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Disadvantaged neighbourhoods, modifiable risk factors, and cerebral small vessel disease in healthy midlife adults: the PREVENT Dementia study

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Publicado en:Alzheimer's & Dementia vol. 21 (Dec 1, 2025)
Autor principal: Low, Audrey
Otros Autores: Ntailianis, Georgios, Tsvetanov, Kamen A, Prats‐Sedano, Maria A, McKiernan, Elizabeth Frances, Carter, Stephen F, Stefaniak, James D, Nannoni, Stefania, McKeever, Anna, Su, Li, Dounavi, Maria‐Eleni, Muniz‐Terrera, Graciela, Bridgeman, Katie, Gregory, Sarah, Ritchie, Karen, Lawlor, Brian A, Naci, Lorina, Malhotra, Paresh, Koychev, Ivan, Ritchie, Craig, O'Brien, John T
Publicado:
John Wiley & Sons, Inc.
Materias:
Physical fitness
Alcohol related crime
Deprivation
Correlation analysis
Dementia
Politics
Magnetic resonance imaging
Health status
Hypertension
Cognition
Middle age
Cognitive ability
Lifestyles
Educational attainment
Cognitive impairment
Resilience
Cognition & reasoning
Disadvantaged
Information processing
Prevention
Alcohol use
Drinking behavior
Health behavior
Discriminant analysis
Neighborhoods
Clinical assessment
Data processing
Deprived areas
Risk factors
Health promotion
Obesity
Risk assessment
Structural equation modeling
Crime
Health education
Attainment
Adults
Disease
Computerization
Statistics
Acceso en línea:Citation/Abstract
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Resumen:Background Individuals living in socioeconomically disadvantaged areas are disproportionately affected by dementia. However, the pathway leading from neighbourhood deprivation to cognitive symptoms is not well understood. To test our hypothesis that this relationship is associated with cerebral small vessel disease (SVD), we examined (1) whether neighbourhood deprivation related to midlife SVD burden and cognition, and (2) whether these links can be explained by modifiable lifestyle risk factors. Method In this multi‐centre cross‐sectional study, 514 cognitively healthy midlife participants aged 40‐59 years (median 52 years, 64.6% female) underwent clinical assessment and 3T MRI. Postcode data were used to obtain national indices of neighbourhood deprivation. To quantify SVD, we assessed white matter hyperintensities (WMH), perivascular spaces, cerebral microbleeds, and lacunes. Cognition was assessed using the Computerized Assessment of Information Processing (COGNITO) battery. Lifestyle risk factors were evaluated based on clinical data. Using multivariate statistics like structural equation modelling (SEM) and canonical correlation analysis (CCA), we examined associations between these constructs both globally and at the item‐level (i.e., distinction between domains of cognition/deprivation), to shed light on specific domains that could inform targeted prevention strategies. Result Neighbourhood deprivation related to greater prevalence of lifestyle risk factors (r&#xa0;=&#xa0;0.36, p&#xa0;<&#xa0;.001), greater SVD burden (b=0.18, p&#xa0;=&#xa0;.01; Figure 1), and greater cognitive impairment (r&#xa0;=&#xa0;0.36, p&#xa0;<&#xa0;.001), independent of educational attainment, sex, and age. These links with neighbourhood deprivation were largely driven by lifestyle factors relating to vascular health (sleep, physical activity, obesity, hypertension) (Figure 2), and cognitive deficits consistent with SVD (processing speed, visuospatial) (Figure 3). Residents of deprived neighbourhoods displayed greater prevalence of lifestyle risk factors, except alcohol consumption. Lower cognitive scores were most closely associated with deprivation domains of Crime and Living Environment (Figure 3). The DEPRIVATION→SVD path was mediated by lifestyle risk factors (z=2.57, p&#xa0;=&#xa0;.010), and the DEPRIVATION→COGNITION path was mediated by SVD (z=‐2.14, p&#xa0;=&#xa0;.032) (global SVD & hypertensive subtype, but not CAA‐SVD). Conclusion The pathway linking neighbourhood disadvantage to cognitive impairment at midlife is influenced by vascular risk factors and cerebrovascular burden. Tailored strategies could promote resilience against dementia by promoting health behaviours aligned with the community's unique needs.
ISSN:1552-5260
1552-5279
DOI:10.1002/alz70860_106158
Fuente:Consumer Health Database