New research from Wake Forest University School of Medicine suggests that living in a disadvantaged neighborhood is associated with higher blood pressure and lower cognitive scores, even among people who do not have an existing diagnosis of mild cognitive impairment. 

The study appears online today in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, a journal of the Alzheimer’s Association. 

“We know that inequitable access to education, employment, income and housing increases the risk for Alzheimer’s disease and related dementias,” said James R. Bateman, M.D., assistant professor of neurology at Wake Forest University School of Medicine and principal investigator of the study. “However, more research is needed to better understand the impact of social determinants of health, including what this study analyzed with neighborhood disadvantage.” 

Bateman said neighborhood disadvantage refers to the lack of social and economic resources in one’s environment. To assess neighborhood disadvantage, the research team used the highly recognized national Area Deprivation Index, which measures housing quality, education and income. 

“Our goal of the study was to analyze the relationship of neighborhood disadvantage with measures of cardiometabolic health and cognition in individuals with and without diagnosed mild cognitive impairment,” said Bateman, who is also a neurologist at Atrium Health Wake Forest Baptist. 

Bateman said it was important for the team to compare individuals with a diagnosis to those without one to better understand how a person's current cognitive state impacts the relationship between their environment and their health.  

Cognition refers to the mental process of thinking, learning, remembering, being aware of surroundings and using judgment. Mild cognitive impairment is a decline in memory and thinking skills that is greater than expected with normal aging and is a risk factor for dementia.  

Bateman noted that many cardiometabolic diseases may increase the risk for cognitive impairment and dementia. Cardiometabolic health is the cardiovascular and metabolic health of an individual and involves the management of risk factors such as blood glucose, high blood pressure, high cholesterol and obesity. 

For the study, Bateman and team analyzed data from 537 adults over the age of 55 from the Alzheimer’s Disease Research Center Healthy Brain Study at Wake Forest University School of Medicine from 2016 to 2021. 

Individuals received clinical exams, neurocognitive testing and neuroimaging, in addition to cardiometabolic tests to screen for diabetes, high cholesterol and high blood pressure. 

The neurocognitive testing included in the study evaluated constructs such as memory, executive function, language, visuospatial skills, concentration and attention. 

“We found an association between neighborhood disadvantage and higher blood pressure and cardiometabolic index, as well as lower cognitive scores in individuals who did not have a diagnosed mild cognitive impairment,” said Sudarshan Krishnamurthy, a fifth-year M.D./Ph.D. student at Wake Forest University School of Medicine and first author of the paper. 

Krishnamurthy said that neighborhood disadvantage was only associated with higher hemoglobin A1C, which measures blood sugar, in people with diagnosed mild cognitive impairment. 

"These findings show that living in a disadvantaged neighborhood has a bigger impact on heart health and brain function in people without preexisting cognitive issues," Bateman said. “Our study highlights the importance of implementing structural changes to address social determinants of health to mitigate cardiometabolic and cognitive risks.” 

Krishnamurthy added that the study underscores the impact of a person’s living environment. 

“This study confirms what we had hypothesized: Where you live and the resources and opportunities that are available to you as a result, have a tangible impact on your risk for dementia,” Krishnamurthy said. 

Established in 2016, the Alzheimer’s Disease Research Center at Wake Forest University School of Medicine is one of only 35 research centers in the country funded by the National Institute on Aging. Its goal is to translate research advances into improved diagnosis and care for people with the disease, and to find a treatment or ways to prevent Alzheimer's and other types of dementia.