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Cerin E, Soloveva MV, Molina MA, Schroers RD, Knibbs LD, Akram M, Wu YT, Mavoa S, Prina M, Sachdev PS, Sorensen Catts V, Jalaludin B, Poudel G, Symmons M, Barnett A, Hamidul Huque M, Leung Y, Cherbuin N, Anstey KJ. Neighbourhood environments and cognitive health in the longitudinal Personality and Total Health (PATH) through life study: A 12-year follow-up of older Australians. ENVIRONMENT INTERNATIONAL 2024; 191:108984. [PMID: 39208561 DOI: 10.1016/j.envint.2024.108984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/17/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Urban neighbourhood environments may impact older adults' cognitive health. However, longitudinal studies examining key environmental correlates of cognitive health are lacking. We estimated cross-sectional and longitudinal associations of neighbourhood built and natural environments and ambient air pollution with multiple cognitive health outcomes in Australian urban dwellers aged 60+ years. METHODS The study included 1160 participants of the PATH Through Life study (60+ cohort) who were followed up for 12 years (four assessments; 2001/02 to 2013/15) and with data on socio-demographics, health, cognitive functions and diagnoses, and full residential address. Neighbourhood environmental features encompassed population and street-intersection densities, non-commercial land use mix, transit points, presence of blue space, percentages of commercial land, parkland and tree cover, and annual average PM2.5 and NO2 concentrations. All exposures except for tree cover were assessed at two time points. Generalised additive mixed models estimated associations of person-level average, and within-person changes in, exposures with cognitive functions. Multi-state hidden Markov models estimated the associations of neighbourhood attributes with transitions to/from mild cognitive impairment (MCI). RESULTS Dense, destination-rich neighbourhoods were associated with a lower likelihood of transition to MCI and reversal to no MCI. Positive cross-sectional and longitudinal associations of non-commercial land use mix, street intersection density and percentage of commercial land were observed especially with global cognition and processing speed. While access to parkland and blue spaces were associated with a lower risk of transition to MCI, the findings related to cognitive functions were mixed and supportive of an effect of parkland on verbal memory only. Higher levels of PM2.5 and NO2 were consistently associated with steeper declines and/or decreases in cognitive functions and worse cognitive states across time. CONCLUSION To support cognitive health in ageing populations, neighbourhoods need to provide an optimal mix of environmental complexity, destinations and access to the natural environment and, at the same time, minimise ambient air pollution.
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Affiliation(s)
- Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR.
| | - Maria V Soloveva
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | - Miguel A Molina
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | - Ralf-Dieter Schroers
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | - Luke D Knibbs
- School of Public Health, The University of Sydney, New South Wales, Australia; Public Health Research Analytics and Methods for Evidence, Public Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia.
| | - Muhammad Akram
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
| | - Yu-Tzu Wu
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Suzanne Mavoa
- Population Health, Murdoch Children's Research Institute, Melbourne School of Population & Global Health, University of Melbourne, Melbourne, Victoria, Australia.
| | - Matthew Prina
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Clinical Medicine, University of New South Wales, Sydney, Australia.
| | - Vibeke Sorensen Catts
- Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, School of Clinical Medicine, UNSW, Sydney, Australia.
| | - Bin Jalaludin
- School of Population Health, University of New South Wales, Randwick, New South Wales, Australia.
| | - Govinda Poudel
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | - Mark Symmons
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia.
| | - Md Hamidul Huque
- School of Psychology, University of New South Wales, Randwick, New South Wales, Australia; Neuroscience Research Australia (NeuRA), Sydney, Australia.
| | - Yvonne Leung
- School of Psychology, University of New South Wales, Randwick, New South Wales, Australia; Neuroscience Research Australia (NeuRA), Sydney, Australia; UNSW Ageing Futures Institute, Sydney, Australia.
| | - Nicolas Cherbuin
- National Centre for Epidemiology and Population Health, Canberra, Australian Capital Territory, Australia.
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Randwick, New South Wales, Australia; Neuroscience Research Australia (NeuRA), Sydney, Australia; UNSW Ageing Futures Institute, Sydney, Australia.
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2
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Cheung ESL, Zhang Z. Moderating Role of Neighborhood Environment in the Associations Between Hearing Loss and Cognitive Challenges Among Older Adults: Evidence From US National Study. Res Aging 2024; 46:400-413. [PMID: 38361482 DOI: 10.1177/01640275241234372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
This study examined the associations between hearing loss and cognitive challenges among community-dwelling older adults and whether neighborhood characteristics (physical disorder and low social cohesion) moderated the associations. Cross-sectional national data from Round 11 of the National Health and Aging Trends Study were adopted (N = 2,515). Multinomial logistic regressions were used to examine associations among variables and interactive analyses were conducted to examine moderating effects. Results indicated significant relationships between the experience of hearing loss and possible dementia and between severe or profound hearing loss and probable dementia. Interactive models suggested that residing in neighborhoods with physical disorder and low social cohesion were negatively associated with possible dementia among older adults with moderate and severe or profound hearing loss, respectively, compared to those without hearing loss. Findings underscore the necessity of environmental and social interventions to enhance cognitive health among older adults with varying degrees of hearing challenges.
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Affiliation(s)
| | - Zhe Zhang
- Teachers College, Columbia University, New York, NY, USA
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3
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Delhey LM, Shi X, Morgenstern LB, Brown DL, Smith MA, Case EC, Springer MV, Lisabeth LD. Neighborhood Resources and Health Outcomes Among Stroke Survivors in a Population-Based Cohort. J Am Heart Assoc 2024; 13:e034308. [PMID: 38958125 PMCID: PMC11292760 DOI: 10.1161/jaha.124.034308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Stroke survivors believe neighborhood resources such as community centers are beneficial; however, little is known about the influence of these resources on stroke outcomes. We evaluated whether residing in neighborhoods with greater resource density is associated with favorable post-stroke outcomes. METHODS AND RESULTS We included Mexican American and non-Hispanic White stroke survivors from the Brain Attack Surveillance in Corpus Christi project (2009-2019). The exposure was density of neighborhood resources (eg, community centers, restaurants, stores) within a residential census tract at stroke onset. Outcomes included time to death and recurrence, and at 3 months following stroke: disability (activities of daily living/instrumental activities of daily living), cognition (Modified Mini-Mental State Exam), depression (Patient Health Questionnaire-8), and quality of life (abbreviated Stroke-Specific Quality of Life scale). We fit multivariable Cox regression and mixed linear models. We considered interactions with stroke severity, ethnicity, and sex. Among 1786 stroke survivors, median age was 64 years (interquartile range, 56-73), 55% men, and 62% Mexican American. Resource density was not associated with death, recurrence, or depression. Greater resource density (75th versus 25th percentile) was associated with more favorable cognition (Modified Mini-Mental State Exam mean difference=0.838, 95% CI=0.092, 1.584) and among moderate-severe stroke survivors, with more favorable functioning (activities of daily living/instrumental activities of daily living=-0.156 [95% CI, -0.284 to 0.027]) and quality of life (abbreviated Stroke-Specific Quality of Life scale=0.194 [95% CI, 0.029-0.359]). CONCLUSIONS We observed associations between greater resource density and cognition overall and with functioning and quality of life among moderate-severe stroke survivors. Further research is needed to confirm these findings and determine if neighborhood resources may be a tool for recovery.
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Affiliation(s)
- Leanna M. Delhey
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - Xu Shi
- Department of BiostatisticsUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - Lewis B. Morgenstern
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
- Stroke Program, University of Michigan Medical SchoolAnn ArborMIUSA
| | - Devin L. Brown
- Stroke Program, University of Michigan Medical SchoolAnn ArborMIUSA
| | - Melinda A. Smith
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | - Erin C. Case
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
| | | | - Lynda D. Lisabeth
- Department of EpidemiologyUniversity of Michigan School of Public HealthAnn ArborMIUSA
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Tian W, Cao K, Kwan MP, Chiu MYL, Chen H. How does urbanization affect the cognitive function among older adults: A geospatial analysis in China. Health Place 2024; 88:103259. [PMID: 38776750 DOI: 10.1016/j.healthplace.2024.103259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 04/03/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024]
Abstract
There has been a plethora of studies on urbanization and older adults, and more recent ones on how older adults adapt to this process with their cognitive competence. Yet it has been unclear about the relationship between them, like how the level and rate of urbanization affect the cognitive function among older adults. This study sourced, formed, and analyzed a set of geospatial big datasets from different sources, such as the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data, and the NPP/VIIRS nighttime light (NTL) data. Results showed a generally negative linear association between the rate of urbanization and cognitive performance among older adults in China. The "U" shaped non-linear relationship between urbanization level and cognitive function, as well as the tipping point, were identified. At the same time, it should be noted that mediators such as education, physical activity, social activity, and community elderly service might be able to mitigate these negative associations. Furthermore, older adults living in eastern regions or urban areas appeared to have better cognitive function than those living in mid-western regions or rural areas in China. The findings also pointed to the importance of focusing on older adults with poor cognitive health status in rapidly urbanizing areas.
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Affiliation(s)
- Wenxin Tian
- School of Geographic Sciences, East China Normal University, Shanghai, China; Key Lab of Geographic Information Science (Ministry of Education), East China Normal University, Shanghai, China
| | - Kai Cao
- School of Geographic Sciences, East China Normal University, Shanghai, China; Key Lab of Geographic Information Science (Ministry of Education), East China Normal University, Shanghai, China.
| | - Mei-Po Kwan
- Department of Geography and Resource Management, The Chinese University of Hong Kong, Hong Kong, China; Institute of Space and Earth Information Science, The Chinese University of Hong Kong, Hong Kong, China; Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong, China
| | - Marcus Yu Lung Chiu
- School of Health and Wellbeing, Bolton University, Bolton, UK; Centre of Mental Health and Society, Bangor University, Bangor, UK; Felizberta Lo Padilla Tong School of Social Sciences, Saint Francis University, Hong Kong, China
| | - Huashuai Chen
- Business School, Xiangtan University, Xiangtan, China.
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5
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Li Y, Menon G, Long JJ, Chen Y, Metoyer GT, Wu W, Crews DC, Purnell TS, Thorpe RJ, Hill CV, Szanton SL, Segev DL, McAdams-DeMarco MA. Neighborhood Racial and Ethnic Segregation and the Risk of Dementia in Older Adults Living with Kidney Failure. J Am Soc Nephrol 2024; 35:936-948. [PMID: 38671538 PMCID: PMC11230717 DOI: 10.1681/asn.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/22/2024] [Indexed: 04/28/2024] Open
Abstract
Key Points
Regardless of race and ethnicity, older adults with kidney failure residing in or receiving care at dialysis facilities located in high-segregation neighborhoods were at a 1.63-fold and 1.53-fold higher risk of dementia diagnosis, respectively.Older adults with kidney failure residing in minority-predominant high-segregation neighborhoods had a 2.19-fold higher risk of dementia diagnosis compared with White individuals in White-predominant neighborhoods.
Background
Dementia disproportionately affects older minoritized adults with kidney failure. To better understand the mechanism of this disparity, we studied the role of racial and ethnic segregation (segregation hereafter), i.e., a form of structural racism recently identified as a mechanism in numerous other health disparities.
Methods
We identified 901,065 older adults (aged ≥55 years) with kidney failure from 2003 to 2019 using the United States Renal Data System. We quantified dementia risk across tertiles of residential neighborhood segregation score using cause-specific hazard models, adjusting for individual- and neighborhood-level factors. We included an interaction term to quantify the differential effect of segregation on dementia diagnosis by race and ethnicity.
Results
We identified 79,851 older adults with kidney failure diagnosed with dementia between 2003 and 2019 (median follow-up: 2.2 years). Compared with those in low-segregation neighborhoods, older adults with kidney failure in high-segregation neighborhoods had a 1.63-fold (95% confidence interval [CI], 1.60 to 1.66) higher risk of dementia diagnosis, an association that differed by race and ethnicity (Asian: adjusted hazard ratio [aHR] = 1.26, 95% CI, 1.15 to 1.38; Black: aHR = 1.66, 95% CI, 1.61 to 1.71; Hispanic: aHR = 2.05, 95% CI, 1.93 to 2.18; White: aHR = 1.59, 95% CI, 1.55 to 1.64; P
interaction < 0.001). Notably, older Asian (aHR = 1.76; 95% CI, 1.64 to 1.89), Black (aHR = 2.65; 95% CI, 2.54 to 2.77), Hispanic (aHR = 2.15; 95% CI, 2.04 to 2.26), and White (aHR = 2.20; 95% CI, 2.09 to 2.31) adults with kidney failure residing in minority-predominant high-segregation neighborhoods had a higher risk of dementia diagnosis compared with older White adults with kidney failure in White-predominant high-segregation neighborhoods. Moreover, older adults with kidney failure receiving care at dialysis facilities located in high-segregation neighborhoods also experienced a higher risk of dementia diagnosis (aHR = 1.53; 95% CI, 1.50 to 1.56); this association differed by race and ethnicity (P
interaction < 0.001).
Conclusions
Residing in or receiving care at dialysis facilities located in high-segregation neighborhoods was associated with a higher risk of dementia diagnosis among older individuals with kidney failure, particularly minoritized individuals.
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Affiliation(s)
- Yiting Li
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Gayathri Menon
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Jane J Long
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Yusi Chen
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Garyn T Metoyer
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Wenbo Wu
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Deidra C Crews
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tanjala S Purnell
- Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Roland J Thorpe
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Sarah L Szanton
- Johns Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
| | - Mara A McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
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6
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Hu LX, Yang BY. Invited Perspective: More Greenspace, Less Cognitive Decline? Current Evidence and Future Directions. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:71302. [PMID: 39016601 PMCID: PMC11253811 DOI: 10.1289/ehp14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/19/2024] [Accepted: 06/14/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Li-Xin Hu
- Joint International Research Laboratory of Environment and Health, Ministry of Education, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Bo-Yi Yang
- Joint International Research Laboratory of Environment and Health, Ministry of Education, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Hyun J, Lovasi GS, Katz MJ, Derby CA, Lipton RB, Sliwinski MJ. Perceived but not objective measures of neighborhood safety and food environments are associated with longitudinal changes in processing speed among urban older adults. BMC Geriatr 2024; 24:551. [PMID: 38918697 PMCID: PMC11197239 DOI: 10.1186/s12877-024-05068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/13/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Although a growing body of literature documents the importance of neighborhood effects on late-life cognition, little is known about the relative strength of objective and subjective neighborhood measures on late-life cognitive changes. This study examined effects of objective and subjective neighborhood measures in three neighborhood domains (neighborhood safety, physical disorder, food environments) on longitudinal changes in processing speed, an early marker of cognitive aging and impairment. METHODS The analysis sample included 306 community-dwelling older adults enrolled in the Einstein Aging Study (mean age = 77, age range = 70 to 91; female = 67.7%; non-Hispanic White: 45.1%, non-Hispanic Black: 40.9%). Objective and subjective measures of neighborhood included three neighborhood domains (i.e., neighborhood safety, physical disorder, food environments). Processing speed was assessed using a brief Symbol Match task (unit: second), administered on a smartphone device six times a day for 16 days and repeated annually for up to five years. Years from baseline was used as the within-person time index. RESULTS Results from mixed effects models showed that subjective neighborhood safety (β= -0.028) and subjective availability of healthy foods (β= -0.028) were significantly associated with less cognitive slowing over time. When objective and subjective neighborhood measures were simultaneously examined, subjective availability of healthy foods remained significant (β= -0.028) after controlling for objective availability of healthy foods. Associations of objective neighborhood crime and physical disorder with processing speed seemed to be confounded by individual-level race and socioeconomic status; after controlling for these confounders, none of objective neighborhood measures showed significant associations with processing speed. CONCLUSION Subjective neighborhood safety and subjective availability of healthy foods, rather than objective measures, were associated with less cognitive slowing over time over a five-year period. Perception of one's neighborhood may be a more proximal predictor of cognitive health outcomes as it may reflect one's experiences in the environment. It would be important to improve our understanding of both objective and subjective neighborhood factors to improve cognitive health among older adults.
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Affiliation(s)
- Jinshil Hyun
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Drexel University, 3215 Market Street, 2nd Floor, Philadelphia, PA, 19104, USA
| | - Mindy J Katz
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Carol A Derby
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Richard B Lipton
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Martin J Sliwinski
- Department of Human Development and Family Studies and Center for Healthy Aging, The Pennsylvania State University, 402 Biobehavioral Health Building, University Park, PA, 16802, USA
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Frndak S, Deng Z, Ward-Caviness CK, Gorski-Steiner I, Thorpe RJ, Dickerson AS. Risk of dementia due to Co-exposure to air pollution and neighborhood disadvantage. ENVIRONMENTAL RESEARCH 2024; 251:118709. [PMID: 38493859 DOI: 10.1016/j.envres.2024.118709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Co-exposure to air pollution and neighborhood disadvantage may influence cognition decline. We tested these associations in the context of dementia risk. METHODS We leveraged a cohort of adults ≥65 years (n = 5397) enrolled from 2011 to 2018 in the National Health and Aging Trends Study (NHATS). Particulate matter (PM) ≤ 10 μm in diameter, PM ≤ 2.5 μm in diameter, carbon monoxide, nitric oxide, and nitrogen dioxide - and neighborhood disadvantage were tested for joint associations with dementia risk. Pollutant concentrations at the 2010 census tract level were assigned using the US Environmental Protection Agency's Community Multiscale Air Quality Modeling System. Neighborhood disadvantage was defined using the tract Social Deprivation Index (SDI). Dementia was determined through self- or proxy-report or scores indicative of "probable dementia" according to NHATS screening tools. Joint effects of air pollutants and SDI were tested using quantile g-computation Cox proportional hazards models. We also stratified joint air pollution effects across SDI tertiles. Analyses adjusted for age at enrollment, sex, education, partner status, urbanicity, income, race and ethnicity, years at residence, census segregation, and census region. RESULTS SDI score (aHR = 1.08; 95% CI 0.96, 1.22), joint air pollution (aHR = 1.03, 95% CI 0.92, 1.16) and joint SDI with air pollution (aHR = 1.04, 95% CI 0.89, 1.22) were not associated with dementia risk. After accounting for competing risk of death, joint SDI with air pollution was not associated with dementia risk (aHR = 1.06; 95% CI 0.87, 1.29). In stratified models, joint air pollution was associated with greater risk of dementia at high (aHR = 1.19; 95% CI 0.87, 1.63), but not at medium or low SDI. CONCLUSION Air pollution was associated with greater dementia risk in disadvantaged areas after accounting for competing risks. Air pollution associations with dementia incidence may be attenuated when other risk factors are more prominent in disadvantaged neighborhoods.
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Affiliation(s)
- Seth Frndak
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA.
| | - Zhengyi Deng
- Department of Urology, Stanford School of Medicine, USA
| | - Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, USA
| | - Irena Gorski-Steiner
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, USA
| | - Roland J Thorpe
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, USA; Johns Hopkins Alzheimer's Disease Resource Center for Minority Aging Research, USA
| | - Aisha S Dickerson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA; Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, USA
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Axmon A, Mattisson K, Lethin C, Fänge AM, Carlsson G, Stroh E. Access to urban green spaces and use of social services and institutional long-term care among older people in Malmö, Sweden: a longitudinal register study. BMC Geriatr 2024; 24:489. [PMID: 38834961 PMCID: PMC11151513 DOI: 10.1186/s12877-024-05112-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Finding ways to prolong independence in daily life among older people would be beneficial for both individuals and society. Urban green spaces have been found to improve health, but only a few studies have evaluated the association between urban green spaces and independence in daily life. The aim of this study was to assess the long-term effect of urban green spaces on independence in daily life, using social services and support, mobility aids, and relocation to institutional long-term care as proxies, among community dwelling people 65 + years. METHODS We identified 40 357 people 65 + years living in the city of Malmö, Sweden in 2010. Using geographical information systems (GIS), we determined the amount of urban green spaces (total, public, and quiet) within 300 m of each person's residence. All three measures were categorized based on their respective percentiles, so that the first quartile represented the 25% with the least access and the fourth quartile the 25% with the most access. In 2015 and 2019, we assessed the outcomes minor assistance (non-personal support), major assistance (personal support), and relocation into institutional long-term care. These three outcome measures were used as proxies for independence in daily life. The effect of amount of urban green spaces in 2010 on the three outcomes in 2015 and 2019, respectively, was assessed by pairwise comparing the three highest quartiles to the lowest. RESULTS Compared to the lowest quartile, those in the highest quartile of quiet green spaces in 2010 were less likely to receive minor assistance in both 2015 and 2019. Besides this, there were no indications that any of the measures of urban green space affected independence in daily life at the five- and nine-year follow-up, respectively. CONCLUSION Although urban green spaces are known to have positive impact on health, physical activity, and social cohesion among older people, we found no effect of total, public, or quiet green spaces on independence in daily life. This could possibly be a result of the choice of measures of urban green spaces, including spatial and temporal aspects, an inability to capture important qualitative aspects of the green spaces, or the proxy measures used to assess independence in daily life.
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Affiliation(s)
- Anna Axmon
- EPI@LUND (Epidemiology, population research, and infrastructures), Department of Laboratory Medicine, Lund University, Biskopsgatan 9, Lund, SE-223 62, Sweden.
| | - Kristoffer Mattisson
- Planetary Health, Department of Laboratory Medicine, Lund University, Biskopsgatan 9, Lund, SE- 223 62, Sweden
| | - Connie Lethin
- Department of Health Sciences, Lund University, P.O. Box 117, Lund, SE-22362, Sweden
| | - Agneta Malmgren Fänge
- Department of Health Sciences, Lund University, P.O. Box 117, Lund, SE-22362, Sweden
| | - Gunilla Carlsson
- Department of Health Sciences, Lund University, P.O. Box 117, Lund, SE-22362, Sweden
| | - Emilie Stroh
- EPI@LUND (Epidemiology, population research, and infrastructures), Department of Laboratory Medicine, Lund University, Biskopsgatan 9, Lund, SE-223 62, Sweden
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10
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Reuben A, Richmond‐Rakerd LS, Milne B, Shah D, Pearson A, Hogan S, Ireland D, Keenan R, Knodt AR, Melzer T, Poulton R, Ramrakha S, Whitman ET, Hariri AR, Moffitt TE, Caspi A. Dementia, dementia's risk factors and premorbid brain structure are concentrated in disadvantaged areas: National register and birth-cohort geographic analyses. Alzheimers Dement 2024; 20:3167-3178. [PMID: 38482967 PMCID: PMC11095428 DOI: 10.1002/alz.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 04/06/2024]
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.
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Affiliation(s)
- Aaron Reuben
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | | | - Barry Milne
- Centre for Methods and Policy Application in Society SciencesUniversity of AucklandAucklandNew Zealand
| | - Devesh Shah
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
| | - Amber Pearson
- Department of Geography, Environment, and Spatial SciencesMichigan State UniversityEast LansingMichiganUSA
- Department of Public HealthUniversity of OtagoWellingtonNew Zealand
| | - Sean Hogan
- Dunedin Multidisciplinary Health and Development Research Unit, Department of PsychologyUniversity of OtagoDunedinNew Zealand
| | - David Ireland
- Brain Health Research Centre, Department of PsychologyUniversity of OtagoDunedinNew Zealand
| | - Ross Keenan
- Brain Health Research Centre, Department of PsychologyUniversity of OtagoDunedinNew Zealand
| | - Annchen R. Knodt
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
| | - Tracy Melzer
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Richie Poulton
- Dunedin Multidisciplinary Health and Development Research Unit, Department of PsychologyUniversity of OtagoDunedinNew Zealand
| | - Sandhya Ramrakha
- Dunedin Multidisciplinary Health and Development Research Unit, Department of PsychologyUniversity of OtagoDunedinNew Zealand
| | - Ethan T. Whitman
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
| | - Ahmad R. Hariri
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
| | - Terrie E. Moffitt
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
- King's College London, Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & NeuroscienceLondonUK
- PROMENTA, Department of PsychologyUniversity of OsloOsloNorway
| | - Avshalom Caspi
- Department of Psychology and NeuroscienceDuke UniversityDurhamNorth CarolinaUSA
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNorth CarolinaUSA
- King's College London, Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & NeuroscienceLondonUK
- PROMENTA, Department of PsychologyUniversity of OsloOsloNorway
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11
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Cavuoto MG, Davies L, Rowsthorn E, Cribb LG, Yiallourou SR, Yassi N, Maruff P, Lim YY, Pase MP. Cross-sectional associations between neighborhood characteristics, cognition and dementia risk factor burden in middle-aged and older Australians. Prev Med Rep 2024; 41:102696. [PMID: 38586469 PMCID: PMC10997895 DOI: 10.1016/j.pmedr.2024.102696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
Dementia disproportionately affects individuals from disadvantaged backgrounds, including those living in areas of lower neighborhood-level socioeconomic status. It is important to understand whether there are specific neighborhood characteristics associated with dementia risk factors and cognition which may inform dementia risk reduction interventions. We sought to examine whether greenspace, walkability, and crime associated with the cumulative burden of modifiable dementia risk factors and cognition. This was a cross-sectional analysis of 2016-2020 data from the Healthy Brain Project, a population-based cohort of community-dwelling individuals across Australia. Participants were aged 40-70 and free of dementia. Measures included greenspace (greenspace % in the local area, and distance to greenspace, n = 2,181); and intersection density (n = 1,159), and crime (rate of recorded offences; n = 1,159). Outcomes included a modified Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) dementia risk score to index the burden of modifiable vascular dementia risk factors; and composite scores of both memory and attention, derived from the Cogstate Brief Battery. Linear regressions adjusted for age, sex, education, and personal socio-economic status, demonstrated distance to greenspace (b ± SE per 2-fold increase = 0.09 ± 0.03, p =.005) and crime rate (b ± SE per 2-fold increase = 0.07 ± 0.03, p =.018) were associated with higher modified CAIDE. Higher crime was associated with lower memory performance (b ± SE = -0.03 ± 0.01, p =.018). The association between distance to greenspace and modified CAIDE was only present in low-moderate socioeconomic status neighborhoods (p interaction = 0.004). Dementia prevention programs that address modifiable risk factors in midlife should consider the possible role of neighborhood characteristics.
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Affiliation(s)
- Marina G. Cavuoto
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- National Ageing Research Institute, Royal Melbourne Hospital, VIC, Australia
| | - Liam Davies
- Centre for Urban Research, School of Global, Urban and Social Studies, RMIT University, City Campus, Melbourne, Victoria, Australia
| | - Ella Rowsthorn
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Lachlan G. Cribb
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Stephanie R. Yiallourou
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Nawaf Yassi
- Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - Paul Maruff
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
- Cogstate Ltd., Melbourne, Victoria, Australia
| | - Yen Ying Lim
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Matthew P. Pase
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
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Michael YL, Senerat AM, Buxbaum C, Ezeanyagu U, Hughes TM, Hayden KM, Langmuir J, Besser LM, Sánchez B, Hirsch JA. Systematic Review of Longitudinal Evidence and Methodologies for Research on Neighborhood Characteristics and Brain Health. Public Health Rev 2024; 45:1606677. [PMID: 38596450 PMCID: PMC11002187 DOI: 10.3389/phrs.2024.1606677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/20/2024] [Indexed: 04/11/2024] Open
Abstract
Objective: Synthesize longitudinal research evaluating neighborhood environments and cognition to identify methodological approaches, findings, and gaps. Methods: Included studies evaluated associations between neighborhood and cognition longitudinally among adults >45 years (or mean age of 65 years) living in developed nations. We extracted data on sample characteristics, exposures, outcomes, methods, overall findings, and assessment of disparities. Results: Forty studies met our inclusion criteria. Most (65%) measured exposure only once and a majority focused on green space and/or blue space (water), neighborhood socioeconomic status, and recreation/physical activity facilities. Similarly, over half studied incident impairment, cognitive function or decline (70%), with one examining MRI (2.5%) or Alzheimer's disease (7.5%). While most studies used repeated measures analysis to evaluate changes in the brain health outcome (51%), many studies did not account for any type of correlation within neighborhoods (35%). Less than half evaluated effect modification by race/ethnicity, socioeconomic status, and/or sex/gender. Evidence was mixed and dependent on exposure or outcome assessed. Conclusion: Although longitudinal research evaluating neighborhood and cognitive decline has expanded, gaps remain in types of exposures, outcomes, analytic approaches, and sample diversity.
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Affiliation(s)
- Yvonne L. Michael
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Araliya M. Senerat
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Channa Buxbaum
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Ugonwa Ezeanyagu
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Timothy M. Hughes
- Department of Internal Medicine, Medical Center Boulevard, Winston-Salem, NC, United States
| | - Kathleen M. Hayden
- Department of Social Sciences and Health Policy, Bowman Gray Center for Medical Education, Winston-Salem, NC, United States
| | - Julia Langmuir
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Lilah M. Besser
- Department of Neurology, Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Brisa Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Jana A. Hirsch
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United States
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13
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Yang TC, Kim S, Choi SWE, Halloway S, Mitchell UA, Shaw BA. Neighborhood Features and Cognitive Function: Moderating Roles of Individual Socioeconomic Status. Am J Prev Med 2024; 66:454-462. [PMID: 37871754 DOI: 10.1016/j.amepre.2023.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION There is an interest in exploring the associations between neighborhood characteristics and individual cognitive function; however, little is known about whether these relationships can be modified by individual socioeconomic status, such as educational attainment and income. METHODS Drawing from the 2010-2018 Health and Retirement Study, this study analyzed 10,621 older respondents (aged 65+) with a total of 33,931 person-waves. These respondents did not have dementia in 2010 and stayed in the same neighborhood throughout the study period. Cognitive function was measured with a 27-point indicator biennially, and neighborhood characteristics (i.e., walkability, concentrated disadvantage, and social isolation) were assessed in 2010. All analyses were performed in 2023. RESULTS Cognitive function is positively associated with neighborhood walkability and negatively related to concentrated disadvantage, suggesting that exposures to these neighborhood characteristics have long-lasting impacts on cognitive function. Furthermore, individual socioeconomic status modifies the relationship between neighborhood characteristics and cognitive function. Compared with those graduating from college, respondents without a bachelor's degree consistently have lower cognitive function but the educational gap in cognitive function narrows with increases in walkability (b= -0.152, SE=0.092), and widens when neighborhood concentrated disadvantage (b=0.212, SE=0.070) or social isolation (b=0.315, SE=0.125) rises. The income gap in cognitive function shrinks with increases in walkability (b= -0.063, SE=0.027). CONCLUSIONS The moderating role of socioeconomic status indicates that low-socioeconomic status older adults who also live in disadvantaged neighborhoods face a higher risk of poor cognitive function. Low-education and low-income aging adults may have the most to gain from investments to improve neighborhood characteristics.
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Affiliation(s)
- Tse-Chuan Yang
- Department of Sociology, University at Albany, State University of New York, Albany, New York.
| | - Seulki Kim
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Seung-Won Emily Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, Lubbock, Texas
| | - Shannon Halloway
- Department of Biobehavioral Nursing Science, University of Illinois Chicago, Chicago, Illinois
| | - Uchechi A Mitchell
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, Illinois
| | - Benjamin A Shaw
- Division of Community Health Sciences, University of Illinois Chicago, Chicago, Illinois
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14
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Li J, Hirsch JA, Michael YL, Besser LM, Auchincloss AH, Hughes TM, Sánchez BN. Spatial scale effects on associations between built environment and cognitive function: Multi-Ethnic Study of Atherosclerosis. Health Place 2024; 86:103181. [PMID: 38340497 DOI: 10.1016/j.healthplace.2024.103181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/26/2023] [Accepted: 01/22/2024] [Indexed: 02/12/2024]
Abstract
Built environments have the potential to favorably support cognitive function. Despite growing work on this topic, most of the work has ignored variation in the spatial scale of the effect. The issue with spatial scale effects is that the size and shape of the areal unit within which built environment characteristics are measured naturally influence the built environment exposure metric and thus the estimated associations with health. We used spatial distributed lag modeling (DLM) to estimate how associations between built environment exposures (walkable destinations [WD], social destinations [SD]) and change in cognition varied across distance of these destinations from participants' residences. Cognition was assessed as maintained/improved processing speed (PS) and global cognition (GC). Person-level data from Exam 5 (2010-2012) and Exam 6 (2016-2018) of the Multi-Ethnic Study of Atherosclerosis was used (N = 1380, mean age 67). Built environment data were derived from the National Establishment Time Series. Higher availability of walkable and social destinations at closer distance from participants' residence was associated with maintained/improved PS. The adjusted associations between maintained/improved PS and destinations waned with increasing distance from the residence; associations were evident until approximately 1.9-km for WD and 1.5-km for SD. Associations were most apparent for participants living in areas with high population density. We found little evidence for associations between change in GC and built environment at any distance. These results highlight the importance of identifying appropriate spatial scale to understand the mechanisms for built environment-cognition associations.
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Affiliation(s)
- Jingjing Li
- Department of Land Resources Management, School of Public Administration, China University of Geosciences, Wuhan, Hubei, 430074, China
| | - Jana A Hirsch
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA.
| | - Yvonne L Michael
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Lilah M Besser
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amy H Auchincloss
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
| | - Timothy M Hughes
- Department of Internal Medicine, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, 27109, USA
| | - Brisa N Sánchez
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, 19104, USA
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15
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Alhasan DM, Larson G, Lohman MC, Cai B, LaPorte FB, Miller MC, Jackson WB, MacNell NS, Hirsch JA, Jackson CL. Features of the Physical and Social Neighborhood Environment and Neighborhood-Level Alzheimer's Disease and Related Dementia in South Carolina. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:27013. [PMID: 38416540 PMCID: PMC10901285 DOI: 10.1289/ehp13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Studies are increasingly examining the relationship between the neighborhood environment and cognitive decline; yet, few have investigated associations between multiple neighborhood features and Alzheimer's disease and related dementias (ADRD). OBJECTIVE We investigated the relationship between neighborhood features and ADRD cumulative incidence from 2010 to 2014 in the South Carolina Alzheimer's Disease Registry (SCADR). METHODS Diagnosed ADRD cases ≥ 50 years of age were ascertained from the SCADR by ZIP code and census tract. Neighborhood features from multiple secondary sources included poverty, air pollution [particulate matter with a diameter of 2.5 micrometers or less (PM 2.5 )], and rurality at the census-tract level and access to healthy food, recreation facilities, and diabetes screening at the county level. In addition to using Poisson generalized linear regression to estimate ADRD incident rate ratios (IRR) with 95% confidence intervals (CIs), we applied integrated nested Laplace approximations and stochastic partial differential equations (INLA-SPDE) to address disparate spatial scales. We estimated associations between neighborhood features and ADRD cumulative incidence. RESULTS The average annual ADRD cumulative incidence was 690 per 100,000 people per census tract (95% CI: 660, 710). The analysis was limited to 98% of census tracts with a population ≥ 50 years old (i.e., 1,081 of 1,103). The average percent of families living below the federal poverty line per census tract was 18.8%, and ∼ 20 % of census tracts were considered rural. The average percent of households with limited access to healthy food was 6.4%. In adjusted models, every 5 μ g / m 3 ) increase of PM 2.5 was associated with 65% higher ADRD cumulative incidence (IRR = 1.65 ; 95% CI: 1.30, 2.09), where PM 2.5 at or below 12 μ g / m 3 is considered healthy. Compared to large urban census tracts, rural and small urban tracts had 10% (IRR = 1.10 ; 95% CI: 1.00, 1.23) and 5% (IRR = 1.05 ; 95% CI: 0.96, 1.16) higher ADRD, respectively. For every percent increase of the county population with limited access to healthy food, ADRD was 2% higher (IRR = 1.02 ; 95% CI: 1.01, 1.04). CONCLUSIONS Neighborhood environment features, such as higher air pollution levels, were associated with higher neighborhood ADRD incidence. The INLA-SPDE method could have broad applicability to data collected across disparate spatial scales. https://doi.org/10.1289/EHP13183.
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Affiliation(s)
- Dana M. Alhasan
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
| | - Gary Larson
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, North Carolina, USA
| | - Matthew C. Lohman
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Frankie B. LaPorte
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, North Carolina, USA
| | - Maggi C. Miller
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - W. Braxton Jackson
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, North Carolina, USA
| | - Nathaniel S. MacNell
- Social & Scientific Systems, Inc., a DLH Holdings Company, Durham, North Carolina, USA
| | - Jana A. Hirsch
- Urban Health Collaborative, Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Chandra L. Jackson
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina, USA
- Intramural Program, National Institute on Minority Health and Health Disparities, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA
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16
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Groulx M, Freeman S, Gourlay K, Hemingway D, Rossnagel E, Chaudhury H, Nouri M. Monitoring and Evaluation of Dementia-Friendly Neighborhoods Using a Walkshed Approach: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e50548. [PMID: 38170573 PMCID: PMC10794960 DOI: 10.2196/50548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The number of people in society living with dementia is growing. In Canada, most people who live with dementia live at home, often in a neighborhood setting. Neighborhood environments can be a source of independence, social engagement, and well-being. They can also contain barriers that limit physical activity, social engagement, and well-being. A dementia-friendly neighborhood includes assets that support persons living with dementia and their caregivers in multiple life domains, including those that support walking within the neighborhood environment. OBJECTIVE The objectives for this scoping review are twofold. First, focusing on walkshed analysis, we aim to extend scholarly understandings of methodological practices used in the monitoring and evaluation of dementia-friendly neighborhoods. Second, we aim to provide clear and practical guidance for those working in planning, design, and public health fields to assess the neighborhood context in support of evidence-based action to improve the lives of persons living with dementia. METHODS The study design follows Arksey and O'Malley's scoping review framework and PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. We will conduct a search of peer-reviewed studies in 6 electronic databases to identify the use of Geographic Information System analysis to measure the walkshed of persons living with dementia in a community setting. As age is a primary risk factor associated with dementia, we will also include studies that focus more broadly on community-dwelling older adults aged 65 years and older. Data will be extracted, analyzed, and represented according to 3 domains. This includes study details, walkshed analysis methods, and criteria and indicators used to measure dementia-friendly neighborhoods. RESULTS The results of the study and the submission of a manuscript for peer review are expected in June 2024. The results of the review are expected to contribute to an understanding of methods for monitoring and evaluating dementia-friendly neighborhoods. Expected findings will include a detailed breakdown of current parameters and routines used to conduct walkshed analysis. Findings will also convey criteria that can be operationalized in a Geographic Information System as indicators to assess barriers and facilitators to walking in a neighborhood setting. CONCLUSIONS As far as we are aware, the proposed scoping review will be the first to provide comprehensive methodological or technical guidance for conducting walkshed analysis specific to persons living with dementia. Both the scalability and objective nature of walkshed analysis are likely to be of direct interest to public health practitioners, planners, and allied professionals. Clearly documenting methods used in walkshed analysis can spur increased collaboration across these disciplines to enable an evidence-informed approach to improving neighborhood environments for persons living with dementia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/50548.
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Affiliation(s)
- Mark Groulx
- University of Northern British Columbia, Prince George, BC, Canada
| | - Shannon Freeman
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Keone Gourlay
- School of Planning and Sustainability, University of Northern British Columbia, Prince George, BC, Canada
| | - Dawn Hemingway
- School of Social Work, University of Northern British Columbia, Prince George, BC, Canada
| | - Emma Rossnagel
- University of Northern British Columbia, Prince George, BC, Canada
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
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Esiaka D, Odo O, Luth E. Unraveling the Threads: Sleep Difficulties, Neighborhood Physical Disorder, and Subjective Cognitive Decline in Older Americans. J Alzheimers Dis 2024; 100:1345-1354. [PMID: 38995787 DOI: 10.3233/jad-240142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Background Research suggests that the neighborhood in which people live can be a risk or protective factor for various health outcomes, including cognitive decline to Alzheimer's disease. Similar to the impact of neighborhood on health outcomes, sleep difficulties have been linked to cognitive function in older adults. However, few studies have examined how neighborhood physical disorders moderate the effects of sleep on subjective cognitive decline (SCD). Objective The study examined the moderating effect of neighborhood factors on the relationship between sleep difficulties and SCD. Methods Data were obtained from 2,494 respondents (1,065 males and 1,429 females) from Wave 11 of the National Health and Aging Trends (NHATS) data. Sleep difficulties were operationalized as the presence of difficulties in falling and staying asleep. Neighborhood physical disorder (e.g., vandalism, graffiti) was based on interviewer observations of respondents' neighborhoods. SCD was operationalized as subjective reports of increasing or worse memory loss in the past 12 months and present memory rating. We utilized Linear regression to test neighborhood physical disorder as a moderator of the relationship between sleep difficulties and SCD. Results We found a significant interaction between sleep difficulties and neighborhood physical disorder on SCD (β=0.046, p = 0.031, 95% CI[0.00,0.51], p < 0.001). Participants who reported higher average sleep difficulties and higher levels of neighborhood physical disorder were more likely to report SCD. Conclusions Our findings add to inform future health interventions and policy recommendations that address modifiable sources of cognitive decline and risk of Alzheimer's disease.
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Affiliation(s)
- Darlingtina Esiaka
- Department of Behavioral Sciences, University of Kentucky College of Medicine, Lexington, KY, USA
- Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Obinna Odo
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Elizabeth Luth
- Department of Family Medicine and Community Health, Rutgers University, New Brunswick, NJ, USA
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
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Montine KS, Berson E, Phongpreecha T, Huang Z, Aghaeepour N, Zou JY, MacCoss MJ, Montine TJ. Understanding the molecular basis of resilience to Alzheimer's disease. Front Neurosci 2023; 17:1311157. [PMID: 38192507 PMCID: PMC10773681 DOI: 10.3389/fnins.2023.1311157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
The cellular and molecular distinction between brain aging and neurodegenerative disease begins to blur in the oldest old. Approximately 15-25% of observations in humans do not fit predicted clinical manifestations, likely the result of suppressed damage despite usually adequate stressors and of resilience, the suppression of neurological dysfunction despite usually adequate degeneration. Factors during life may predict the clinico-pathologic state of resilience: cardiovascular health and mental health, more so than educational attainment, are predictive of a continuous measure of resilience to Alzheimer's disease (AD) and AD-related dementias (ADRDs). In resilience to AD alone (RAD), core features include synaptic and axonal processes, especially in the hippocampus. Future focus on larger and more diverse cohorts and additional regions offer emerging opportunities to understand this counterforce to neurodegeneration. The focus of this review is the molecular basis of resilience to AD.
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Affiliation(s)
| | - Eloïse Berson
- Department of Pathology, Stanford University, Stanford, CA, United States
- Department of Anesthesiology, Stanford University, Stanford, CA, United States
| | - Thanaphong Phongpreecha
- Department of Pathology, Stanford University, Stanford, CA, United States
- Department of Anesthesiology, Stanford University, Stanford, CA, United States
| | - Zhi Huang
- Department of Pathology, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - Nima Aghaeepour
- Department of Anesthesiology, Stanford University, Stanford, CA, United States
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
| | - James Y. Zou
- Department of Biomedical Data Science, Stanford University, Stanford, CA, United States
- Department of Computer Science, Stanford University, Stanford, CA, United States
| | - Michael J. MacCoss
- Department of Genome Sciences, University of Washington, Seattle, WA, United States
| | - Thomas J. Montine
- Department of Pathology, Stanford University, Stanford, CA, United States
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Zhou W, Wang Q, Li R, Zhang Z, Wang W, Zhou F, Ling L. The effects of heatwave on cognitive impairment among older adults: Exploring the combined effects of air pollution and green space. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 904:166534. [PMID: 37647952 DOI: 10.1016/j.scitotenv.2023.166534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/23/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
The association between heatwaves and cognitive impairment in older adults, especially the joint effect of air pollution and green space on this association, remains unknown. The present cohort study used data from waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018. Heatwaves were defined as having daily maximum temperature ≥ 92.5th, 95th and 97.5th percentile that continued at least two, three and four days, measured as the one-year heatwave days prior to the participants' incident cognitive impairment. Data on the annual average air pollutant concentrations of fine particulate matter (PM2.5) and ozone (O3) as well as green space exposure (according to the Normalized Difference Vegetation Index (NDVI)) were collected. Time-varying Cox proportional hazards models were constructed to examine the independent effect of heatwaves on cognitive impairment and the combined effect of heatwaves, air pollution, and green space on cognitive impairment. Potential multiplicative interactions were examined by adding a product term of air pollutants and NDVI with heatwaves in the models. The relative excess risk due to interaction (RERI) was calculated to reflect additive interactions. We found that heatwave exposure was associated with higher risks of cognitive impairment, with hazard ratios (HRs) and 95 % confidence intervals (CIs) ranging from 1.035 (95 % CI: 1.016-1.055) to 1.058 (95 % CI: 1.040-1.075). We observed a positive interaction of PM2.5 concentrations, O3 concentrations, lack of green space, and heatwave exposure on a multiplicative scale (HRs for product terms >1). Furthermore, we found a synergistic interaction of PM2.5 concentrations, O3, lack of green space, and heatwave exposure on an additive scale, with RERIs >0. These results suggest that extreme heat exposure may be a potential risk factor for cognitive impairment in older adults. Additionally, coexposure to air pollution and lack of green space exacerbated the adverse effects of heatwaves on cognitive function.
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Affiliation(s)
- Wensu Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qiong Wang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Rui Li
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zhirong Zhang
- School of Mathematics, Sun Yat-Sen University, Sun Yat-sen University, Guangzhou, China
| | - Wenjuan Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Fenfen Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China; Clinical Research Design Division, Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
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Bridi L, Kaki DA, Behnam R, Khan X, Albahsahli B, Bencheikh N, Aljenabi R, Ahmadi N, Dajani R, Al-Rousan T. Attitudes toward dementia and cognitive aging among Syrian refugees resettled in Jordan: a qualitative study. BMC Public Health 2023; 23:2307. [PMID: 37990313 PMCID: PMC10664261 DOI: 10.1186/s12889-023-17183-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Mounting evidence is revealing disparities in cognitive function and heightened dementia risk among refugees, yet research in this area remains scant. Despite bearing most of the world's refugee burden, limited-resource countries like Jordan are facing challenges when dealing with refugee health. There is a lack of research on the attitudes toward dementia and the cognitive healthcare gaps among refugees in Jordan. METHODS 32 older (≥ 55 years) Syrian refugees resettled in Jordan were recruited through a local community-based organization and interviewed in four focus groups (2 female and 2 male groups). Interviews were transcribed and translated, then coded using inductive thematic analysis. RESULTS Mean age of the sample was 60.1 years and 53.1% were female. Only 34.4% rated their memory as good or excellent. Themes were organized using the socioecological model: 1) At the individual level, participants believed high levels of stress, including low socioeconomic status, poor health, and traumatic history from their refugee experience increased their dementia risk. 2) Interpersonally, there is a fear of dementia due to the possible impact and burden on loved ones, particularly with the stigma surrounding dementia. 3) At the community level, participants noted that resettlement in Jordan - with a shared language, religion, and culture - offered protective effects due to facilitated access to social connection, information, and mental health self-care. 4) At the institution and policy level, participants believed older refugees faced restrictive policies for economic aid, healthcare, and employment, presenting a significant barrier to healthy aging. CONCLUSIONS Findings from this study are the first to examine the attitudes of Syrian refugees in Jordan toward dementia and cognitive aging. These results could provide essential data inclusive of refugees as Jordan develops its National Dementia Plan. Investing in dementia awareness interventions and age-friendly neighborhoods may benefit aging refugees in limited-resources settings.
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Affiliation(s)
- Lana Bridi
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Dahlia A Kaki
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rawnaq Behnam
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Xara Khan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Social Sciences, University of California, San Diego, San Diego, CA, USA
| | - Behnan Albahsahli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Nissma Bencheikh
- School of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Raghad Aljenabi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
- School of Social Sciences, University of California, San Diego, San Diego, CA, USA
| | - Nargis Ahmadi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA
| | - Rana Dajani
- Department of Biology and Biotechnology, The Hashemite University, Zarqa, Jordan
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, USA.
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Choi J, Han SH, Ng YT, Muñoz E. Neighborhood Cohesion Across the Life Course and Effects on Cognitive Aging. J Gerontol B Psychol Sci Soc Sci 2023; 78:1765-1774. [PMID: 37350749 PMCID: PMC10561885 DOI: 10.1093/geronb/gbad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES Greater neighborhood cohesion is associated with better cognitive function in adulthood and may serve as a protective factor against cognitive impairment and decline. We build on prior work by examining the effects of perceived neighborhood cohesion across the life course on level and change in cognitive function in adulthood. METHODS Utilizing longitudinal data from the Health and Retirement Study (1998-2016) and its Life History Mail Survey, we leveraged data from 3,599 study participants (baseline age: 51-89) who participated in up to 10 waves. Respondents provided retrospective ratings of neighborhood cohesion at childhood (age 10), young adulthood (age at the first full-time job), early midlife (age 40), and concurrently at baseline (i.e., late midlife/adulthood); they completed the modified version of the Telephone Interview for Cognitive Status. We fit a univariate latent growth curve model of change in cognitive function across waves and tested whether neighborhood cohesion during each recollected life stage predicted level and change in cognitive function. RESULTS Greater neighborhood cohesion during childhood and late midlife/adulthood each predicted higher cognitive function at baseline but not the rate of cognitive decline. The final model showed that greater neighborhood cohesion in childhood and in late midlife/adulthood remained significantly associated with higher baseline cognitive function, even after accounting for one another. DISCUSSION Findings provide insight into life-course neighborhood contextual influences on cognitive aging. Our results emphasize the need for more research to understand the life-course dynamics between neighborhood environments and cognitive aging.
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Affiliation(s)
- Jean Choi
- Department of Human Development and Family Sciences and Population Research Center, The University of Texas at Austin, Austin, Texas, USA
| | - Sae Hwang Han
- Department of Human Development and Family Sciences and Population Research Center, The University of Texas at Austin, Austin, Texas, USA
| | - Yee To Ng
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth Muñoz
- Department of Human Development and Family Sciences and Population Research Center, The University of Texas at Austin, Austin, Texas, USA
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Yang HW, Wu YH, Lin MC, Liao SF, Fan CC, Wu CS, Wang SH. Association between neighborhood availability of physical activity facilities and cognitive performance in older adults. Prev Med 2023; 175:107669. [PMID: 37595898 DOI: 10.1016/j.ypmed.2023.107669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 08/20/2023]
Abstract
The existing evidence on the contextual influence of the availability of local facilities for physical activity on the cognitive health of elderly residents is sparse. This study examined the association between neighborhood physical activity facilities and cognitive health in older individuals. A cohort study of community-dwelling older adults was performed using baseline data and follow-up data from the Taiwan Biobank. Cognitive health was measured in 32,396 individuals aged 60-70 years using the Mini-Mental State Examination (MMSE) with follow-up information on 8025 participants. The district was used as the proxy for local neighborhood. To determine neighborhood physical activity facilities, school campuses, parks, activity centers, gyms, swimming pools, and stadiums were included. Multilevel linear regression models were applied to examine the associations of neighborhood physical activity facilities with baseline MMSE and MMSE decline during follow-up, with adjustment for individual factors and neighborhood socioeconomic characteristics. Multilevel analyses revealed that there was a neighborhood-level effect on cognitive health among older adults. After adjusting for compositional and neighborhood socioeconomic characteristics, baseline MMSE was higher in individuals living in the middle- (beta = 0.12, p-value = 0.140) and high-density facility (beta = 0.22, p-value = 0.025) groups than in the low-density group (p-value for trend-test = 0.031). MMSE decline during follow-up was slower in the middle- (beta = 0.15, p-value = 0.114) and high-density facility (beta = 0.27, p-value = 0.052) groups than in the low-density group (p-value for trend-test = 0.032). Greater neighborhood availability of physical activity facilities was associated with better cognitive health among older residents. These findings have implications for designing communities and developing strategies to support cognitive health of an aging population.
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Affiliation(s)
- Hui-Wen Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Yun-Hsuan Wu
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Mei-Chen Lin
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Shu-Fen Liao
- Department of Medical Research, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Fan
- Center for Population Neuroscience and Genetics, Laureate Institute for Brain Research, Tulsa, OK, USA; Department of Radiology, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Chi-Shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Yunlin branch, Douliu, Taiwan
| | - Shi-Heng Wang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Miaoli County, Taiwan.
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Gong R, Xia D, Hu Z, Hu Y. The impact of neighborhood mental health on the mental health of older adults. BMC Public Health 2023; 23:1352. [PMID: 37452289 PMCID: PMC10347814 DOI: 10.1186/s12889-023-16263-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/07/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND In this article, we use cross-sectional data obtained from the 2018 China Health and Aging Tracking Survey (CHARLS) to examine the impact of neighborhood mental health at the community level on the mental health of older adults aged 60 years and older. METHODS NMH is the average mental health of older adults in the same community, excluding the older adults themselves. The explained variable mental health in this paper was measured using the simple CES-D depression scale. The mediating variables were social connectedness, social participation and social inclusion, and the instrumental variables were physical exercise and amusement. regression analysis was conducted using OLS regression models, two-stage least squares (IV-2SLS) instrumental variables to address the two-way causality of NMH and MH, and KHB decomposition was used to investigate the effect mechanism. RESULTS Baseline regressions showed that the neighborhood mental health effect positively influenced the mental health of older adults (Coef. = 0.356, 95% CI 0.315,0.397). The neighborhood mental health effect estimated by IV-2SLS (Coef. = 0.251, 95% CI 0.096,0.405) was higher than the OLS regression, indicating endogeneity. The mediated effects of KHB showed total (Coef. = 0.356, 95% CI 0.314,0.398), direct (Coef. = 0.281, 95% CI 0.232,0.330), and indirect effects (Coef. = 0.075, 95% CI 0.049,0.101). While the total effect was 1.266 times higher than the direct effect, 21.03% of the total effect came from mediating variables. CONCLUSIONS First, the neighborhood mental health effect has a positive impact on the mental health of older adults, but there are heterogeneous differences based on gender, age, and place of residence. Second, the results of the IV-2SLS estimation showed that the effect of the neighborhood mental health effect was underestimated if endogenous problems were not controlled for. Third, the effect of neighborhood mental health on older adults' mental health was tested to be stable. Moreover, social connectedness, social participation, and social interaction are important mediating mechanisms for the effect of neighborhood mental health on older adults' mental health. This study provides new perspectives and ideas for an in-depth understanding of the mental health of older adults in the context of social transformation in China.
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Affiliation(s)
- Rengui Gong
- School of Public Management and Law, Anhui University of Technology, Ma'anshan, China
| | - Dongping Xia
- College of Public Administration and law, Hunan Agricultural University, Changsha, China
| | - Zan Hu
- The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China.
| | - Yangming Hu
- College of Public Administration and law, Hunan Agricultural University, Changsha, China.
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Groulx M, Freeman S, Gourlay K, Hemingway D, Rossnagel E, Chaudhury H, Nouri M. Monitoring and evaluation of dementia-friendly neighbourhoods using a walkshed approach: A scoping review protocol (Preprint).. [DOI: 10.2196/preprints.50548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
UNSTRUCTURED
The number of people in society living with Dementia is growing. In Canada, most people who live with dementia live at home, often in a neighbourhood setting. Neighbourhood environments can be source of independence, social engagement, and well-being, but can also contain barriers that limit physical activity, social engagement, and well-being. A dementia-friendly neighbourhood includes assets that support persons living with dementia and their caregivers in multiple life domains, including those that support walking within the neighbourhood environment. The study design follow’s Arksey and O’Malley’s scoping review framework and PRISMA-P guidelines. A search of peer-reviewed studies in six electronic databases will be conducted to identify the use of GIS analysis to measure the walkshed of persons living with dementia in a community setting. Data will be extracted, analyzed and represented according to three domains, including study details, walkshed analysis methods, and criteria and indicators used to measure dementia-friendly neighbourhoods. Results of the review are expected to contribute understanding of methods for monitoring and evaluation of dementia friendly neighbourhoods. Both the scalability and objective nature of walkshed analysis are likely to be of direct interest to public health practitioners and planning and allied professionals.
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Adkins-Jackson PB, George KM, Besser LM, Hyun J, Lamar M, Hill-Jarrett TG, Bubu OM, Flatt JD, Heyn PC, Cicero EC, Zarina Kraal A, Pushpalata Zanwar P, Peterson R, Kim B, Turner RW, Viswanathan J, Kulick ER, Zuelsdorff M, Stites SD, Arce Rentería M, Tsoy E, Seblova D, Ng TKS, Manly JJ, Babulal G. The structural and social determinants of Alzheimer's disease related dementias. Alzheimers Dement 2023; 19:3171-3185. [PMID: 37074203 PMCID: PMC10599200 DOI: 10.1002/alz.13027] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 04/20/2023]
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.
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Affiliation(s)
- Paris B Adkins-Jackson
- Departments of Epidemiology & Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Kristen M George
- Department of Public Health Sciences, University of California, Davis School of Medicine, Davis, California, USA
| | - Lilah M Besser
- Comprehensive Center for Brain Health, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jinshil Hyun
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, New York, USA
| | - Melissa Lamar
- Rush Alzheimer's Disease Center and the Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Tanisha G Hill-Jarrett
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Omonigho M Bubu
- Departments of Psychiatry, Population Health & Neurology, New York University Grossman School of Medicine, New York, New York, USA
| | - Jason D Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Nevada, USA
| | - Patricia C Heyn
- Center for Optimal Aging, Marymount University, Arlington, Virginia, USA
| | - Ethan C Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - A Zarina Kraal
- Department of Neurology, Columbia University, New York, New York, USA
| | - Preeti Pushpalata Zanwar
- Applied Health Economics & Outcomes Research & Health Policy, Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- NIA Funded Network on Life Course and Health Dynamics and Disparities, University of Southern California, Los Angeles, California, USA
| | - Rachel Peterson
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Boeun Kim
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Robert W Turner
- Clinical Research & Leadership, Neurology, The George Washington University, Washington, D.C., USA
| | | | - Erin R Kulick
- MPH Department of Epidemiology and Biostatistics, Temple University, Philadelphia, Pennsylvania, USA
| | - Megan Zuelsdorff
- School of Nursing, Alzheimer's Disease Research Center, and School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Shana D Stites
- MA Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Miguel Arce Rentería
- Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, New York, New York, USA
| | - Elena Tsoy
- Department of Neurology, Memory and Aging Center, University of California San Francisco, Global Brain Health Institute, University of California San Francisco and Trinity College Dublin, San Francisco, California, USA
| | - Dominika Seblova
- Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ted K S Ng
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, Arizona, USA
| | - Jennifer J Manly
- Department of Neurology, Columbia University, New York, New York, USA
| | - Ganesh Babulal
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
- Institute of Public Health, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C., USA
- Department of Psychology, Faculty of Humanities, University of Johannesburg, South Africa
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Lai KY, Kumari S, Webster C, Gallacher JEJ, Sarkar C. Neighbourhood residential density, urbanicity and incident dementia and Alzheimer's disease: A 12-year prospective cohort study from the UK Biobank. ENVIRONMENTAL RESEARCH 2023; 226:115627. [PMID: 36894118 DOI: 10.1016/j.envres.2023.115627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/25/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION An increasing proportion of global population is exposed to urban densification in an aging society. However, little is known of the role of residential density and urbanicity on the risk of developing dementia including Alzheimer's disease. We examined long-term associations between residential density and urbanicity and risks of incident dementia and Alzheimer's disease. METHODS This prospective cohort study included participants from the UK Biobank who lived at the same residential address, had no self-reported neurological conditions and without dementia at baseline. Residential density was measured as the number of dwelling units within 1-km street neighbourhood of participant's home address. A composite index of urbanicity was developed from neighbourhood-level z-standardized densities of housing, retail, public transport and street centrality. Hazard ratios were derived from Cox proportional hazard models adjusted for known risk factors. RESULTS The analytic sample included 239,629 participants aged 38-72 years. During a median follow-up of 12.3 years (interquartile range 11.5-13.0 years), 2,176 participants developed dementia and 1,004 Alzheimer's disease. After adjustments for potential risk factors, each 1,000 units/Km2 increment in residential density was associated with higher risks of dementia (hazard ratio [HR]=1.10, 95% confidence interval [CI]: 1.06-1.15) and Alzheimer's disease (HR=1.10, 95% CI: 1.04-1.16). Consistently, categorical models showed that living in neighbourhoods of higher residential density and urbanicity were associated with higher risks of dementia (HR = 1.30, 95% CI: 1.12-1.51 for the highest density quintile compared to the lowest and HR = 1.21, 95% CI: 1.05-1.39 for the highest urbanicity quintile relative to the lowest). The associations were more pronounced in female, age >65 years, and among participants of the low income and those being frail and having shorter leucocyte telomere length (LTL). CONCLUSIONS Higher residential density and urbanicity was found to be positively associated with elevated risks of dementia and Alzheimer's disease. Optimizing neighbourhood residential density maybe one of the upstream considerations for mitigating against neurodegenerative diseases.
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Affiliation(s)
- Ka Yan Lai
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China; Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Sarika Kumari
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - Chris Webster
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China; Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China
| | - John E J Gallacher
- UK Dementias Platform, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom
| | - Chinmoy Sarkar
- Healthy High Density Cities Lab, HKUrbanLab, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China; Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Knowles Building, Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China; UK Dementias Platform, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
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Hyun J, Katz MJ, Derby CA, Roque N, Muñoz E, Sliwinski MJ, Lovasi GS, Lipton RB. Availability of healthy foods, fruit and vegetable consumption, and cognition among urban older adults. BMC Geriatr 2023; 23:302. [PMID: 37198552 PMCID: PMC10189949 DOI: 10.1186/s12877-023-04003-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/26/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND . Although prior studies have examined the associations between neighborhood characteristics and cognitive health, little is known about whether local food environments, which are critical for individuals' daily living, are associated with late-life cognition. Further, little is known about how local environments may shape individuals' health-related behaviors and impact cognitive health. The aim of this study is to examine whether objective and subjective measures of healthy food availability are associated with ambulatory cognitive performance and whether behavioral and cardiovascular factors mediate these associations among urban older adults. METHODS . The sample consisted of systematically recruited, community-dwelling older adults (N = 315, mean age = 77.5, range = 70-91) from the Einstein Aging Study. Objective availability of healthy foods was defined as density of healthy food stores. Subjective availability of healthy foods and fruit/vegetable consumption were assessed using self-reported questionnaires. Cognitive performance was assessed using smartphone-administered cognitive tasks that measured processing speed, short-term memory binding, and spatial working memory performance 6 times a day for 14 days. RESULTS . Results from multilevel models showed that subjective availability of healthy foods, but not objective food environments, was associated with better processing speed (estimate= -0.176, p = .003) and more accurate memory binding performance (estimate = 0.042, p = .012). Further, 14~16% of the effects of subjective availability of healthy foods on cognition were mediated through fruit and vegetable consumption. CONCLUSIONS . Local food environments seem to be important for individuals' dietary behavior and cognitive health. Specifically, subjective measures of food environments may better reflect individuals' experiences regarding their local food environments not captured by objective measures. Future policy and intervention strategies will need to include both objective and subjective food environment measures in identifying impactful target for intervention and evaluating effectiveness of policy changes.
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Affiliation(s)
- Jinshil Hyun
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Mindy J Katz
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Carol A Derby
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Nelson Roque
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Elizabeth Muñoz
- Department of Human Development and Family Sciences, University of Texas Austin, Austin, TX, USA
| | - Martin J Sliwinski
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - Gina S Lovasi
- Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, PA, USA
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Richard B Lipton
- The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
- Headache Center, Montefiore Medical Center, Bronx, NY, USA
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Badaloni C, De Sario M, Caranci N, De' Donato F, Bolignano A, Davoli M, Leccese L, Michelozzi P, Leone M. A spatial indicator of environmental and climatic vulnerability in Rome. ENVIRONMENT INTERNATIONAL 2023; 176:107970. [PMID: 37224679 DOI: 10.1016/j.envint.2023.107970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/14/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Urban areas are disproportionately affected by multiple pressures from overbuilding, traffic, air pollution, and heat waves that often interact and are interconnected in producing health effects. A new synthetic tool to summarize environmental and climatic vulnerability has been introduced for the city of Rome, Italy, to provide the basis for environmental and health policies. METHODS From a literature overview and based on the availability of data, several macro-dimensions were identified on 1,461 grid cells with a width of 1 km2 in Rome: land use, roads and traffic-related exposure, green space data, soil sealing, air pollution (PM2.5, PM10, NO2, C6H6, SO2), urban heat island intensity. The Geographically Weighted Principal Component Analysis (GWPCA) method was performed to produce a composite spatial indicator to describe and interpret each spatial feature by integrating all environmental dimensions. The method of natural breaks was used to define the risk classes. A bivariate map of environmental and social vulnerability was described. RESULTS The first three components explained most of the variation in the data structure with an average of 78.2% of the total percentage of variance (PTV) explained by the GWPCA, with air pollution and soil sealing contributing most in the first component; green space in the second component; road and traffic density and SO2 in the third component. 56% of the population lives in areas with high or very high levels of environmental and climatic vulnerability, showing a periphery-centre trend, inverse to the deprivation index. CONCLUSIONS A new environmental and climatic vulnerability indicator for the city of Rome was able to identify the areas and population at risk in the city, and can be integrated with other vulnerability dimensions, such as social deprivation, providing the basis for risk stratification of the population and for the design of policies to address environmental, climatic and social injustice.
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Affiliation(s)
- Chiara Badaloni
- Department of Epidemiology of the Lazio Regional Health Service, ASL Roma 1, Rome, Italy.
| | - Manuela De Sario
- Department of Epidemiology of the Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | - Nicola Caranci
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy
| | - Francesca De' Donato
- Department of Epidemiology of the Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | | | - Marina Davoli
- Department of Epidemiology of the Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | - Letizia Leccese
- Department of Epidemiology of the Lazio Regional Health Service, ASL Roma 1, Rome, Italy
| | - Paola Michelozzi
- Department of Epidemiology of the Lazio Regional Health Service, ASL Roma 1, Rome, Italy
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Lamar M, Kershaw KN, Leurgans SE, Mukherjee RR, Lange-Maia BS, Marquez DX, Barnes LL. Neighborhood-level social vulnerability and individual-level cognitive and motor functioning over time in older non-Latino Black and Latino adults. Front Hum Neurosci 2023; 17:1125906. [PMID: 37250695 PMCID: PMC10213534 DOI: 10.3389/fnhum.2023.1125906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Despite known health disparities in cognitive aging, a comprehensive rationale for the increased burden in older minoritized populations including non-Latino Black and Latino adults has yet to be elucidated. While most work has focused on person-specific risk, studies are increasingly assessing neighborhood-level risk. We evaluated multiple aspects of the environmental milieu that may be critical when considering vulnerability to adverse health outcomes. Methods We investigated associations between a Census-tract derived Social Vulnerability Index (SVI) and level of and change in cognitive and motor functioning in 780 older adults (590 non-Latino Black adults, ∼73 years old at baseline; 190 Latinos, ∼70 years old baseline). Total SVI scores (higher = greater neighborhood-level vulnerability) were combined with annual evaluations of cognitive and motor functioning (follow-up ranged from 2 to 18 years). Demographically-adjusted mixed linear regression models tested for associations between SVI and cognitive and motor outcomes in analyses stratified by ethno-racial group. Results For non-Latino Black participants, higher SVI scores were associated with lower levels of global cognitive and motor functioning-specifically, episodic memory, motor dexterity and gait-as well as longitudinal change in visuospatial abilities and hand strength. For Latinos, higher SVI scores were associated with lower levels of global motor functioning only-specifically, motor dexterity; there were no significant associations between SVI and change in motor functioning. Discussion Neighborhood-level social vulnerability is associated with cognitive and motor functioning in non-Latino Black and Latino older adults, although associations appear to contribute to level more so than longitudinal change.
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Affiliation(s)
- Melissa Lamar
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - R. Reshmi Mukherjee
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Claremont McKenna College, Claremont, CA, United States
| | - Brittney S. Lange-Maia
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL, United States
| | - David X. Marquez
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Kinesiology and Nutrition, University of Illinois Chicago, Chicago, IL, United States
| | - Lisa L. Barnes
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
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30
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Han Z, Xia T, Xi Y, Li Y. Healthy Cities, A comprehensive dataset for environmental determinants of health in England cities. Sci Data 2023; 10:165. [PMID: 36966167 PMCID: PMC10039331 DOI: 10.1038/s41597-023-02060-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/08/2023] [Indexed: 03/27/2023] Open
Abstract
This paper presents a fine-grained and multi-sourced dataset for environmental determinants of health collected from England cities. We provide health outcomes of citizens covering physical health (COVID-19 cases, asthma medication expenditure, etc.), mental health (psychological medication expenditure), and life expectancy estimations. We present the corresponding environmental determinants from four perspectives, including basic statistics (population, area, etc.), behavioural environment (availability of tobacco, health-care services, etc.), built environment (road density, street view features, etc.), and natural environment (air quality, temperature, etc.). To reveal regional differences, we extract and integrate massive environment and health indicators from heterogeneous sources into two unified spatial scales, i.e., at the middle layer super output area (MSOA) and the city level, via big data processing and deep learning. Our data holds great promise for diverse audiences, such as public health researchers and urban designers, to further unveil the environmental determinants of health and design methodology for a healthy, sustainable city.
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Affiliation(s)
- Zhenyu Han
- Beijing National Research Center for Information Science and Technology (BNRist), Beijing, P. R. China
- Department of Electronic Engineering, Tsinghua University, Beijing, P. R. China
| | - Tong Xia
- Department of Computer Science and Technology, University of Cambridge, Cambridge, UK
| | - Yanxin Xi
- Department of Computer Science, University of Helsinki, Helsinki, Finland
| | - Yong Li
- Beijing National Research Center for Information Science and Technology (BNRist), Beijing, P. R. China.
- Department of Electronic Engineering, Tsinghua University, Beijing, P. R. China.
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Cerin E, Barnett A, Wu YT, Martino E, Shaw JE, Knibbs LD, Poudel G, Jalaludin B, Anstey KJ. Do neighbourhood traffic-related air pollution and socio-economic status moderate the associations of the neighbourhood physical environment with cognitive function? Findings from the AusDiab study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 858:160028. [PMID: 36368384 DOI: 10.1016/j.scitotenv.2022.160028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/02/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
Characteristics of the neighbourhood environment, including the built and natural environment, area-level socio-economic status (SES) and air pollution, have been linked to cognitive health. However, most studies have focused on single neighbourhood characteristics and have not considered the extent to which the effects of environmental factors may interact. We examined the associations of measures of the neighbourhood built and natural environment, area-level SES and traffic-related air pollution (TRAP) with two cognitive function domains (memory and processing speed), and the extent to which area-level SES and TRAP moderated the associations. We used cross-sectional data from the AusDiab3 study, an Australian cohort study of adults (mean age: 61 years) in 2011-12 (N = 4141) for which geocoded residential addresses were available. Spatial data were used to create composite indices of built environment complexity (population density, intersection density, non-commercial land use mix, commercial land use) and natural environment (parkland and blue spaces). Area-level SES was obtained from national census indices and TRAP was based on estimates of annual average levels of nitrogen dioxide (NO2). Confounder-adjusted generalised additive mixed models were used to estimate the independent associations of the environmental measures with cognitive function and the moderating effects of area-level SES and TRAP. The positive associations between built environment complexity and memory were stronger in those living in areas with higher SES and lower NO2 concentrations. A positive association between the natural environment and memory was found only in those living in areas with lower NO2 concentrations and average or below-average SES. Built environment complexity and the natural environment were positively related to processing speed. Complex urban environments and access to nature may benefit cognitive health in ageing populations. For higher-order cognitive abilities, such as memory, these positive effects may be stronger in areas with lower levels of TRAP.
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Affiliation(s)
- Ester Cerin
- Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring St., Melbourne, VIC, Australia; School of Public Health, The University of Hong Kong, 7 Sassoon Rd., Sandy Bay, Hong Kong; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway.
| | - Anthony Barnett
- Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring St., Melbourne, VIC, Australia
| | - Yu-Tzu Wu
- Population Health Sciences Institute, Newcastle University, Newcastle NE4 5PL, United Kingdom
| | - Erika Martino
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Life Sciences, La Trobe University, Melbourne, VIC, Australia
| | - Luke D Knibbs
- Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia; Public Health Unit, Sydney Local Health District, Camperdown, NSW, Australia
| | - Govinda Poudel
- Mary MacKillop Institute for Health Research, Australian Catholic University, 215 Spring St., Melbourne, VIC, Australia
| | - Bin Jalaludin
- School of Population Health, University of New South Wales, Randwick, NSW, Australia
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Randwick, NSW, Australia; Neuroscience Research Australia (NeuRA), Sydney, Australia; UNSW Ageing Futures Institute, Sydney, Australia
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Ricciardi E, Spano G, Lopez A, Tinella L, Clemente C, Elia G, Dadvand P, Sanesi G, Bosco A, Caffò AO. Long-Term Exposure to Greenspace and Cognitive Function during the Lifespan: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11700. [PMID: 36141977 PMCID: PMC9517665 DOI: 10.3390/ijerph191811700] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 05/13/2023]
Abstract
Recent advances in environmental psychology highlighted the beneficial role of greenspace exposure on cognition. We conducted a systematic review of the available studies on the association of long-term exposure to greenspace and cognitive functions across the lifespan. PRISMA guidelines and the PECOs method were applied to screen for eligible studies. Twenty-five studies from Scopus, PubMed, and PsycINFO met the inclusion criteria. Six studies were longitudinal and nineteen cross-sectional. Fifteen studies focused on schoolchildren, six studies on adults, and four on the elderly. Twenty studies used the NDVI to assess greenspace exposure and the remaining used other indexes. Eight studies employed academic achievement as the outcome, eight studies global cognition, six studies attention/executive functions, and three studies memory. The evidence was inconsistent but suggestive for a beneficial role of greenspace exposure on cognitive functions. Further studies are required, especially among adults and older people, by adopting longitudinal designs.
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Affiliation(s)
- Elisabetta Ricciardi
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, 70122 Bari, Italy
| | - Giuseppina Spano
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, 70122 Bari, Italy
- Department of Agricultural and Environmental Sciences, University of Studies of Bari, 70126 Bari, Italy
| | - Antonella Lopez
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, 70122 Bari, Italy
- Faculty of Law, Giustino Fortunato University, 82100 Benevento, Italy
| | - Luigi Tinella
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, 70122 Bari, Italy
| | - Carmine Clemente
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, 70122 Bari, Italy
| | - Giuseppe Elia
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, 70122 Bari, Italy
| | - Payam Dadvand
- Barcelona Institute for Global Health, 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- CIBER Epidemiologíay Salud Publica (CIBERESP), 28029 Madrid, Spain
| | - Giovanni Sanesi
- Department of Agricultural and Environmental Sciences, University of Studies of Bari, 70126 Bari, Italy
| | - Andrea Bosco
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, 70122 Bari, Italy
| | - Alessandro Oronzo Caffò
- Department of Educational Sciences, Psychology, Communication, University of Studies of Bari, 70122 Bari, Italy
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Wong R, Wang Y. Role of Neighborhood Physical Disorder and Social Cohesion on Racial and Ethnic Disparities in Dementia Risk. J Aging Health 2022; 34:1178-1187. [PMID: 35580113 DOI: 10.1177/08982643221101352] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To analyze how neighborhood physical disorder and social cohesion are associated with racial and ethnic disparities in dementia risk. Methods: Nine years of data (2011-2019) were retrieved from the National Health and Aging Trends Study, a nationally representative U.S. older adult (age 65+) sample. Cox regression analyzed time to dementia diagnosis using composite scores for neighborhood physical disorder and social cohesion. Results: Higher baseline neighborhood physical disorder (Adjusted Hazard Ratio [aHR]=1.11, 95% Confidence Interval [CI]=1.01-1.23) and increased disorder at follow-up (aHR=1.10, 95% CI=1.01-1.19) significantly increased dementia risk. Hispanic older adults with higher physical disorder at baseline (aHR=0.62, 95% CI=0.49-0.79) and follow-up (aHR=0.81, 95% CI=0.67-0.98) had a significantly decreased dementia risk. There were no significant associations for social cohesion. Discussion: Physical but not social neighborhood characteristics are associated with dementia risk. Future research is needed to understand protective mechanisms for dementia among Hispanic older adults in neighborhoods with high physical disorder.
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Affiliation(s)
- Roger Wong
- Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Yi Wang
- School of Social Work, University of Iowa, Iowa City, IA, USA
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34
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Zhang L, Luo Y, Zhang Y, Pan X, Zhao D, Wang Q. Green Space, Air Pollution, Weather, and Cognitive Function in Middle and Old Age in China. Front Public Health 2022; 10:871104. [PMID: 35586008 PMCID: PMC9108722 DOI: 10.3389/fpubh.2022.871104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
Prior research has shown that environmental hazards, such as limited green space, air pollution, and harmful weather, have the strong adverse impact on older adults' cognitive function; however, most of the studies were conducted in developed countries and limited to cross-sectional analyses. China has the largest aging population in the world so the research evidence from it can offer an insight to the study in other developing countries facing similar issues and inform future public health policy and disease control. This study examined the long-term impact of environmental factors, namely, green space coverage, air pollution, and weather conditions on cognitive function using a nationally representative sample consisting of adults aged 45 years and older selected from the China Health and Retirement Longitudinal Study (CHARLS 2011–2018), the China City Statistical Yearbook, and other sources. Multilevel growth curve models were utilized for analysis and the mediator effects of physical activity and social engagement on the relationship between environmental factors and cognitive function were examined. Findings of this study showed that after controlling for sociodemographic characteristics, annual precipitation of 80 cm or more, living in areas with July temperature of 28°C or higher, urban community, and green space coverage were positively associated with cognition score at the baseline and lower precipitation, urban community, and greater green space coverage were associated with slower cognitive decline over a 7-year period. The impact of gross domestic product (GDP) seemed to take into effect more and more over time. These effects did not substantially change after weekly total hours of physical activities and levels of social engagement were added. More research on the mechanisms of the effect of environmental factors on cognition is needed such as the subgroup analyses and/or with more aspects of environmental measures.
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Affiliation(s)
- Lingling Zhang
- Department of Nursing, University of Massachusetts Boston, Boston, MA, United States
| | - Ye Luo
- Department of Sociology, Anthropology and Criminal Justice, Clemson University, Clemson, SC, United States
- *Correspondence: Ye Luo
| | - Yao Zhang
- Department of Nursing, University of Massachusetts Boston, Boston, MA, United States
| | - Xi Pan
- Department of Sociology, Texas State University, San Marcos, TX, United States
| | - Dandan Zhao
- Department of Sociology, Anthropology and Criminal Justice, Clemson University, Clemson, SC, United States
| | - Qing Wang
- Department of Biostatistics, Shandong University, Jinan, China
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Zagnoli F, Filippini T, Jimenez MP, Wise LA, Hatch EE, Vinceti M. Is Greenness Associated with Dementia? A Systematic Review and Dose-Response Meta-analysis. Curr Environ Health Rep 2022; 9:574-590. [PMID: 35857243 PMCID: PMC9729322 DOI: 10.1007/s40572-022-00365-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW We assessed the relation between environmental greenness and risk of dementia and cognitive impairment, based on a systematic review and meta-analysis up to March 30, 2022, characterizing whenever possible the shape of the association using dose-response meta-analysis. RECENT FINDINGS Twelve studies were included in this review, either using normalized difference vegetation index (NDVI) or land use/cover (LU/LC) methodology to assess greenness. Comparing the highest versus lowest exposure categories of greenness assessed using the NDVI (6 studies) or LU/LC (6 studies), we found no association with dementia. Dose-response meta-analysis of the association between greenness measured by LU/LC and dementia, based on only 3 studies, indicated a U-shaped association, but estimates were imprecise. Our systematic review and meta-analysis provided some evidence of a slight inverse association between greenness and dementia at intermediate exposure levels, but not at high levels. Potential methodological limitations, such as exposure misclassification and unmeasured confounding, may have affected the results.
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Affiliation(s)
- Federico Zagnoli
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia Medical School, 287 Via Campi, 41125 Modena, Italy
| | - Tommaso Filippini
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia Medical School, 287 Via Campi, 41125 Modena, Italy ,School of Public Health, University of California Berkeley, Berkeley, CA 94704 USA
| | - Marcia P. Jimenez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118 USA
| | - Lauren A. Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118 USA
| | - Elizabeth E. Hatch
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118 USA
| | - Marco Vinceti
- Environmental, Genetic and Nutritional Epidemiology Research Center (CREAGEN), Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia Medical School, 287 Via Campi, 41125 Modena, Italy ,Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118 USA
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