Author: Maha Vijayakrishnan
What is Alzheimer’s Disease?
Alzheimer’s disease is a disorder that negatively affects memory, thinking, and behavior (1). It progresses as a neurodegenerative disease, which results in brain neuronal death (1). With no known cure, Alzheimer’s affects more than 6 million people per year, usually those who are past the age of 60 years old (2). While characterized by physical symptoms, Alzheimer’s and dementia are both greatly impacted by social determinants of health, which can have significant influences on patients’ risk and access to quality care.
What are the Social Determinants of Health?
Social determinants are the “conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health” outcomes and risks (3). In other words, social determinants are lifestyle factors that affect the well-being and health of individuals and communities. For example, studies show that a person’s education is associated with the risk of developing Alzheimer’s (4). Those who had a college degree versus those without a high school diploma were three times less likely to experience subjective cognitive decline (5). Another example includes social circles one may have. Those who experienced social isolation are more likely to experience a decline in mental and physical health (e.g. depression, anxiety, impaired immune function, etc.) (6). Even a person’s religious and cultural background may affect how they perceive care, influencing their willingness to seek health services and adhere to their treatments. Culture and beliefs can impact how people experience and cope with their illnesses. For example, African American patients have more distrust in the medical care system than do white patients due to histories of systemic abuse and mistreatment by the medical system (7). This could decrease the chances of them seeking care compared to white patients.
With this in mind, it is important to not only address the clinical side of diseases, but also the social side.
How Do Social Determinants Affect Alzheimer’s Risk and Care?
There are various ways in which social determinants can affect one’s risk for Alzheimer’s. Common factors such as education, access to health care, one’s built environment, social circles, and cultural beliefs are just a few examples.
Education
Studies have reported a positive relationship between education level and cognitive functioning (5). Out of adults at least 45 years old, those who were college graduates compared to those who were not had less cognitive decline (5). This makes sense, as acquiring knowledge by engaging in mentally stimulating activities can enrich brain engagement. Cognitive enrichment can in turn help delay or prevent the onset of Alzheimer's symptoms.
Access to Health Care
One’s access to healthcare can affect Alzheimer’s risk and care in various ways. Being able to engage in preventive care, for example, can help older people spot Alzheimer's symptoms early. This can help them receive treatment as early as possible to mitigate symptoms, prevent hospitalizations, and improve health outcomes. Patients can also plan ahead in end-of-life decision-making and enroll in clinical trials.
Built Environment
Although one’s social environment may be important, the physical environment around a person also impacts one’s risk for Alzheimer’s. Inadequate transportation, housing, water, and air quality in residential areas can expose people to toxins that can affect brain health. For example, lead, mercury, and pesticides can cause inflammation and neurotoxic effects (8). These factors can also affect lifestyle choices, such as physical activity, social interaction, and mental stimulation. For example, physical activity has shown great promise in protecting the brain against dementia symptoms. In fact, resistance training has been shown to have neuroprotective effects, protecting hippocampal regions and Alzheimer-vulnerable subfields in those aged 55+ years and diagnosed with mild cognitive impairment (9).
Social Interaction and Beliefs
Social interaction can help engage and enrich one’s brain. Individuals who are lonely have been found to have a 26% higher risk of developing dementia compared to those who frequently engage with their social circles (10). Furthermore, those who do not engage in social interactions may have a harder time finding help and treatment. As for social and cultural beliefs, stigma can play a large role in an individual’s willingness to seek help. In fear of being judged, one may be hesitant to seek help or access health services for their disorder. As such, it is important to be aware of how strong of an influence cultural beliefs can have on how people may perceive, experience, and cope with Alzheimer's.
Conclusion
It is important to realize that the prognosis of Alzheimer’s disease can be affected by not only clinical, but also nonclinical factors. Recognizing and improving social determinants of health----such as education, access to health services, one’s physical environment, and one's social and community context--particularly for vulnerable and marginizalized groups, can have a profound impact on one’s risk and prognosis. By addressing these key social determinants, we can improve the health and well-being of people with Alzheimer's; however this takes the coordination not only of healthcare professionals, but advocates and policy makers.
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Sources
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Social Determinants of Health—Healthy People 2030 | health.gov. (n.d.). Retrieved December 20, 2023, from https://health.gov/healthypeople/priority-areas/social-determinants-health
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