New research from Wake Forest University School of Medicine suggests that living in an underserved neighborhood is associated with higher blood pressure and lower cognitive scores, even in people who do not have an existing diagnosis of mild cognitive impairment.
The study appears online today in Alzheimer’s and dementia: diagnosis, assessment and disease monitoringa journal of the Alzheimer’s Association.
We know that unequal access to education, employment, income and housing increases the risk of Alzheimer’s disease and related dementias. However, more research is needed to better understand the impact of social determinants of health, including what this study analyzed regarding neighborhood disadvantages.”
James R. Bateman, MD, assistant professor of neurology at Wake Forest University School of Medicine and principal investigator of the study
Bateman said neighborhood disadvantage refers to the lack of social and economic resources in one’s own area. To assess neighborhood deprivation, the research team used the highly recognized national Area Deprivation Index, which measures the quality of housing, education and income.
“Our purpose in the study was to analyze the relationship between neighborhood disadvantage and measures of cardiometabolic health and cognition in individuals with and without diagnosed mild cognitive impairment,” said Bateman, who is also a neurologist at Atrium Health Wake Forest Baptist.
Bateman said it was important for the team to compare individuals with a diagnosis to those without a diagnosis, to better understand how a person’s current cognitive state affects the relationship between their environment and their health.
Cognition refers to the mental process of thinking, learning, remembering, being aware of the environment and using judgments. Mild cognitive impairment is a decline in memory and thinking ability that is greater than expected with normal aging and is a risk factor for dementia.
Bateman noted that many cardiometabolic diseases can increase the risk of cognitive impairment and dementia. Cardiometabolic health is an individual’s cardiovascular and metabolic health and includes managing risk factors such as blood glucose, high blood pressure, high cholesterol and obesity.
For the study, Bateman and team analyzed data from 537 adults over age 55 from the Alzheimer’s Disease Research Center Healthy Brain Study at Wake Forest University School of Medicine from 2016 to 2021.
Individuals received clinical examinations, neurocognitive testing and neuroimaging, in addition to cardiometabolic testing to screen for diabetes, high cholesterol and high blood pressure.
The neurocognitive tests included in the study evaluated constructs such as memory, executive function, language, visuospatial skills, concentration and attention.
“We found an association between neighborhood disadvantage and higher blood pressure and cardiometabolic index, as well as lower cognitive scores in individuals who were not diagnosed with mild cognitive impairment,” said Sudarshan Krishnamurthy, a fifth-year MD/Ph.D. student at Wake Forest University School of Medicine and first author of the paper.
Krishnamurthy said neighborhood disadvantage was only associated with higher hemoglobin A1C, which measures blood sugar levels, in people with diagnosed mild cognitive impairment.
“These findings show that living in a disadvantaged neighborhood has a greater impact on heart health and brain function in people without pre-existing cognitive problems,” Bateman said. “Our study highlights the importance of implementing structural changes to address social determinants of health to reduce cardiometabolic and cognitive risks.”
Krishnamurthy added that the study underlines the impact of a person’s living environment.
“This study confirms what we had hypothesized: where you live and the resources and opportunities available to you as a result have a tangible impact on your risk of dementia,” Krishnamurthy said.
Founded in 2016, the Alzheimer’s Disease Research Center at Wake Forest University School of Medicine is one of only 35 research centers in the country funded by the National Institute on Aging. The goal is to translate research advances into better diagnosis and care for people with the disease, and to find a treatment or ways to prevent Alzheimer’s disease and other forms of dementia.
This study was supported by funding from NIH P30 AG072947, AHA 24PRE1200264, R01AG054069, R01AG058969, NIH R01 AG072547, NIH R01 AG079388, NIH UG1 CA189974, and NIH U19 AG074865.
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Magazine reference:
Krishnamurthy, S., et al. (2024). Impact of neighborhood disadvantage on cardiometabolic health and cognition in a community-dwelling cohort. Diagnosis of Alzheimer’s and dementia and disease monitoring. doi.org/10.1002/dad2.70021.