Socioeconomic factors such as education, occupation, and wealth influence the likelihood of developing cognitive impairment or dementia in later life, and whether a person is likely to recover is found in a new study led by UCL researchers.
The research, published in Scientific Reports, followed 8,442 adults aged 50 and above in England over 10 years to examine how socioeconomic factors at the start of the study were associated with changes in cognitive status. The researchers tracked how these people moved between various states: healthy, mild cognitive impairment, and dementia. They also considered the possibility of reversals, where individuals improved from a mild cognitive impairment state to a healthy one.
Information on socioeconomic factors was collected through a self-completion questionnaire. Cognitive impairment was determined using a mix of sources, including participants’ reports of a doctor’s diagnosis, cognitive test results, and their reports of symptoms and complaints, providing a full picture of each participant’s cognitive health. In addition to these aspects, the study also accounted for demographic factors, such as age, sex, and marital status. By estimating the time spent in each cognitive state and the likelihood of transitions to neurocognitive disorders such as cognitive impairment and dementia, the researchers were able to gain a comprehensive understanding of how socioeconomic factors impact the progression of a person’s disorder, as well as the duration spent within each cognitive state over time. The team found that people from more socioeconomically advantaged backgrounds – particularly those with post-secondary school education (such as university or college), managerial or professional-level occupations, and those in the wealthiest third of the population – were less likely to move from a healthy cognitive state to mild cognitive impairment, or from mild cognitive impairment to dementia compared to those with primary education (no higher than secondary school), working in manual or routine occupations, and in the most socioeconomically disadvantaged third of the population.
For instance, having a post-secondary education level was linked with a 43% lower chance of moving from a healthy cognitive state to mild cognitive impairment. Meanwhile, being in the wealthiest third of the population was linked with a 26% lower chance of shifting from mild cognitive impairment to dementia. Notably, these advantaged individuals were also more likely to recover from mild cognitive impairment and return to a healthy cognitive state, with wealthy individuals being 56% more likely and those with post-secondary education level or working in manual occupation being 81% more likely to improve, compared to socioeconomically disadvantaged individuals.
Senior author Dr Dorina Cadar (UCL Department of Behavioral Science and Health and Brighton and Sussex Medical School) said, “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 reversing cognitive impairment to a healthy cognitive state, which is promising."
What is Cognitive Impairment?
Cognitive impairment refers to a condition where an individual experiences a noticeable decline in their cognitive abilities, impacting memory, thinking, attention, or decision-making skills. In simple terms cognitive is related to thinking, conscious mental process, or the brain's ability to reason. This decline can vary from mild to severe and often affects a person’s ability to manage everyday tasks, such as remembering appointments, making plans, or even understanding language. Bhupender Sharma practicing psychologist at Hospital for Mental Health in Ahmedabad says cognitive impairment can be temporary or progressive, depending on its underlying causes and the individual’s health conditions.
What causes cognitive impairment?
Cognitive impairment can result from many factors including ageing, neurological disorders, traumatic brain injuries, medical conditions, mental health issues and other lifestyle factors. "Diseases like Alzheimer’s, Parkinson’s, Huntington's, and frontotemporal dementia involve progressive brain deterioration. They often disrupt neurotransmitters and damage critical brain regions responsible for cognition," says Sharma.
Symptoms of cognitive impairment
Cognitive impairment, one's abilities to think, process, rationalize and remember can be affected in various ways, depending on its severity and causes. Some common signs include:
Memory loss: forgetting recent events, appointments, or familiar tasks.
Confusion: Difficulty understanding time, place, or familiar environments.
Difficulty with problem-solving: Struggling with decisions, planning, or organizing.
Language problems: Trouble finding words or following conversations.
Poor judgement: Unable to make decisions or making risky decisions
Mood and personality changes: Increased irritability, anxiety, or depression.
Types of cognitive impairment
There are majorly two types of cognitive impairments including mild cognitive impairment and dementia. In the former which is also known as MCI, the patient is at an intermediate stage between normal and ageing and more severe conditions like dementia. "People with MCI may notice memory or thinking problems but can still perform daily activities independently. However, in the case of dementia, the patient experiences more severe cognitive impairment like Alzheimer's disease. Patients with severe conditions struggle with daily activities," says Sharma.
Managing cognitive impairment
Although, some causes such as neurodegenerative disease of cognitive impairment are irreversible, there are ways to manage and potentially improve cognitive health.
Medical management:
Medications: Depending on the cause, medications may be used.
Treat underlying conditions: Treating metabolic issues, controlling vascular risks (like hypertension, and diabetes), and addressing vitamin deficiencies can improve or stabilize cognitive function.
Antipsychotics and antidepressants: Used cautiously for symptoms like agitation or depression, especially in dementia.
Cognitive rehabilitation:
Programs designed to enhance cognitive functioning through targeted exercises. Techniques may include memory exercises, attention training, and problem-solving tasks.
Behavioral therapy can help improve function and adapt coping skills to specific deficits.
Psychotherapy and counselling:
Especially helpful in managing depression, anxiety, or frustration resulting from cognitive impairment.
Cognitive-behavioral therapy (CBT) may be used to improve coping strategies.
Lifestyle Modifications:
Exercise: Regular physical activity can boost blood flow to the brain and improve mood.
Diet: A balanced diet with antioxidants, omega-3s, and other nutrients supports brain health. The Mediterranean diet, for example, has been shown to benefit cognitive function.
Sleep hygiene: Adequate sleep is critical for cognitive health. Managing sleep disorders can lead to improvements in attention, memory, and mood.
Social engagement and activities:
Engagement in social, cognitive, and physical activities can help maintain brain function. Activities like puzzles, games, reading, and community involvement are beneficial.
Environmental modifications:
Adjusting the person’s environment for better navigation, labelling items, or using reminders and cues can assist daily functioning and reduce confusion. Using assistive devices like reminder alarms, medication dispensers, or smartphone applications can support independence.
Family and caregiver support:
Educating family members about cognitive impairment is essential. Support groups and resources for caregivers help manage the challenges of care and reduce burnout.
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