Are Well-Off People Protected from Dementia?

MedicalResearch.com Interview with:
Dr Dorina Cadar
Research Associate in Dementia
Psychobiology Group
Department of Behavioural Science and Health
University College London
London

MedicalResearch.com: What is the background for this study?

Response: Dementia is one of the most feared medical conditions, which represents a significant global challenge to health and social care.

Education may serve different roles in the development of dementia: it is a proxy for early life experiences and (parental) socioeconomic status, it is related to future employment prospects, income and wealth, determines occupational exposures and characteristics of adult life (e.g., job complexity, work stress, environmental exposures) and it provides lifelong skills for optimal mental abilities and mastery. However, given that education is typically completed many decades before dementia onset, other individual and area-based components of socioeconomic status, such as wealth, income and area deprivation may provide a more accurate indication of current socioeconomic resources.  Also, at older ages, accumulated wealth represents a more robust measure of socioeconomic resources than income or occupation alone.

MedicalResearch.com: What are the main findings? 

Response: In an English nationally representative sample, the incidence of dementia appeared to be socioeconomically patterned, primarily by the level of wealth. We also investigate if dementia incidence changed over time by comparing the rates of dementia incidence in two independent groups: those born between 1902-1925 and 1926-1943; and found that socioeconomic disparities were somehow stronger for later born participants.

It is, possible, that individuals born before WW2 may not necessarily have been able to access higher education (due to military service, financial restrictions and limited university place availability), but may have gained access to intellectually challenging jobs and growth financial opportunities after the war.

MedicalResearch.com: What should readers take away from your report?

Response: Our study confirms that the risk of dementia is reduced among well-off older people compared with those who have fewer economic resources. Many factors could be involved. Differences in healthy lifestyle and medical risk factors are relevant.  It may also be that better off people have greater social and cultural opportunities that allow them to remain actively engaged with the world.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: Avenues for future studies include examining the mediating role of cardiovascular disease, lifestyle factors, medical care and other risk factors that could influence the association between various socioeconomic markers and dementia. 

MedicalResearch.com: Is there anything else you would like to add?

Response: Public health strategies for dementia prevention should target socioeconomic gaps to reduce health disparities and protect those who are particularly disadvantaged, in addition to addressing vascular risk factors such as hypertension, diabetes mellitus, smoking, and heart disease.

Citation:

Cadar D, Lassale C, Davies H, Llewellyn DJ, Batty GD, Steptoe A. Individual and Area-Based Socioeconomic Factors Associated With Dementia Incidence in EnglandEvidence From a 12-Year Follow-up in the English Longitudinal Study of AgeingJAMA Psychiatry. Published online May 16, 2018. doi:10.1001/jamapsychiatry.2018.1012

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