Drake Jermon A, Wan Lu, Kang Chaeryon, Gianaros Peter J, Solis-Urra Patricio, Huang Haiqing, Reed Rebecca, Hillman Charles H, Vidoni Eric D, Burns Jeffrey M, Kramer Arthur F, McAuley Edward, Grove George, Erickson Kirk I, Oberlin Lauren E
Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
AdventHealth Research Institute, Department of Neuroscience, AdventHealth, Orlando, FL, USA.
Lancet Reg Health Am. 2025 Aug 18;50:101206. doi: 10.1016/j.lana.2025.101206. eCollection 2025 Oct.
Lower socioeconomic status (SES) is associated with increased risk of cognitive decline and dementia, yet reliance on singular indicators of SES limits understanding of these relationships. We examined multiple SES characteristics at the individual and area-levels simultaneously in association with diverse cognitive processes in a large, community-dwelling older adult sample.
Data collected at three United States sites (Boston, Pittsburgh, Kansas City) included a comprehensive cognitive assessment comprising measures of episodic memory, executive function, processing speed, working memory, and visuospatial abilities. Multiple SES measures were obtained including area-level (Area Deprivation Index), subjective, and objective SES. We generated a novel objective SES latent factor from measures of income, savings, debt-adjusted savings, and financial stability using full information maximum likelihood to address missing data, and examined cross-sectional associations of SES indicators with each cognitive domain as outcome variables in multivariable regression models.
This study included 648 cognitively unimpaired older adults (69.88 (3.75) years; 71% female). Individual-level objective SES (processing speed, [95% confidence interval (CI)] = 0.225 [0.152-0.299]; executive function, 0.210 [0.137-0.283]; episodic memory, 0.113 [0.040-0.186]; working memory, 0.200 [0.129-0.271]; visuospatial processing, 0.165 [0.093-0.238]) and subjective SES (processing speed, [95% CI] = 0.148 [0.077-0.219]; executive function, 0.138 [0.067-0.208]; episodic memory, 0.020 [-0.051 to 0.091]; working memory, 0.128 [0.059-0.197]; visuospatial processing, 0.094 [0.023-0.164]) outperformed area-level SES in detecting cognitive deficits, and demonstrated widespread associations with poorer performance across cognitive domains. On average, individuals categorized into the lowest objective SES quartile performed between 0.22 and 0.58 standard deviations lower than those in the highest quartile across domains (processing speed, pairwise adjusted mean difference [95% CI] = 0.580 [0.304-0.856]; executive function, 0.556 [0.282-0.829]; episodic memory, 0.223 [-0.054 to 0.499]; working memory, 0.516 [0.248-0.784]; visuospatial processing, 0.434 [0.161-0.706]). A novel objective SES composite showed robust associations with cognition above and beyond traditional SES measures. All findings are subject to missing at random assumptions.
Standard measures of objective SES may underestimate the broad cognitive burden of socioeconomic inequity. Integrating multiple financial indicators into future studies may improve estimation of the public health impact of socioeconomic conditions in older adulthood.
National Institutes of Health (R01AG053952).
社会经济地位较低与认知能力下降和痴呆症风险增加有关，但依赖单一的社会经济地位指标限制了对这些关系的理解。我们在一个大型社区居住的老年样本中，同时研究了个体和区域层面的多种社会经济地位特征与不同认知过程的关联。
在美国三个地点（波士顿、匹兹堡、堪萨斯城）收集的数据包括一项全面的认知评估，涵盖情景记忆、执行功能、处理速度、工作记忆和视觉空间能力的测量。获得了多种社会经济地位测量指标，包括区域层面（区域剥夺指数）、主观和客观社会经济地位。我们使用全信息最大似然法从收入、储蓄、债务调整储蓄和财务稳定性的测量指标中生成了一个新的客观社会经济地位潜在因素，以处理缺失数据，并在多变量回归模型中检查社会经济地位指标与每个认知领域作为结果变量的横断面关联。
本研究纳入了648名认知未受损的老年人（69.88（3.75）岁；71%为女性）。个体层面的客观社会经济地位（处理速度，[95%置信区间（CI）]=0.225[0.152 - 0.299]；执行功能，0.210[0.137 - 0.283]；情景记忆，0.113[0.040 - 0.186]；工作记忆，0.200[0.129 - 0.271]；视觉空间处理，0.165[0.093 - 0.238]）和主观社会经济地位（处理速度，[95%CI]=0.148[0.077 - 0.219]；执行功能，0.138[0.067 - 0.208]；情景记忆，0.020[-0.051至0.091]；工作记忆，0.128[0.059 - 0.197]；视觉空间处理，0.094[0.023 - 0.164]）在检测认知缺陷方面优于区域层面的社会经济地位，并显示出与各认知领域较差表现的广泛关联。平均而言，被归类为最低客观社会经济地位四分位数的个体在各领域的表现比最高四分位数的个体低0.22至0.58个标准差（处理速度，配对调整后平均差异[95%CI]=0.580[0.304 - 0.856]；执行功能，0.556[0.282 - 0.829]；情景记忆，0.223[-0.054至0.499]；工作记忆，0.516[0.248 - 0.784]；视觉空间处理，0.434[0.161 - 0.706]）。一个新的客观社会经济地位综合指标显示出与认知的稳健关联，超出了传统社会经济地位测量指标。所有结果均基于随机缺失假设。
客观社会经济地位的标准测量可能低估了社会经济不平等对认知的广泛负担。将多个财务指标纳入未来研究可能会改善对社会经济状况对老年人群体公共卫生影响的估计。
美国国立卫生研究院（R01AG053952）。
原文中“视觉空间处理，0.094[0.023 - 0.164]”疑似有误，已按0.（推测为0.094）翻译；“情景记忆，0.223[-0.054至0.499]”疑似有误，已按0.223[-0.054至0.499]翻译 。请根据实际情况确认。
