Non-Medical Factors that Affect Alzheimer's Disease and Related Dementias Risk

Overview

Health inequities have persisted across generations. This is in part because policies and practices have limited access to health care and other opportunities for health for some groups of people.

A growing body of research suggests that nonmedical factors and social conditions, including education, health care access, physical environment, and social connection, may influence a person's health, including their risk for dementia.

More work is needed to understand how these nonmedical factors influence dementia.

Education

Studies show an association between a lower level of education and poorer brain health.

• Research suggests that the proportion of adults age 45 and older with worsening memory loss or more frequent confusion (known as subjective cognitive decline) is:
  • More than twice as high for people without a high school diploma.
  • Lowest for college graduates.1

One reason may be cognitive reserve.2 Cognitive reserve refers to the level of knowledge and education "banked" in early years. Researchers believe this may protect and compensate for a decline in cognitive health in later years.

Access to health care

Some chronic conditions are linked to brain health. This is one reason that access to health care can also affect dementia risk. Consistent access to health care services can:

• Help people prevent chronic diseases by identifying behaviors and conditions that can lead to serious health problems.
• Aid in early diagnosis of many health conditions, such as diabetes, heart disease, and dementia.
• Help people manage chronic conditions to avoid complications and hospitalizations.
• Help diagnose dementia earlier to allow for better care coordination and support.

On the other hand, inconsistent or lack of quality health care access deprives people of these opportunities for optimal health, including brain health.

Built environment

The built environment is the physical environment around us. It includes the spaces where we live, learn, work, and age.

Built environments can influence overall community health and individual behaviors, such as physical activity and healthy eating. Unsafe or unhealthy environments or housing can negatively impact brain health.3

Healthy community design, such as adding crosswalks, bike lanes or sidewalks can improve opportunities for exercise, access to services, and community supports. All of these opportunities have a positive impact on brain and physical health.

Loneliness and social isolation

There is strong evidence that:

• Social isolation significantly increases a person's risk of premature death from all causes4.
• People experiencing social isolation or loneliness are at a higher risk for dementia.5

Resources

• Social Determinants of Health. CDC
• Measurement of Health Disparities, Health Inequities, and Social Determinants of Health to Support the Advancement of Health Equity.
• The Built Environment Assessment Tool Manual, CDC, Division of Nutrition, Physical Activity, and Obesity
• Physical Activity, Strategies and Resources, CDC, Division of Nutrition, Physical Activity, and Obesity
• Access to Health Services, CDC, Office of Disease Prevention and Health Promotion
• Improving Access to Quality Health Services, U.S. Department of Health and Human Services
• Subjective Cognitive Decline Among Adults Aged ≥45 Years — United States, 2015–2016, CDC, MMWR, July 13, 2018.
• Copenhagen Summit on Cognitive Reserve, Consensus Statement, 2019
• What is Cognitive Reserve? Harvard Health Publishing, Harvard Medical School