Neighborhood Built Environment Characteristics and Cognition in Non-demented Older Adults Public Deposited

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  • March 20, 2019
Creator
  • Besser, Lilah
    • Affiliation: College of Arts and Sciences, Department of City and Regional Planning
Abstract
  • Research suggests that neighborhood built environment (BE) characteristics consistent with increasing urban density may be associated with better cognition in older adults; however, few of these studies have been conducted to date. Focusing on older adults, my study aimed to: 1) systematically review studies on neighborhood social and BE and cognition; 2) examine whether social/walking destination density, intersection density, residential/retail land use, distance to nearest bus/train stop, or population density is associated with cognition; and 3) investigate if BE-cognition associations vary by individual-level characteristics (education, race/ethnicity, sex, apolipoprotein e4 genotype [APOE; genetic risk factor for Alzheimer’s disease], or sedentary behavior). I used cross-sectional, Exam 5 data on 4,123 participants from the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal study of subclinical cardiovascular disease that began in 2000. MESA recruited from six US regions (New York, Baltimore, Chicago, Los Angeles, Minneapolis-St. Paul, and Winston Salem) and oversampled minorities (Chinese, African American, and Hispanic). The literature review suggested that BE features such as presence of a community center and transit stops, increased land use mix, and public spaces in better condition may be associated with better cognition. Additionally, the literature suggested that lower neighborhood socioeconomic status (SES) is associated with worse cognition, independent of individual-level SES. Aim 2 analyses suggested that increasing population and intersection density are associated with worse cognition, whereas increased land dedicated to retail uses is associated with better cognition. Aim 3 analyses suggested that BE-cognition associations vary significantly by an individual’s education, race/ethnicity, sex, APOE genotype, and sedentary behavior. BE characteristics consistent with increasing urban density were associated with worse cognition in Hispanics but not Whites and in APOE e4 carriers but not APOE e4 non-carriers. Although an increase in neighborhood retail destinations was associated with better cognition in the overall sample, these results suggest that increasing urban density may have a disproportionately negative effect on cognition in racial/ethnic minorities and those with genetic susceptibility for Alzheimer’s disease. Compact growth policies may not be beneficial to all, and thus, planners and public health researchers need to consider the BE’s positive and negative effects on cognition in vulnerable populations.
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  • In Copyright
Advisor
  • Kaza, Nikhil
  • Song, Yan
  • Rodriguez, Daniel
  • Kukull, Walter
  • McDonald, Noreen
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2017
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