New research from Brighton and Sussex Medical School (BSMS) and University College London (UCL) has revealed a significant link between socioeconomic factors and the progression of neurocognitive disorders among older adults. Conducted over 10 years, the study tracked 9,821 adults aged 50 and older, examining how factors such as education, occupation, and wealth impact their risk of cognitive decline and mortality in later life.
The research used sophisticated Markov modelling to assess how participants transitioned between various cognitive states—healthy, mild cognitive impairment, and dementia—and ultimately mortality. Notably, this study is among the first to investigate the impact of wealth specifically on these cognitive transitions, shedding new light on how economic resources can influence cognitive health over time.
Socioeconomic advantage linked to cognitive resilience
The study’s findings indicate that individuals from socioeconomically advantaged backgrounds – those with higher education levels, professional occupations, and greater wealth – were less likely to progress from a healthy cognitive state to mild cognitive impairment, or from mild impairment to dementia. Conversely, people from disadvantaged backgrounds faced a higher risk of cognitive decline.
One of the most striking findings was that wealthier individuals not only experienced slower progression into cognitive impairment but were also more likely to recover from mild impairment and return to a healthy cognitive state. This suggests that economic advantages may play a crucial role in enhancing resilience to cognitive decline and improving quality of life in older age.
The study found that, on average, participants from higher socioeconomic backgrounds spent more time in healthy cognitive states and less time in neurocognitive disorders than those from lower socioeconomic positions. This reflects a profound disparity in health outcomes that extends well into later life.
Expert insights on the socioeconomic gradient in cognitive health
Dr Dorina Cadar, Senior Lecturer in Neuroepidemiology and Dementia and Director of the CEDAR Lab at BSMS, and senior author of the study, commented on the significance of the findings. “This study offers a unique contribution to the growing body of research on neurocognitive disorders by revealing how socioeconomic position influences the transitions between different cognitive states and impacts mortality among older adults in England. Using a multistate Markov model and data from the English Longitudinal Study of Ageing, our study highlights the critical role of wealth, education, and occupation not only in reducing the risk of transitioning from mild cognitive impairment to dementia but also in increasing the likelihood of reversion to a healthy cognitive state. This comprehensive approach, tracking cognitive transitions over a decade, provides valuable insights into the socioeconomic factors affecting cognitive health and offers guidance for targeted interventions.”
Lead author Aswathikutty Gireesh, a PhD candidate at UCL Epidemiology & Health Care, added: “Education and intellectually demanding jobs may provide mental stimulation and help build a stronger brain reserve, offering protection against cognitive impairment and dementia. Additionally, individuals with higher education, more intellectually demanding careers, and wealth often have better access to healthcare and health-promoting resources, including a nutritious diet, exercise, and preventive care—all of which support cognitive health.”
Listen to Dorina and Aswathikutty discuss the study below.
Implications for policy and future research
The study’s insights into the protective effects of wealth and socioeconomic position could inform policy initiatives focused on health equity, particularly in the context of ageing populations. The researchers believe their findings open up new opportunities to explore how socioeconomic factors, especially wealth, might act as a buffer against early cognitive impairment, potentially guiding policies aimed at mitigating health disparities in older adults.
Funded by the U.S. National Institutes of Health’s National Institute on Aging (grant R01AG017644), and supported by the National Institute for Health and Care Research (NIHR), the Economic and Social Research Council (ESRC), and the Biotechnology and Biological Sciences Research Council (BBSRC), this research underscores the need for further investigation into how social and economic resources influence cognitive health.
This landmark study not only underscores the connection between socioeconomic advantage and cognitive resilience but also suggests actionable insights for policymakers aiming to create a more equitable and supportive framework for older adults across all socioeconomic backgrounds.
The study is published in Nature Scientific Reports.
Read the study in full here >
This study also received media coverage and was featured by more than 50 news outlets, including The Telegraph, Medical News; MedicalXPress; Science Daily, EurekAlert; and USNews.