Social Determinants of Health and Neurocognitive Aging in Indigenous and Non-Indigenous Older Adults in Rural Andean Ecuador: A Population-Based Study in Cotacachi

Abstract

Introduction: Social determinants of health shape dementia risk in Latin America, particularly in rural and Indigenous populations. Methods: This cross-sectional study examined cognitive impairment and associated social factors in 75 adults aged 60 years or older in Cotacachi, Ecuador, identifying as Indigenous, Mestizo, or Other. Cognition was assessed with the RUDAS using education-adjusted cutoffs, alongside daily functioning and depression. Results: Cognitive impairment affected 22.7% and was more frequent among Indigenous participants. Limited early education emerged as a key social factor. In adjusted analyses, older age and depression were associated with impairment, whereas vascular conditions were not; ethnicity could not be disentangled from rurality. Discussion: These findings suggest that observed ethnic differences are embedded within structural inequalities, particularly educational and territorial disadvantage, supporting dementia prevention strategies addressing social inequities and mental health in rural Andean communities.