Abstract
Socioeconomic disadvantage is associated with greater risk of dementia. This has been theorised to reflect inequalities in cognitive reserve, healthcare access, lifestyle, and other health factors which may contribute to the clinical manifestation of dementia. We aimed to assess whether area deprivation in the United Kingdom was associated with greater risk or severity of the specific neurodegenerative diseases which lead to dementia in a multi-centre cohort with autopsy assessment. Participants underwent clinical assessment prior to brain tissue donation post-mortem. Each then underwent detailed, standardised neuropathological assessment. National area deprivation statistics were derived for each participant’s neighbourhood, for use as a predictor in binary and ordinal logistic models assessing the respective presence and severity of staging of key neuropathological changes, adjusting for theorised confounders. Individuals from among the 20% most deprived neighbourhoods in the United Kingdom had significantly higher neurofibrillary tangle and neuritic plaque staging, and increased risk of cerebral amyloid angiopathy. These findings were not explained by a greater risk of diabetes or hypertension, APOE genotype, alcohol misuse or tobacco smoking, sex, or age differences. A sensitivity analysis conditioning on baseline cognitive impairment did not meaningfully change the observed association. Socioeconomic disadvantage may contribute to dementia incidence through a greater severity of specific neuropathological changes (neurofibrillary tangles, neuritic plaques, and cerebral amyloid angiopathy), independent of other indirect influences. Mechanisms through which deprivation is associated with these require further exploration.
Highlights
Dementia is responsible for considerable financial, health, and quality of life costs to individuals with this condition, caregivers, and healthcare services
Fifty-seven had postcodes which could not be matched to an Indices of multiple deprivation (IMD) rank and so were excluded from subsequent analysis; these did not significantly differ from those with valid IMD ranks in their baseline age (Z = 1.55, p = 0.12), education level (Z = − 0.85, p = 0.40), or male/ female proportion (χ(1)2 = 0.26, p = 0.61)
We found that those living within the top 20% most deprived areas of England and Wales were at greater risk of more severe Alzheimer’s disease (AD)-related neuropathological changes, with higher severity of Neurofibrillary tangle (NFT) and neuritic plaque staging, and greater risk of cerebral amyloid angiopathy (CAA)
Summary
Dementia is responsible for considerable financial, health, and quality of life costs to individuals with this condition, caregivers, and healthcare services. In the United Kingdom, greater local area deprivation is associated with poorer quality of life after diagnosis of dementia [6], and reduced access to dementia treatments [7]. It has been theorised [2] that addressing several deprivation-associated modifiable risk factors could serve to reduce dementia inequalities through increasing cognitive reserve, and by attenuating the neuropathological changes responsible for dementia through bettering overall brain health: reducing incidence of cerebrovascular disease (CVD); one of a number of contributors to dementia, including common neurodegenerative diseases such as Alzheimer’s disease (AD) and Lewy body (LB) disease. That socioeconomic disadvantage and associated health factors directly contribute to the risk or severity of neuropathological changes, rather than risk of dementia diagnosis, has not been clearly demonstrated
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