Neighbourhood environment and dementia in older people from high-, middle- and low-income countries: results from two population-based cohort
Date
2020Author
Wu, Yu-Tzu
Brayne, Carol
Liu, Zhaorui
Huang, Yueqin
Sosa, Ana Luisa
Acosta, Daisy
Prina, Matthew
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Show full item recordAbstract
A growing number of studies have explored how features of the neighbourhood environment can
be related to cognitive health in later life. Yet few have focused on low- and middle-income countries and
compared the results across different settings. The aim of this study is to investigate the cross-sectional associations
between neighbourhood amenities and dementia in older people from high-, middle- and low-income countries.
Methods: This study was based on two population-based cohort studies of people aged≥65: the Cognitive Function
and Ageing Study II (CFAS II) in UK (N = 4955) and a subset of the 10/66 study in China, Dominican Republic and
Mexico (N = 3386). In both cohorts, dementia was assessed using the Geriatric Mental State−Automated Geriatric
Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm. The 10/66 dementia diagnostic algorithm was
also used as an additional criterion in the 10/66 study. Publicly accessible databases, Google Maps and Open Street
Map, were used to obtain geographic information system data on distance to neighbourhood amenities, including
lifestyle (cafés, libraries, movie theatres, parks), daily life (post offices, convenience stores), healthcare (hospitals,
pharmacies) and percentages of local green and blue spaces within 400 and 800m of participants’ residences.
Multilevel logistic regression was used to investigate the associations between these environmental features and
dementia adjusting for sociodemographic factors and self-rated health.
Results: Living far from daily life amenities was associated with higher odds of dementia in both CFAS II (1.47; 95% CI:
0.96, 2.24) and the 10/66 study (1.53; 95% CI: 1.15, 2.04), while living far from lifestyle (1.50; 95% CI: 1.13, 1.99) and
healthcare amenities (1.32; 95% CI: 0.93, 1.87) was associated with higher odds of dementia only in the 10/66 study. A
high availability of local green and blue spaces was not associated with dementia in either cohort yet living far from
public parks was associated with lower odds of dementia in CFAS II (0.64; 95% CI: 0.41, 1.00).
Conclusions: The different relationships across cohorts may indicate a varying role for local amenities in diverse
settings. Future research may investigate mechanisms related to these differences and social, cultural and historical
influences on the interaction between neighbourhood amenities and older people
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