Bridging Individual and Contextual Risk Factors for Cognitive Decline
In comparison to other racial/ethnic groups, Black Americans often face heightened risk for adverse health outcomes for a variety of medical conditions, including neurological disorders such as multiple sclerosis and Alzheimer's disease. Racial/ethnic health disparities are often attributed to social determinants of health (SDOH), which refers to how the conditions in which people live, learn, work, and play can affect a wide range of health outcomes. Existing research on the effects of SDOH on brain health has largely focused on individual-level factors, such as a person's level of education, their access to healthcare, or whether they have cardiometabolic conditions that increase the risk of cognitive decline. An alternative approach is examining SDOH at the contextual level, exploring how various features of a person's environment and structural barriers predict the risk of cognitive decline. There is considerable debate on whether efforts to mitigate adverse health outcomes in Black Americans and other marginalized communities should primarily focus on individual or contextual-level factors.
This presentation will highlight the empirical research that attempts to bridge the divide between individual and contextual-level approaches to mitigating cognitive decline. The studies will examine how well-known influences on brain health—such as cognitive reserve and physical activity—can be examined in the context of neighborhood disadvantage. The first study examines the extent to which three proxies of cognitive reserve—years of education, education quality, and cognitive enrichment—differ in their prediction of cognitive performance in Black and White adults with multiple sclerosis. Furthermore, the study explores the protective effects of psychological resilience for cognitive function and how this relationship differs by race and neighborhood disadvantage. The second study examines the extent to which neighborhood disadvantage predicts exercise adherence in older adults with metabolic syndrome. Together, the findings indicate that examining cognitive enrichment can provide a more nuanced approach to predicting cognitive reserve than simply relying on years of education and that examining neighborhood disadvantage can provide a more nuanced approach to predicting cognitive decline than solely examining race.