Stark racial and ethnic disparities in Alzheimer’s disease (AD) and related dementias (ADRD) have been documented, largely attributable to the impact of social and structural drivers of health. The structural drivers of health include the institutions, practices, cultural norms, and policies that dictate the inequitable distribution of the social determinants of health (SDoH), defined as the conditions where people live, work, play, and age, and consist of various forms of systemic oppression including structural racism. The overlapping effects of race and place on health have been studied extensively, with an increased focus on the operationalization and measurement of “place-effects” on health through neighborhood characteristics and the built environment. Previous studies have demonstrated associations of place-based SDoH with cardiometabolic health and cognition. However, research studying the relationship of place-based SDoH with ADRD-associated neuroimaging and plasma biomarkers is still limited.

Biomarkers serve as proxies for underlying pathological changes and can play a crucial role in the detection of etiology underlying cognitive decline and ADRD. More specifically, neuroimaging biomarkers of brain structure and function, assessed using magnetic resonance imaging (MRI), are helpful in the early detection of disease processes and prognosis for progression. Additionally, numerous blood-based biomarkers have recently emerged as candidates for improved diagnosis and management of ADRD, along with a demonstrated need to examine varying SDoH profiles in correlation with these biomarkers due to observed differences in biomarker levels by medical comorbidities. Plasma biomarkers have been associated with brain health differences assessed with neuroimaging, most notably with lower total gray matter brain volume and higher amyloid deposition. Importantly, abnormal plasma amyloid β 42/40 ratio helps in identifying those with higher dementia risk, while phosphorylated-Tau 181 has been shown to increase with clinical severity of AD.

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(alz-journals.onlinelibrary.wiley.com)