Social Environment and Health Program, Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, United States; Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States.
Department of Sociology, Washington University in St. Louis, St. Louis, MO, 63130, United States.
Soc Sci Med. 2022 Sep;309:115220. doi: 10.1016/j.socscimed.2022.115220. Epub 2022 Jul 20.
While a growing body of evidence points to potentially modifiable individual risk factors for dementia, the built and social environments in which people develop and navigate cognitive decline are largely overlooked. This paper proposes a new theoretical concept, Cognability, to conceptualize how supportive an area is to cognitive health among aging residents. Cognability incorporates a constellation of both positive and negative neighborhood features related to physical activity, social interaction and cognitive stimulation in later life. We analyzed data from the REasons for Geographic And Racial Differences in Stroke Study, a national sample of older Black and white adults in the United States (n = 21,151; mean age at assessment = 67; data collected 2006-2017). Generalized additive multilevel models examined how cognitive function varied by neighborhood features. Access to civic and social organizations, recreation centers, fast-food and coffee establishments, arts centers, museums, and highways were significantly associated with cognitive function. Race-, gender-, and education-specific models did not yield substantial improvements to the full-model. Our results suggest that the unequal distribution of amenities and hazards across neighborhoods may help account for considerable inequities observed in cognitive health among older adults. Cognability advances ecological theories of aging through an innovative "whole neighborhood" approach. It aims to identify which specific neighborhood features are most protective of cognitive health among aging adults to inform upstream public health initiatives, community interventions, and policy.
尽管越来越多的证据表明痴呆症存在潜在的可改变的个体风险因素，但人们在认知能力下降过程中所处的建筑和社会环境在很大程度上被忽视了。本文提出了一个新的理论概念“Cognability”，用于概念化一个区域对老年居民认知健康的支持程度。Cognability 包含了一系列与老年人身体活动、社会互动和认知刺激相关的积极和消极的邻里特征。我们分析了来自美国全国黑人及白人老年人的地理和种族差异原因研究（REasons for Geographic And Racial Differences in Stroke Study，REGARDS）的数据（n=21151；平均评估年龄 67 岁；数据收集于 2006-2017 年）。广义加性多层模型考察了邻里特征如何影响认知功能。公民和社会组织、娱乐中心、快餐店和咖啡店、艺术中心、博物馆和高速公路的可达性与认知功能显著相关。针对种族、性别和教育的特定模型并没有对全模型产生实质性的改进。我们的结果表明，邻里之间设施和危害的不平等分布可能有助于解释在老年人认知健康方面观察到的相当大的不平等现象。Cognability 通过创新的“整个邻里”方法推进了老龄化的生态理论。它旨在确定哪些特定的邻里特征对老年人的认知健康最具保护作用，以便为上游公共卫生倡议、社区干预和政策提供信息。
