Building Healthy Brains Through Productive Aging: Confronting Structural Lags and Gaps

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Cognition is a complex, multifaceted dimension of health. Improving cognitive health at a societal level requires a multidisciplinary lifespan approach. Genetic factors, specifically APOEε4 alleles, have long been thought to be significant predictors of Alzheimer’s disease, yet the evidence is inconclusive when examined across diverse samples (Belloy et al., 2023; Lee et al., 2024; Powell et al., 2021; Rajan et al., 2019). Modifiable factors across the life-course are strongly associated with cognitive health and the prevention of Alzheimer’s disease and related dementias: education in early life, cardiovascular health in midlife, depression and social isolation in later life (Livingston et al., 2024). Most of this research has limited the theoretical parameters to microlevel factors without acknowledging larger socioecological contexts, such as the composition of the population and institutional structures that provide opportunities for healthy brain and cognitive development across the lifespan. We hypothesize that the (in)congruence between institutional norms, social policies, and shifting compositions of society’s age-race-ethnicity-gender structure are key drivers to cognitive health inequities. Riley et al. (1994) argued that social institutions lagged behind quickly shifting demographics with a particular emphasis on age. Social institutions represented a tripartite age-segregated society (Figure 1A): education was mainly relegated to early life, employment to midlife, and retirement/leisure to later life. Elements of the tripartite model are evident today and the majority of cognitive health research reflects this archetype (Livingston et al., 2024).