New research emerging from the Wake Forest University School of Medicine indicates that residing in a disadvantaged neighborhood is associated with elevated blood pressure and lower cognitive scores, even among individuals without an existing diagnosis of mild cognitive impairment. The study has been published online in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, a journal affiliated with the Alzheimer’s Association.
“We know that unequal access to education, employment, income, and housing heightens the risk for Alzheimer’s disease and related dementias. However, more research is needed to comprehensively understand the impact of social determinants of health, including what our study analyzed regarding neighborhood disadvantage,” explained James R. Bateman, M.D., assistant professor of neurology at Wake Forest University School of Medicine and the principal investigator of the study.
Bateman elaborated that neighborhood disadvantage pertains to the scarcity of social and economic resources in one’s surroundings. To evaluate this, the research team utilized the widely recognized national Area Deprivation Index, which gauges aspects like housing quality, education, and income. “Our aim with this study was to analyze the relationship between neighborhood disadvantage and measures of cardiometabolic health and cognition in both individuals with and without a diagnosed mild cognitive impairment,” said Bateman, who also practices as a neurologist at Atrium Health Wake Forest Baptist. He emphasized the importance of comparing those with a diagnosis to those without to better understand how a person’s current cognitive state influences the connection between their environment and health.
Cognition encompasses mental processes such as thinking, learning, remembering, awareness of surroundings, and the use of judgment. Mild cognitive impairment involves a decline in memory and thinking skills that exceeds what is typical with normal aging and serves as a risk factor for dementia. Bateman also noted that numerous cardiometabolic diseases can increase the risk for cognitive impairment and dementia. Cardiometabolic health relates to an individual’s cardiovascular and metabolic well-being and involves managing risk factors like blood glucose, high blood pressure, high cholesterol, and obesity.
For the study, Bateman and his team analyzed data from 537 adults aged over 55 who were part of the Alzheimer’s Disease Research Center Healthy Brain Study at Wake Forest University School of Medicine between 2016 and 2021. These individuals underwent clinical examinations, neurocognitive testing, neuroimaging, as well as cardiometabolic tests to screen for diabetes, high cholesterol, and high blood pressure. The neurocognitive testing covered constructs including memory, executive function, language, visuospatial skills, concentration, and attention.
“We discovered an association between neighborhood disadvantage and higher blood pressure and cardiometabolic index, as well as lower cognitive scores in individuals who did not have a diagnosed mild cognitive impairment,” stated Sudarshan Krishnamurthy, a fifth-year M.D./Ph.D. student at Wake Forest University School of Medicine and the first author of the paper. Krishnamurthy added that neighborhood disadvantage was only linked to higher hemoglobin A1C, which measures blood sugar, in people with diagnosed mild cognitive impairment.
“These findings demonstrate that living in a disadvantaged neighborhood has a more significant impact on heart health and brain function in people without preexisting cognitive issues,” Bateman said. “Our study highlights the importance of implementing structural changes to address social determinants of health in order to mitigate cardiometabolic and cognitive risks.”
Krishnamurthy further emphasized the impact of a person’s living environment. “This study confirms our hypothesis: Where you live and the resources and opportunities available to you as a result have a tangible impact on your risk for dementia,” Krishnamurthy noted.
The Alzheimer’s Disease Research Center at Wake Forest University School of Medicine, established in 2016, is one of just 35 research centers in the country funded by the National Institute on Aging. Its mission is to translate research advancements into improved diagnosis and care for those with the disease and to discover treatments or preventive measures for Alzheimer’s and other forms of dementia.
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