Trani Jean-Francois, Singh Ramkrishna K, Walker Alexis I B, Bekena Semere, Zhu Yiqi, Williams Jonathan P, Buckner Terri, Millsap Mario, Chen Chen, Taylor Kaylin, Intagliata Maeve, Damera Nikitha, Vogel Mia T, Orukari Inema E, Hart Robbie, Babulal Ganesh M
School of Public Health, Washington University in St. Louis, St. Louis, Missouri, USA.
National Pedagogical Health & Solidarity, National Conservatory of Arts and Crafts, Paris, France.
Alzheimers Dement. 2025 Jul;21(7):e70494. doi: 10.1002/alz.70494.
Alzheimer's disease and related dementias (ADRD) disproportionately affect Black Americans compared to non-Hispanic White individuals. We examined perceived dementia risk factors among Black adults in St. Louis via a participatory approach.
In 36 community-based system dynamics workshops (CBSD), 234 participants co-created causal loop diagrams capturing influences on dementia. We analyzed these diagrams using ecological methods to identify a shared core model and examine variation by neighborhood-level deprivation.
CBSD revealed a framework for how economic hardship, especially low income and unemployment, reduces access to physical and mental healthcare, driving dementia risk. Those from more deprived areas highlighted the need for improved health education, public transportation, healthcare access, and job opportunities.
Addressing dementia disparities requires targeting modifiable social and structural drivers. Our findings emphasize the significance of tailored public health interventions that expand access to quality healthcare, reduce socioeconomic barriers, and broadly mitigate racism's pervasive impact on cognitive health.
Workshop groups from areas with higher neighborhood deprivation (as measured by the Area Deprivation Index [ADI]) were more likely to emphasize stress, poor diet, and limited healthcare access-underscoring the critical influence of socioeconomic disadvantage on both lived experiences and views of dementia risk. Across multiple feedback loops, structural racism emerged as an "external yet ubiquitous" force accelerating other drivers of dementia (e.g., poverty, insufficient community investment, and poorer-quality healthcare), demonstrating the complex pathways by which discrimination exacerbates risk in Black communities. Participants outlined multi-level interventions-ranging from grassroots community programs (e.g., health literacy campaigns, community wellness initiatives) to policy-focused strategies (e.g., political engagement, equitable public resource allocation)-to counteract the self-perpetuating cycle of disadvantage and mitigate dementia risk in under-resourced neighborhoods.
与非西班牙裔白人相比，阿尔茨海默病及相关痴呆症（ADRD）对美国黑人的影响尤为严重。我们通过参与式方法研究了圣路易斯黑人成年人对痴呆症风险因素的认知。
在36个基于社区的系统动力学研讨会（CBSD）中，234名参与者共同创建了因果循环图，以捕捉对痴呆症的影响因素。我们使用生态学方法分析这些图表，以确定一个共享的核心模型，并研究邻里层面贫困程度的差异。
CBSD揭示了一个框架，即经济困难，尤其是低收入和失业，如何减少获得身心健康护理的机会，从而增加痴呆症风险。来自贫困地区的参与者强调需要改善健康教育、公共交通、医疗保健服务和就业机会。
解决痴呆症差异问题需要针对可改变的社会和结构驱动因素。我们的研究结果强调了量身定制的公共卫生干预措施的重要性，这些措施应扩大获得优质医疗保健的机会，减少社会经济障碍，并广泛减轻种族主义对认知健康的普遍影响。
来自邻里贫困程度较高地区（通过地区贫困指数[ADI]衡量）的研讨会小组更有可能强调压力、不良饮食和有限的医疗保健服务，这凸显了社会经济劣势对生活经历和痴呆症风险认知的关键影响。在多个反馈回路中，结构性种族主义成为一种“外部但普遍存在”的力量，加速了其他痴呆症驱动因素（如贫困、社区投资不足和医疗质量较差），这表明了歧视加剧黑人社区风险的复杂途径。参与者概述了多层次干预措施，从基层社区项目（如健康素养运动、社区健康倡议）到以政策为重点的战略（如政治参与、公平的公共资源分配），以抵消自我延续的劣势循环，并减轻资源不足社区的痴呆症风险。
