Neighborhood characteristics and dementia symptomology among community-dwelling older adults with Alzheimer’s disease
BackgroundNeuropsychiatric symptoms (NPSs) lead to myriad poor health outcomes among individuals with Alzheimer’s disease (AD). Prior studies have observed associations between the various aspects of the home environment and NPSs, but macro-level environmental stressors (e.g., neighborhood income) m...
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| Format: | Article |
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Aging Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnagi.2022.937915/full |
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| author | Dana M. Alhasan Matthew C. Lohman Jana A. Hirsch Maggi C. Miller Bo Cai Chandra L. Jackson Chandra L. Jackson |
| author_facet | Dana M. Alhasan Matthew C. Lohman Jana A. Hirsch Maggi C. Miller Bo Cai Chandra L. Jackson Chandra L. Jackson |
| author_sort | Dana M. Alhasan |
| collection | DOAJ |
| description | BackgroundNeuropsychiatric symptoms (NPSs) lead to myriad poor health outcomes among individuals with Alzheimer’s disease (AD). Prior studies have observed associations between the various aspects of the home environment and NPSs, but macro-level environmental stressors (e.g., neighborhood income) may also disrupt the neuronal microenvironment and exacerbate NPSs. Yet, to our knowledge, no studies have investigated the relationship between the neighborhood environment and NPSs.MethodsUsing 2010 data among older adults with AD collected from a sample of the South Carolina Alzheimer’s Disease Registry, we estimated cross-sectional associations between neighborhood characteristics and NPSs in the overall population and by race/ethnicity. Neighborhood measures (within a 1/2-mile radius of residence) came from the American Community Survey and Rural Urban Commuting Area Code. We categorized median household income into tertiles: < $30,500, $30,500–40,000, and > $40,000, and rurality as: rural, small urban, and large urban. Residential instability was defined as the percent of residents who moved within the past year. NPSs were defined using the Neuropsychiatric Inventory Questionnaire that included the composite measure of all 12 domains. Adjusting for age, sex/gender, race/ethnicity, and caregiver educational attainment, we used negative binomial regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for NPSs by neighborhood characteristics.ResultsAmong 212 eligible participants, mean age was 82 ± 8.7 years, 72% were women, and 55% non-Hispanic (NH)-Black. Individuals with AD living in < $30,500 vs. > $40,000 income neighborhoods had a 53% (PR = 1.53; 95% CI = 1.06–2.23) higher prevalence of NPSs while individuals living in rural vs. large urban neighborhoods had a 36% lower prevalence of NPSs (PR = 0.64; 95% CI = 0.45–0.90), after adjustment. We did not observe an association between residential instability and NPSs (PR = 0.92; 95% CI = 0.86–1.00); however, our estimates suggested differences by race/ethnicity where NH-White older adults living in residential instable areas had lower NPSs (PR = 0.89; 95% CI = 0.82–0.96) compared to NH-Black older adults (PR = 0.96; 95% CI = 0.86–1.07).DiscussionAcross racial/ethnic groups, individuals with AD had more symptomology when living in lower income areas. Pending replication, intervention efforts should consider resource allocation to high-need neighborhoods (e.g., lower income), and studies should investigate underlying mechanisms for this relationship. |
| first_indexed | 2024-04-11T21:01:45Z |
| format | Article |
| id | doaj.art-50b74493fed04526966de93871fcd6ce |
| institution | Directory Open Access Journal |
| issn | 1663-4365 |
| language | English |
| last_indexed | 2024-04-11T21:01:45Z |
| publishDate | 2022-09-01 |
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| series | Frontiers in Aging Neuroscience |
| spelling | doaj.art-50b74493fed04526966de93871fcd6ce2022-12-22T04:03:27ZengFrontiers Media S.A.Frontiers in Aging Neuroscience1663-43652022-09-011410.3389/fnagi.2022.937915937915Neighborhood characteristics and dementia symptomology among community-dwelling older adults with Alzheimer’s diseaseDana M. Alhasan0Matthew C. Lohman1Jana A. Hirsch2Maggi C. Miller3Bo Cai4Chandra L. Jackson5Chandra L. Jackson6Epidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United StatesDepartment of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United StatesUrban Health Collaborative, Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, United StatesDepartment of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United StatesDepartment of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United StatesEpidemiology Branch, Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, United StatesIntramural Program, Department of Health and Human Services, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United StatesBackgroundNeuropsychiatric symptoms (NPSs) lead to myriad poor health outcomes among individuals with Alzheimer’s disease (AD). Prior studies have observed associations between the various aspects of the home environment and NPSs, but macro-level environmental stressors (e.g., neighborhood income) may also disrupt the neuronal microenvironment and exacerbate NPSs. Yet, to our knowledge, no studies have investigated the relationship between the neighborhood environment and NPSs.MethodsUsing 2010 data among older adults with AD collected from a sample of the South Carolina Alzheimer’s Disease Registry, we estimated cross-sectional associations between neighborhood characteristics and NPSs in the overall population and by race/ethnicity. Neighborhood measures (within a 1/2-mile radius of residence) came from the American Community Survey and Rural Urban Commuting Area Code. We categorized median household income into tertiles: < $30,500, $30,500–40,000, and > $40,000, and rurality as: rural, small urban, and large urban. Residential instability was defined as the percent of residents who moved within the past year. NPSs were defined using the Neuropsychiatric Inventory Questionnaire that included the composite measure of all 12 domains. Adjusting for age, sex/gender, race/ethnicity, and caregiver educational attainment, we used negative binomial regression to estimate prevalence ratios (PR) and 95% confidence intervals (CI) for NPSs by neighborhood characteristics.ResultsAmong 212 eligible participants, mean age was 82 ± 8.7 years, 72% were women, and 55% non-Hispanic (NH)-Black. Individuals with AD living in < $30,500 vs. > $40,000 income neighborhoods had a 53% (PR = 1.53; 95% CI = 1.06–2.23) higher prevalence of NPSs while individuals living in rural vs. large urban neighborhoods had a 36% lower prevalence of NPSs (PR = 0.64; 95% CI = 0.45–0.90), after adjustment. We did not observe an association between residential instability and NPSs (PR = 0.92; 95% CI = 0.86–1.00); however, our estimates suggested differences by race/ethnicity where NH-White older adults living in residential instable areas had lower NPSs (PR = 0.89; 95% CI = 0.82–0.96) compared to NH-Black older adults (PR = 0.96; 95% CI = 0.86–1.07).DiscussionAcross racial/ethnic groups, individuals with AD had more symptomology when living in lower income areas. Pending replication, intervention efforts should consider resource allocation to high-need neighborhoods (e.g., lower income), and studies should investigate underlying mechanisms for this relationship.https://www.frontiersin.org/articles/10.3389/fnagi.2022.937915/fulldementianeuropsychiatric symptomsbehavioral and psychological symptomsresidence characteristicsrural healthpoverty area |
| spellingShingle | Dana M. Alhasan Matthew C. Lohman Jana A. Hirsch Maggi C. Miller Bo Cai Chandra L. Jackson Chandra L. Jackson Neighborhood characteristics and dementia symptomology among community-dwelling older adults with Alzheimer’s disease Frontiers in Aging Neuroscience dementia neuropsychiatric symptoms behavioral and psychological symptoms residence characteristics rural health poverty area |
| title | Neighborhood characteristics and dementia symptomology among community-dwelling older adults with Alzheimer’s disease |
| title_full | Neighborhood characteristics and dementia symptomology among community-dwelling older adults with Alzheimer’s disease |
| title_fullStr | Neighborhood characteristics and dementia symptomology among community-dwelling older adults with Alzheimer’s disease |
| title_full_unstemmed | Neighborhood characteristics and dementia symptomology among community-dwelling older adults with Alzheimer’s disease |
| title_short | Neighborhood characteristics and dementia symptomology among community-dwelling older adults with Alzheimer’s disease |
| title_sort | neighborhood characteristics and dementia symptomology among community dwelling older adults with alzheimer s disease |
| topic | dementia neuropsychiatric symptoms behavioral and psychological symptoms residence characteristics rural health poverty area |
| url | https://www.frontiersin.org/articles/10.3389/fnagi.2022.937915/full |
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