More than 55 million people across the world are living with dementia, and 10 million more people are diagnosed with dementia each year.

Dementia. World Health Organization.

Although several nonmodifiable risk factors (eg, age, genetics, and family history) cannot be prevented, 40% of dementia cases could be prevented or delayed through modifiable risk factors, according to a study published in The Lancet.

Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, Volume 396, Issue 10248, 413 - 446. August 8, 2020.

 

 

 

Looking at the research

 

According to the American Psychological Association, SES encompasses income, educational attainment, financial security, and subjective perceptions of social status and social class.

Education and Socioeconomic Status. American Psychological Association. 2017.

 

There have been multiple studies across the globe looking at the relationship between dementia and low SES neighborhoods. In a meta-analysis of 39 prospective studies (1,485,702 individuals), 25 studies reported an incidence of dementia, and 14 studies reported cognitive decline in relation to living in low SES neighborhoods.

Wang AY, Hu HY, Ou YN, et al. Socioeconomic Status and Risks of Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of 39 Prospective Studies. J Prev Alzheimers Dis. 2023;10(1):83-94. doi: 10.14283/jpad.2022.81.

 

 

Additionally, a prospective cohort study that recruited a nationally representative sample of US Medicare beneficiaries aged ≥65 years examined the relationship between low SES and dementia in the United States. Results showed “low income and greater financial strain predict incident dementia among older adults.”

Samuel LJ, Szanton SL, Wolff JL, et al. Socioeconomic disparities in six-year incident dementia in a nationally representative cohort of U.S. older adults: an examination of financial resources. BMC Geriatr 20, 156 (2020). https://doi.org/10.1186/s12877-020-01553-4.

 

A study that took place over a 20-year span based out of New Zealand published in The Journal of Alzheimer's Association also found this to be true.

Reuben A, Richmond-Rakerd LS, Milne B, et al. Dementia, dementia's risk factors and premorbid brain structure are concentrated in disadvantaged areas: National register and birth-cohort geographic analyses. J Alzheimers Dis. March 14, 2024. https://doi.org/10.1002/alz.13727.

“People residing in disadvantaged neighborhoods were at greater risk of dementia [and], decades before clinical endpoints typically emerge, evidenced elevated dementia-risk scores [...] and displayed dementia-associated brain structural deficits and cognitive difficulties/decline,” the authors concluded.

 

In a press release from Duke University, study lead Aaron Reuben, PhD, said, “If you want to prevent dementia, and you’re not asking someone about their neighborhood, you're missing information that's important to know.”

Many individual choices, like what you eat, what you do for fun, or who you spend time with, are constrained by where you live.

 

SES as a modifiable risk factor

 

There are many individual modifiable risk factors for dementia, such as poor diet and physical inactivity. Recently, researchers have begun to look into the community spaces where these individual modifiable risk factors for dementia occur. 

 

With higher violence and crime rates, the feeling of safety is jeopardized. Individuals may be less inclined to exercise or play outdoors because they feel unsafe, reducing the amount of physical exercise and socialization.

Additionally, a lack of schools, medical clinics, social centers, and green spaces can mean reduced access to better education, healthcare, social functions, and time spent in nature. Diabetes, high blood pressure, and social isolation are known modifiable risk factors for dementia, and if an individual is less likely to receive medical care or engage in social activities because these resources are lacking in their neighborhood, they could be at heightened risk.