CoChat
Sign Up
Cited by 191Dementia and Cognitive Impairment ResearchHealth disparities and outcomesPublic Health and Social Inequalities

Effect of Social Determinants of Health on Cognition and Risk of Alzheimer Disease and Related Dementias

Open access
Majoka, Muniza Anum, Schimming, Corbett·2021·Clinical Therapeutics
DOI 10.1016/j.clinthera.2021.05.005
Open this paper in CoChat — free accountOpen PDF

Abstract

Social determinants of health are the conditions in which people are born, work, live, and age and the wider set of forces and systems that shape the conditions of daily life. They affect every area of life, particularly health and health care. There is increasing focus on modifiable factors that affect cognition and risk of Alzheimer disease and related dementias (ADRDs). This article examines the impact of various social determinants of health, which are potentially reversible, on the incidence, prevalence, and risk of ADRDs and cognition. Various social determinants of health affect cognition and risk of ADRDs. Lower socioeconomic status (SES) and less education are associated with a higher incidence of ADRDs, whereas higher SES and education level appear to be protective, leading to a deceleration of time to diagnosis. In terms of employment, manual labor is associated with a higher risk of ADRDs. Higher body mass index in midlife and a decreasing body mass index in old age are associated with a higher risk of ADRDs. Furthermore, lower food security in early and late life is associated with a higher risk of ADRD diagnosis. Neighborhoods that are economically disadvantaged with fewer physical resources are associated with a higher risk of ADRDs. Higher levels of social engagement have a protective effect on diagnosis of ADRDs. Higher levels of stress are associated with a higher likelihood of developing ADRDs. Early-life adversity is associated with an increased risk of ADRDs, and further work in this area will be illuminating. Racial discrimination also leads to higher risk of ADRDs through the direct effect of discrimination and indirectly through lower SES, educational level, employment, and residential segregation. With an aim of reducing of ADRDs, future work in enhancing education, improving socioeconomic conditions, work, and neighborhood environments, and eliminating racial discrimination could potentially have a drastic impact.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.clinthera.2021.05.005

Cites

7 of 7 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Several studies have shown an association of SDoH factors such as education level, isolation, and loneliness with the onset of Alzheimer's disease and related dementias (ADRD) in older adults.

    “Several studies have shown the association of SDoH factors such as education level, isolation, and loneliness with the onset of Alzheimer’s disease and related dementias (ADRD) in older adults84–86.”

    From Social determinants of health extraction from clinical notes across institutions using large language models (2025) · cites this paper as [85]

    The Education section reports an association between lower education and higher ADRD risk. The Social Engagement section links isolation to poorer cognition and reports that greater middle- and late-life engagement reduces later ADRD diagnosis risk. Loneliness appears in a cited study’s title, but our copy does not separately report an association between loneliness and ADRD onset. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 51

  1. Ajnakina O , Cadar D , Steptoe A . Interplay between Socioeconomic Markers and Polygenic Predisposition on Timing of Dementia Diagnosis. J Am Geriatr Soc . 2020;68:1529-1536 .
  2. Marden JR , et al. Contribution of Socioeconomic Status at 3 Life-Course Periods to Late-Life Memory Function and Decline: Early and Late Predictors of Dementia Risk. American journal of epidemiology . 2017;186:805-814 .
  3. Gracia Rebled AC , et al. [Occupation and Risk of Cognitive Impairment and Dementia in People in over 55 Years: A Systematic Review, Spain]. Rev Esp Salud Publica . 2016;90:e1-e15 .
  4. Nakahori N , et al. A pathway from low socioeconomic status to dementia in Japan: results from the Toyama dementia survey. BMC Geriatr . 2018;18:102 .
  5. Hughes TF , Ganguli M . Modifiable Midlife Risk Factors for Late-Life Cognitive Impairment and Dementia. Curr Psychiatry Rev . 2009;5:73-92 .
  6. Potter GG , et al. Job demands and dementia risk among male twin pairs. Alzheimer's & dementia: the journal of the Alzheimer's Association . 2007;3:192-199 .
  7. Na M , et al. Food Insecurity and Cognitive Function in Middle to Older Adulthood: A Systematic Review. Adv Nutr . 2020;11:667-676 .
  8. Wong JC , et al. Food Insecurity Is Associated with Subsequent Cognitive Decline in the Boston Puerto Rican Health Study. J Nutr . 2016;146:1740-1745 .
  9. Weuve J , et al. Cognitive Aging in Black and White Americans: Cognition, Cognitive Decline, and Incidence of Alzheimer Disease Dementia. Epidemiology . 2018;29:151-159 .
  10. Reuser M , Willekens FJ , Bonneux L . Higher education delays and shortens cognitive impairment: a multistate life table analysis of the US Health and Retirement Study. Eur J Epidemiol . 2011;26:395-403 .
  11. Anstey KJ , et al. Body mass index in midlife and late-life as a risk factor for dementia: a meta-analysis of prospective studies. Obes Rev . 2011;12:e426-e437 .
  12. Kivimäki M , et al. Body mass index and risk of dementia: Analysis of individual-level data from 1.3 million individuals. Alzheimer's & dementia: the journal of the Alzheimer's Association . 2018;14:601-609 .
  13. Buchman AS , et al. Change in body mass index and risk of incident Alzheimer disease. Neurology . 2005;65:892-897 .
  14. Arvanitakis Z , et al. Body Mass Index and Decline in Cognitive Function in Older Black and White Persons. J Gerontol A Biol Sci Med Sci . 2018;73:198-203 .
  15. Wagner M , et al. Evaluation of the Concurrent Trajectories of Cardiometabolic Risk Factors in the 14 Years Before Dementia. JAMA Psychiatry . 2018;75:1033-1042 .
  16. Lupien SJ , et al. The effects of stress and stress hormones on human cognition: Implications for the field of brain and cognition. Brain Cogn . 2007;65:209-237 .
  17. Aggarwal NT , et al. Perceived stress and change in cognitive function among adults 65 years and older. Psychosom Med . 2014;76:80-85 .
  18. Turner AD , et al. Perceived Stress and Cognitive Decline in Different Cognitive Domains in a Cohort of Older African Americans. Am J Geriatr Psychiatry . 2017;25:25-34 .
  19. Wu YT , Prina AM , Brayne C . The association between community environment and cognitive function: a systematic review. Soc Psychiatry Psychiatr Epidemiol . 2015;50:351-362 .
  20. Besser LM , et al. Neighborhood Environment and Cognition in Older Adults: A Systematic Review. Am J Prev Med . 2017;53:241-251 .
  21. Clarke PJ , et al. Cognitive decline and the neighborhood environment. Ann Epidemiol . 2015;25:849-854 .
  22. Luo Y , Zhang L , Pan X . Neighborhood Environments and Cognitive Decline Among Middle-Aged and Older People in China. J Gerontol B Psychol Sci Soc Sci . 2019;74:e60-e71 .
  23. Peters R , et al. Air Pollution and Dementia: A Systematic Review. Journal of Alzheimer's disease: JAD . 2019;70:S145-S163 .
  24. Peterson RL , et al. The role of social and behavioral risk factors in explaining racial disparities in age-related cognitive impairment: a structured narrative review. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn . 2020;27:173-196 .
  25. Krueger KR , et al. Social engagement and cognitive function in old age. Exp Aging Res . 2009;35:45-60 .
  26. Barnes LL , et al. Social resources and cognitive decline in a population of older African Americans and whites. Neurology . 2004;63:2322-2326 .
  27. Zhou Z , Wang P , Fang Y . Social Engagement and Its Change are Associated with Dementia Risk among Chinese Older Adults: A Longitudinal Study. Sci Rep . 2018;8:1551 .
  28. Penninkilampi R , et al. The Association between Social Engagement, Loneliness, and Risk of Dementia: A Systematic Review and Meta-Analysis. J Alzheimers Dis . 2018;66:1619-1633 .
  29. Barnes LL , et al. Effects of early-life adversity on cognitive decline in older African Americans and whites. Neurology . 2012;79:2321-2327 .
  30. Radford K , et al. Childhood Stress and Adversity is Associated with Late-Life Dementia in Aboriginal Australians. Am J Geriatr Psychiatry . 2017;25:1097-1106 .
  31. Council, N.R., Measuring Racial Discrimination , ed. R.M. Blank, M. Dabady, and C.F. Citro. 2004, Washington, DC: The National Academies Press. 334.
  32. Pager D , Shepherd H . The Sociology of Discrimination: Racial Discrimination in Employment, Housing, Credit, and Consumer Markets. Annual review of sociology . 2008;34:181-209 .
  33. Gurland BJ , et al. Rates of dementia in three ethnoracial groups. Int J Geriatr Psychiatry . 1999;14:481-493 .
  34. Cooper C , et al. A systematic review and meta-analysis of ethnic differences in use of dementia treatment, care, and research. American Journal of Geriatric Psychiatry . 2010;18:193-203 .
  35. Rajan KB , et al. Race, APOE ɛ 4, and Long-Term Cognitive Trajectories in a Biracial Population Sample. J Alzheimers Dis . 2019;72:45-53 .
  36. Williams DR , Lawrence JA , Davis BA . Racism and Health: Evidence and Needed Research. Annual review of public health . 2019;40:105-125 .
  37. Barnes LL , et al. Perceived discrimination and cognition in older African Americans. Journal of the International Neuropsychological Society: JINS . 2012;18:856-865 .
  38. Zahodne LB , Sol K , Kraal Z . Psychosocial Pathways to Racial/Ethnic Inequalities in Late-Life Memory Trajectories. The journals of gerontology. Series B, Psychological sciences and social sciences . 2019;74:409-418 .
  39. Coogan P , et al. Experiences of racism and subjective cognitive function in African American women. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring . 2020;12:e12067 .
  40. Sisco S , et al. The role of early-life educational quality and literacy in explaining racial disparities in cognition in late life. The journals of gerontology. Series B, Psychological sciences and social sciences . 2015;70:557-567 .
  41. Shadlen MF , et al. Education, cognitive test scores, and black-white differences in dementia risk. J Am Geriatr Soc . 2006;54:898-905 .
  42. Yaffe K , et al. Effect of socioeconomic disparities on incidence of dementia among biracial older adults: prospective study. Bmj . 2013;347:f7051 .
  43. George KM , et al. Life-Course Individual and Neighborhood Socioeconomic Status and Risk of Dementia in the Atherosclerosis Risk in Communities Neurocognitive Study. Am J Epidemiol . 2020;189:1134-1142 .
  44. Schwartz BS , et al. Disparities in cognitive functioning by race/ethnicity in the Baltimore Memory Study. Environmental health perspectives . 2004;112:314-320 .
  45. Tomaskovic-Devey D , Thomas M , Johnson K . Race and the accumulation of human capital across the career: A theoretical model and fixed-effects application. American Journal of Sociology . 2005;111:58-89 .
  46. Cancio AS , Evans TD , Maume Jr DJ . Reconsidering the declining significance of race: Racial differences in early career wages. American Sociological Review . 1996:541-556 .
  47. Gee GC , Ford CL . Structural Racism and Health Inequities: Old Issues, New Directions. Du Bois review: social science research on race . 2011;8:115-132 .
  48. WILLIAMS DR . Race, Socioeconomic Status, and Health The Added Effects of Racism and Discrimination. Annals of the New York Academy of Sciences . 1999;896:173-188 .
  49. White K , Borrell LN . Racial/ethnic residential segregation: framing the context of health risk and health disparities. Health & place . 2011;17:438-448 .
  50. Williams DR, Mohammed SA. Racism and Health I: Pathways and Scientific Evidence. The American behavioral scientist . 2013;57. doi: 10.1177/0002764213487340 . · DOI · Paper page
  51. Meeker KL , et al. Socioeconomic Status Mediates Racial Differences Seen Using the AT(N) Framework. Annals of Neurology . 2021;89:254-265 .

Cited by

Sorted by citations

Authors
Majoka, M. A., & Schimming, C.
Affiliations
  • Icahn School of Medicine at Mount Sinai (US)
  • James J. Peters VA Medical Center (US)
Corresponding author
Majoka, Muniza Anum
Venue
Clinical Therapeutics
Publisher
Elsevier BV
Published
2021-06
Volume
43
Issue
6
Pages
922-929
ISSN
0149-2918 (ISSN-L)
DOI
10.1016/j.clinthera.2021.05.005
OpenAlex
W3167009549
Cited by
191
References
7
Citations by year
2026: 36 · 2025: 39 · 2024: 55 · 2023: 42 · 2022: 16 · 2021: 3
FWCI
20.82
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Therapeutics (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
social determinants of health, Alzheimer's disease and related dementias, cognitive function, socioeconomic status, employment, manual labor, body mass index, food security, neighborhood disadvantage, social engagement, stress, childhood adversity, racial discrimination, residential segregation, dementia risk
MeSH terms
Social Factors, Alzheimer Disease, Cognition, Humans, Residence Characteristics, Social Determinants of Health

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review