The role of social participation in cognitive health in an underserved older population: Evidence from AfroBrazilian-Quilombola Communities

Quilombos are settlements founded by descendants of runaway enslaved populations in Brazil, and often present social vulnerabilities, high levels of illiteracy, and limited health access. The Quilombola population likely presents an increased risk for dementia; however, it is underrepresented in aging research. This study aimed to investigate the association between cognition and social participation, which remains unclear in underserved communities. This cross-sectional study was conducted in 11 Quilombola rural underserved communities in Brazil. The study comprised 221 older adults (60-104 years). Participants completed a health survey and a cognitive screening. Demographics, cardiovascular risk factors, mood, cognition, and social participation were assessed. Regression models examined the association between social participation and cognition, accounting for demographics and health measures. Our models also examined the moderation role of age and sex. Higher social participation was associated with better cognition (p < 0.001) above and beyond demographics, functional capacity, mood, and a cardiovascular risk factor (waist-to-hip ratio). The social activity that mostly drove the result was attending "religious/faith services". Age and sex did not moderate the associations. Our findings extend the scope of the potential protective role of social participation for cognitive health to socially vulnerable contexts. In a disadvantaged context, social participation may be a crucial aspect for promoting cognitive and brain health. We hypothesize that social participation may provide not only cognitive stimulation and emotional support, but also facilitate access to the community's needs (e.g., health services). The results are limited by the cross-sectional design and survival bias, which restrict the interpretation of causality, although they may inform future research in underserved populations.