Influence of activity space on the association between neighborhood characteristics and dementia risk: results from the 3-City study cohort

• Published in: BMC geriatrics Vol. 19; no. 1; pp. 4 - 11
• Main Authors: Letellier, Noémie, Carrière, Isabelle, Gutierrez, Laure-Anne, Gabelle, Audrey, Dartigues, Jean-François, Dufouil, Carole, Helmer, Catherine, Cadot, Emmanuelle, Berr, Claudine
• Format: Journal Article
• Language: English
• Published: London BioMed Central 07.01.2019; BioMed Central Ltd; BMC
• Subjects: Activities of daily living; Activities of Daily Living - psychology; Aged; Aged, 80 and over; Aging; Cities - epidemiology; Cognitive ability; Cognitive aging; Cognitive science; Cohort Studies; Dementia; Dementia - economics; Dementia - epidemiology; Dementia - psychology; Dementia disorders; Demographic aspects; Deprivation; Economic aspects; Environment and Society; Environment Design - economics; Environmental aspects; Environmental Sciences; Female; Geography; Geriatrics; Geriatrics/Gerontology; Health aspects; Health care disparities; Humanities and Social Sciences; Humans; Life-space mobility; Living environment; Longitudinal Studies; Male; Medicine; Medicine & Public Health; Neighborhoods; Neuroscience; Older people; Population studies; Poverty - economics; Poverty - trends; psychiatry and quality of life; Psychology; Rehabilitation; Research Article; Residence Characteristics; Risk Factors; Shopping; Social aspects; Social Class; Social Environment; Social health inequalities; Socioeconomic Factors; Cities; France; Deprivation; Cognitive aging; Life-space mobility; Social health inequalities; Living environment
• ISSN: 1471-2318; 1471-2318
• DOI: 10.1186/s12877-018-1017-7

Background Socioeconomic level of residential environment was found to influence cognitive performance. However, individuals from the same place of residence may be affected differently. We aim to investigate for the first time the influence of individual activity space on the association between neighborhood socioeconomic status (NSES) and the risk of dementia. Methods In the frame of the Three-City cohort, a French population-based study, we followed longitudinally (12 years) 7009 participants aged over 65. The activity space (i.e., the spatial area through which a person moves daily) was defined using two questions from Lawton’s Instrumental Activities of Daily Living scale (“Goes shopping independently”,“Travels alone”), and one question about mobility restriction. The survival analysis was performed using a Cox marginal model that takes into account intra-neighborhood correlations and includes a large number of potential confounders. Results Among people with a limited activity space ( n  = 772, 11%), risk of dementia is increased in subjects living in a deprived area (characterized by high GINI index or low median income) compared to those living in more favored. Conclusion This study shows that the individual activity space modifies the association between NSES and the risk of dementia providing a more complete picture of residential inequalities. If confirmed in different populations, these findings suggest that people with limited activity space and living in a deprived neighborhood are particularly at risk and should be targeted for prevention.