Neighborhood Deprivation Linked to AD Outcomes

TOPLINEHigher neighborhood deprivation was linked to lower cognitive scores among White/European American and Hispanic/Latinx/Spanish older adults, but not among Black/African American/African participants, a study showed. Compared with noncarriers, apolipoprotein E (APOE) epsilon 4 carriers had higher amyloid in low- and moderate-deprivation areas and higher white matter hyperintensities (WMH) and tau in high-deprivation areas. Women in moderately deprived areas had higher tau than men. However, most findings did not survive correction for multiple testing.METHODOLOGYResearchers conducted an analysis of baseline data from US POINTER, a randomized trial of cognitively unimpaired adults aged 60-79 years who were at risk for dementia, across five sites in the US.The study included 1880 participants (67.9% women; 71.1% White/European American individuals; 31.2% APOE epsilon 4 carriers) with Area Deprivation Index (ADI) and Preclinical Alzheimer's Cognitive Composite (PACC) data.A subset of participants had at least one imaging measure of Alzheimer's disease (AD) pathology or brain structure: amyloid PET (n = 868), tau PET (n = 845), WMH (n = 825), or gray matter volume (n = 836).National ADI percentile was analyzed both continuously and in three categories (low, 0-30; moderate, 30-70; high, 70-100), with higher values indicating greater disadvantage.Researchers tested whether ADI-outcome associations differed by sex, race and ethnicity, or APOE epsilon 4 status, adjusting for age, with and without education.TAKEAWAYThe ADI × race and ethnicity interaction on cognition was significant with categorical ADI (P = .040). Higher continuous ADI was linked to lower PACC in White/European American (P < .001), Hispanic/Latinx/Spanish (P < .001), and Other (P = .021) participants.After adjustment for education, the categorical ADI × race and ethnicity interaction was no longer significant, and the continuous interaction remained nonsignificant. In exploratory mediation analyses, education statistically accounted for about 22.6% of the overall ADI-PACC association. Neither interaction survived false discovery rate (FDR) correction.For amyloid, the categorical ADI × APOE epsilon 4 interaction was significant (P = .001) and survived FDR correction. Carriers had higher amyloid than noncarriers in low-ADI (P < .001) and moderate-ADI areas (P < .001), but not in high-ADI areas.Higher continuous ADI was linked to greater WMH among APOE epsilon 4 carriers (P = .040). In high-ADI areas, carriers had higher tau (P = .016) and WMH (P = .046) than noncarriers, and women in moderate-ADI areas had higher tau than men (P = .005); these did not survive FDR correction.IN PRACTICE"Differential associations of ADI with AD-related outcomes across biological and social factors may reflect systemic health disparities and study design," the authors wrote.SOURCEThe study was led by Pablo Aguilar-Dominguez, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain. It was published online on November 1 in Alzheimer's & Dementia.LIMITATIONSThe study's exploratory, cross-sectional design precluded causal inference, and most findings did not survive correction for multiple comparisons. The imaging sample skewed toward less deprived areas, which may have led to underestimated biomarker associations. Other limitations included coarse racial and ethnic categories, unmeasured cardiometabolic and lifestyle factors, small subgroups, and ADI assigned from baseline residence only.DISCLOSURESThe study was funded by a POINTER imaging grant, as well as the Alzheimer's Association, the Fondo de Investigación Sanitaria, the Instituto de Salud Carlos III, the Ministerio de Ciencia e Innovación, and the Barcelona City Council–"la Caixa" Foundation. Disclosure information for the study investigators is available in the original study publication.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.