OBJECTIVES: Early-life rural-urban residence has been linked to differences in later-life cognitive functioning and dementia risk. However, the contextual pathways underlying these associations, particularly emergent associations later in life, remain underexplored. We examined the associations between young adult urbanicity and domain-specific cognition in older adulthood and whether late midlife neighborhood socioeconomic disadvantage may mediate such associations. METHODS: Participants were 881 community-dwelling men aged 61-73 from across the United States. Young adult urbanicity (rural, suburban, urban) was assessed at a mean age of 20 based on the Rural-Urban Continuum Codes. Late midlife neighborhood disadvantage was indexed by the area deprivation index (ADI), and cognitive performance in older adulthood was assessed in five domains: executive function, episodic memory, processing speed, verbal fluency, and visual-spatial ability. RESULTS: Compared to those in rural areas, participants who resided in urban areas during young adulthood had lower late midlife ADI (β= -0.85, p<0.05), and better executive function (β = 0.19), processing speed (β = 0.24), and verbal fluency (β = 0.30) (ps<0.05) in older adulthood. ADI partially mediated these associations, such that urban residence was associated with lower ADI, which was then associated with better performance in these three domains (indirect effects: βs = 0.02 to 0.03). DISCUSSION: Late midlife neighborhood disadvantage represents a contextual pathway linking early-life rural-urban residence to cognitive function in older adulthood. Reducing socioeconomic disadvantage through health policies and interventions at both the community-level early in life and the neighborhood-level later in life may help reduce the risk of cognitive impairment and dementia.
Tang et al. (Wed,) studied this question.