Department of Social Sciences, University of Luxembourg, Esch-Sur-Alzette, Luxembourg.
Department of Psychiatry and Neuropsychology, Maastricht, The Netherlands; Department of Internal Medicine, Maastricht, The Netherlands; Heart and Vascular Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht, The Netherlands.
Soc Sci Med. 2024 Aug;355:117111. doi: 10.1016/j.socscimed.2024.117111. Epub 2024 Jul 10.
Socioeconomic inequalities in cognitive impairment may partly act through structural brain damage and reduced connectivity. This study investigated the extent to which the association of early-life socioeconomic position (SEP) with later-life cognitive functioning is mediated by later-life SEP, and whether the associations of SEP with later-life cognitive functioning can be explained by structural brain damage and connectivity.
We used cross-sectional data from the Dutch population-based Maastricht Study (n = 4,839; mean age 59.2 ± 8.7 years, 49.8% women). Early-life SEP was assessed by self-reported poverty during childhood and parental education. Later-life SEP included education, occupation, and current household income. Participants underwent cognitive testing and 3-T magnetic resonance imaging to measure volumes of white matter hyperintensities, grey matter, white matter, cerebrospinal fluid, and structural connectivity. Multiple linear regression analyses tested the associations between SEP, markers of structural brain damage and connectivity, and cognitive functioning. Mediation was tested using structural equation modeling.
Although there were direct associations between both indicators of SEP and later-life cognitive functioning, a large part of the association between early-life SEP and later-life cognitive functioning was explained by later-life SEP (72.2%). The extent to which structural brain damage or connectivity acted as mediators between SEP and cognitive functioning was small (up to 5.9%).
We observed substantial SEP differences in later-life cognitive functioning. Associations of structural brain damage and connectivity with cognitive functioning were relatively small, and only marginally explained the SEP gradients in cognitive functioning.
认知障碍方面的社会经济不平等可能部分通过结构性脑损伤和连通性降低起作用。本研究旨在调查与早年社会经济地位（SEP）与晚年认知功能相关的程度，以及 SEP 与晚年认知功能的关联是否可以通过结构性脑损伤和连通性来解释。
我们使用了荷兰人群为基础的马斯特里赫特研究（Maastricht Study）的横断面数据（n=4839；平均年龄 59.2±8.7 岁，49.8%为女性）。早年 SEP 通过童年时期的自述贫困和父母教育程度来评估。晚年 SEP 包括教育、职业和当前家庭收入。参与者接受认知测试和 3T 磁共振成像，以测量白质高信号、灰质、白质、脑脊液和结构连通性的体积。多元线性回归分析测试了 SEP、结构性脑损伤和连通性标志物与认知功能之间的关联。结构方程模型用于测试中介作用。
尽管 SEP 的两个指标与晚年认知功能之间存在直接关联，但早年 SEP 与晚年认知功能之间的关联很大一部分可以用晚年 SEP 来解释（72.2%）。结构性脑损伤或连通性作为 SEP 和认知功能之间的中介作用的程度较小（最多 5.9%）。
我们观察到晚年认知功能存在显著的 SEP 差异。结构性脑损伤和连通性与认知功能的关联相对较小，仅略微解释了认知功能中 SEP 的梯度。
