Social determinants of health in different cognitive domains: a PROMOTE study analysis

Abstract

Background: Social determinants of health (SDH) frame a complex interplay between environmental factors that increase the risk of many health conditions, including dementia. However, it is unclear whether SDH impairs cognitive domains differently. This study aimed to investigate the impact of SDH across distinct cognitive domains in a South American population, expanding current understanding predominantly based on European and North American cohorts. Objective: To assess the association between social determinants of health (education, ethnicity, and family income) and performance across global cognition and specific cognitive domains, as measured by MoCA subscores, in a Brazilian cohort. Methods: Baseline data from the PROMOTE trial, conducted in a Brazilian cohort, was collected between 2023 and 2022. Participants were clinically evaluated and underwent the Montreal Cognitive Assessment (MoCA), with scores divided into subscores for six cognitive domains: Memory Index Score (MIS), Executive Index Score (EIS), Attention Index Score (AIS), Language Index Score (LIS), Visuospatial Index Score (VIS), and Orientation Index Score (OIS). SDH variables included years of education, ethnicity, and family income. Regression models were used to evaluate the impact of SDH altogether on total MoCA scores and subscores, adjusted for age and sex. Results: Data from 226 participants (59.5 ± 6.2 years of age; 13.2 ± 4.65 years of education) were analyzed. The majority of participants were White (n = 202). The regression analysis revealed that SDH had distinct associations with MoCA subscores. Education was associated with total MOCA scores (beta = 0.22, p < 0.001), EIS (beta 0.17, p < 0.001), MIS (beta 0.12, p = 0.009), AIS (beta 0.09, p = 0.02), LIS (beta 0.04, p = 0.008), VIS (beta 0.05, p < 0.001), but not with OIS. Non-white race was associated only with EIS (beta = -0.5, p = 0.04). Lower family income was not associated with any MOCA subscore in the model (p > 0.05). Conclusion: Education showed a major impact in executive function, memory, attention, language and vision domains. Non-white race was associated with worse executive functions score. These findings underscore the critical role of social determinants in cognitive health and the nuanced ways in which SDH affect distinct cognitive domains.