MedicalResearch.com Interview with:
Amy Kind, M.D., Ph.D.
Associate Professor, Division of Geriatrics
Director, Department of Medicine Health Services and Care Research Program
University of Wisconsin School of Medicine and Public Health and
Associate Director- Clinical
Geriatrics Research, Education and Clinical Center (GRECC)
William S. Middleton Veteran’s Affairs Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Background: Dementia due to Alzheimer’s Disease (AD) disproportionately impacts racial/ethnic minorities and the socioeconomically disadvantaged—populations often exposed to neighborhood disadvantage. Neighborhood disadvantage is associated with education, health behaviors and mortality. Health improves with moving to less disadvantaged neighborhoods (Ludwig, Science 2012). Although studies have linked neighborhood disadvantage to diseases like diabetes and cancer, little is known about its effect on development of dementia.
Objective: To examine the association between neighborhood disadvantage, baseline cognition, and CSF biomarkers of Alzheimer’s Disease among participants in the WRAP study, comprising a cohort of late-middle-aged adults enriched for parental family history of AD.
Methods: We created and validated neighborhood-level quantifications of socioeconomic contextual disadvantage for the full US—over 34 million Zip+4 codes—employing the latest American Community Survey and Census data. This metric–the Area Deprivation Index (ADI)–incorporates poverty, education, housing and employment indicators; predicts disparity-related health outcomes; and is employed by Maryland and Medicare through our provision. We used standard techniques to geocode all WRAP subjects with a documented address (N= 1479). WRAP participants were ranked into deciles of neighborhood disadvantage, by ADI. Baseline cognitive function (indexed by factor scores) and CSF biomarker outcomes for levels of Aβ42 and P-tau181 (n=153 with CSF samples) were examined by neighborhood disadvantage decile.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Higher levels of neighborhood disadvantage were associated with worse baseline cognitive outcomes, especially within the most disadvantaged neighborhood decile (p<0.0001). After adjustment for age and education, those within the most disadvantaged decile demonstrated worse cognitive performance across all domains (beta [95% confidence interval] and p-value by domain: working memory: -0.45 [-0.62, -0.28], <0.0001; immediate memory: -0.34 [-0.52, -0.17], <0.0001; speed/flexibility: -0.62 [-0.78, -0.45], <0.0001; verbal learning: -0.44 [-0.61, -0.27], <0.0001). Furthermore, subjects within the most disadvantaged neighborhood decile exhibited a mean CSF P-tau 11.61 units higher (p=0.064) than those within less disadvantaged neighborhoods. Aβ42 did not differ by neighborhood decile.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: These early data suggest that neighborhood disadvantage may account for some of the observed disparities in prevalence of dementia.
MedicalResearch.com: Is there anything else you would like to add?
Response: Given the urgent need to reduce dementia and Alzheimer’s Disease disparities, the current results suggest that neighborhood disadvantage deserves additional study.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
AAIC 2017 abstract:
Neighborhood Socioeconomic Contextual Disadvantage, Baseline Cognition and Alzheimer’s Disease Biomarkers in the Wisconsin Registry for Alzheimer’s Prevention (WRAP) Study
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