom Caspi^{1

10

11

12}

Affiliations

¹ Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA.
² Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
³ Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA.
⁴ Centre for Methods and Policy Application in Society Sciences, University of Auckland, Auckland, New Zealand.
⁵ Department of Geography, Environment, and Spatial Sciences, Michigan State University, East Lansing, Michigan, USA.
⁶ Department of Public Health, University of Otago, Wellington, New Zealand.
⁷ Dunedin Multidisciplinary Health and Development Research Unit, Department of Psychology, University of Otago, Dunedin, New Zealand.
⁸ Brain Health Research Centre, Department of Psychology, University of Otago, Dunedin, New Zealand.
⁹ Department of Medicine, University of Otago, Christchurch, New Zealand.
¹⁰ Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA.
¹¹ King's College London, Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & Neuroscience, London, UK.
¹² PROMENTA, Department of Psychology, University of Oslo, Oslo, Norway.

PMID: 38482967
DOI: 10.1002/alz.13727

Abstract

Introduction: Dementia risk may be elevated in socioeconomically disadvantaged neighborhoods. Reasons for this remain unclear, and this elevation has yet to be shown at a national population level.

Methods: We tested whether dementia was more prevalent in disadvantaged neighborhoods across the New Zealand population (N = 1.41 million analytic sample) over a 20-year observation. We then tested whether premorbid dementia risk factors and MRI-measured brain-structure antecedents were more prevalent among midlife residents of disadvantaged neighborhoods in a population-representative NZ-birth-cohort (N = 938 analytic sample).

Results: People residing in disadvantaged neighborhoods were at greater risk of dementia (HR per-quintile-disadvantage-increase = 1.09, 95% confidence interval [CI]:1.08-1.10) and, decades before clinical endpoints typically emerge, evidenced elevated dementia-risk scores (CAIDE, LIBRA, Lancet, ANU-ADRI, DunedinARB; β's 0.31-0.39) and displayed dementia-associated brain structural deficits and cognitive difficulties/decline.

Discussion: Disadvantaged neighborhoods have more residents with dementia, and decades before dementia is diagnosed, residents have more dementia-risk factors and brain-structure antecedents. Whether or not neighborhoods causally influence risk, they may offer scalable opportunities for primary dementia prevention.

Keywords: Alzheimer's disease and related dementias; Area Deprivation; Health disparities; Preventive medicine; Residential neighborhood socioeconomic status.

Abstract

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