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Where you live affects your dementia risk

MDlinx Jun 14, 2024

More than 55 million people across the world are living with dementia, and 10 million more people are diagnosed with dementia each year.

Dementia. World Health Organization.

Although several nonmodifiable risk factors (eg, age, genetics, and family history) cannot be prevented, 40% of dementia cases could be prevented or delayed through modifiable risk factors, according to a study published in The Lancet.

Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, Volume 396, Issue 10248, 413 - 446. August 8, 2020.



One such risk factor is living in a low socioeconomic (SES) neighborhood, where individuals have a higher likelihood of developing dementia or cognitive decline compared with those living in a high SES neighborhood.


Looking at the research


According to the American Psychological Association, SES encompasses income, educational attainment, financial security, and subjective perceptions of social status and social class.

Education and Socioeconomic Status. American Psychological Association. 2017.


There have been multiple studies across the globe looking at the relationship between dementia and low SES neighborhoods. In a meta-analysis of 39 prospective studies (1,485,702 individuals), 25 studies reported an incidence of dementia, and 14 studies reported cognitive decline in relation to living in low SES neighborhoods.

Wang AY, Hu HY, Ou YN, et al. Socioeconomic Status and Risks of Cognitive Impairment and Dementia: A Systematic Review and Meta-Analysis of 39 Prospective Studies. J Prev Alzheimers Dis. 2023;10(1):83-94. doi: 10.14283/jpad.2022.81.



Primary results of the meta-analyses found an elevated combined risk of cognitive impairment and dementia in low-SES participants compared with high-SES participants. The authors concluded that “low SES substantially increased the risk of dementia and cognitive dysfunction, suggesting that public health strategies could reduce the dementia burden by reducing social inequalities.”

Additionally, a prospective cohort study that recruited a nationally representative sample of US Medicare beneficiaries aged ≥65 years examined the relationship between low SES and dementia in the United States. Results showed “low income and greater financial strain predict incident dementia among older adults.”

Samuel LJ, Szanton SL, Wolff JL, et al. Socioeconomic disparities in six-year incident dementia in a nationally representative cohort of U.S. older adults: an examination of financial resources. BMC Geriatr 20, 156 (2020). https://doi.org/10.1186/s12877-020-01553-4.


A study that took place over a 20-year span based out of New Zealand published in The Journal of Alzheimer's Association also found this to be true.

Reuben A, Richmond-Rakerd LS, Milne B, et al. Dementia, dementia's risk factors and premorbid brain structure are concentrated in disadvantaged areas: National register and birth-cohort geographic analyses. J Alzheimers Dis. March 14, 2024. https://doi.org/10.1002/alz.13727.

“People residing in disadvantaged neighborhoods were at greater risk of dementia [and], decades before clinical endpoints typically emerge, evidenced elevated dementia-risk scores [...] and displayed dementia-associated brain structural deficits and cognitive difficulties/decline,” the authors concluded.


In a press release from Duke University, study lead Aaron Reuben, PhD, said, “If you want to prevent dementia, and you’re not asking someone about their neighborhood, you're missing information that's important to know.”

Many individual choices, like what you eat, what you do for fun, or who you spend time with, are constrained by where you live.


SES as a modifiable risk factor


There are many individual modifiable risk factors for dementia, such as poor diet and physical inactivity. Recently, researchers have begun to look into the community spaces where these individual modifiable risk factors for dementia occur. 

Although it is still unclear as to the exact reasons why living in a low SES neighborhood is a risk factor for dementia, many plausible clauses have to do with physical, mental, and social stressors known to contribute to cognitive decline in older adults, including air pollution, poor water quality, high crime, food deserts, lack of green space, and a lack of community resources.

Pase MP, Rowsthorn E, Cavuoto MG, et al. Association of Neighborhood-Level Socioeconomic Measures With Cognition and Dementia Risk in Australian Adults. JAMA Netw Open. 2022;5(3):e224071.



With higher violence and crime rates, the feeling of safety is jeopardized. Individuals may be less inclined to exercise or play outdoors because they feel unsafe, reducing the amount of physical exercise and socialization.

Additionally, a lack of schools, medical clinics, social centers, and green spaces can mean reduced access to better education, healthcare, social functions, and time spent in nature. Diabetes, high blood pressure, and social isolation are known modifiable risk factors for dementia, and if an individual is less likely to receive medical care or engage in social activities because these resources are lacking in their neighborhood, they could be at heightened risk. 


What this means for you

The more we learn about dementia and its modifiable risk factors, the more active steps we can take to prevent it. Asking patients about where they live; if they feel safe in their neighborhood; and whether they have access to green spaces, community centers, and medical clinics can give us better insight into identifying if they are at risk for dementia.


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