Abstract
Preliminary evidence suggests that neighborhood environments, such as socioeconomic disadvantage, pedestrian and physical activity infrastructure, and availability of neighborhood destinations (e.g., parks), may be associated with late-life cognitive functioning and risk of Alzheimer’s disease and related disorders (ADRD). The supposition is that these neighborhood characteristics are associated with factors such as mental health, environmental exposures, health behaviors, and social determinants of health that in turn promote or diminish cognitive reserve and resilience in later life. However, observed associations may be biased by self-selection or reverse causation, such as when individuals with better cognition move to denser neighborhoods because they prefer many destinations within walking distance of home, or when individuals with deteriorating health choose residences offering health services in neighborhoods in rural or suburban areas (e.g., assisted living). Research on neighborhood environments and ADRD has typically focused on late-life brain health outcomes, which makes it difficult to disentangle true associations from associations that result from reverse causality. In this paper, we review study designs and methods to help reduce bias due to reverse causality and self-selection, while drawing attention to the unique aspects of these approaches when conducting research on neighborhoods and brain aging.
Highlights
Studies on the influence of neighborhood environments (NE) (i.e., social and built environments (BE)) on brain health are still in their infancy but are growing rapidly and provide tentative evidence that our community environments may affect the brain throughout the lifespan [1,2,3]
We demonstrate that inverse probability weighting may be preferable to adjustment or stratification when attempting to account for neighborhood selfselection
While inverse probability weighting attenuated the findings when compared to adjustment or no adjustment for self-selection as a covariate, the association between living in Abacoa and walking/week remained and suggests that either neighborhood self-selection is either only a partial confounder or that the measure of self-selection used in our study did not fully capture the pertinent construct of self-selection
Summary
Studies on the influence of neighborhood environments (NE) (i.e., social and built environments (BE)) on brain health are still in their infancy but are growing rapidly and provide tentative evidence that our community environments may affect the brain throughout the lifespan [1,2,3]. Measures of the BE such as greater land use mix (e.g., mix of retail and residential) [11], access to retail destinations [12], public transportation availability [13], greater walkability [14] (i.e., environment conducive to walking by providing multiple destinations and density of street connections), and greater greenness/park space access [15,16,17,18] have been associated with various measures of brain health in older adults including diagnoses of Alzheimer’s disease and related disorders (ADRD) This body of research is typically rooted in the socioecological framework that posits that beyond individual level determinants of brain.
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