Social Determinants, Minority Stress May Impact Cognitive Function

Minority-related stress, which is more likely experienced by minority social identities, is not predictive of changes in memory.

Social determinants and minority stress may not be consistently associated with cognitive change over a 3-year period, according to a study published in the Archives of Gerontology and Geriatrics.

It is well known that changes in memory can interfere with instrumental activities of daily living and may portend serious health concerns, including mild cognitive impairment or dementia. Risk factors for cognitive decline and dementia appear to cluster around inequalities, suggesting that minority populations may be at an elevated risk for cognitive decline.

Recognizing that the extent to which social determinants of health are associated with changes in memory remains unclear, researchers sought to elucidate the association between social determinants and change in memory function over a 3-year follow-up period, after accounting for health and demographic variables.

The Canadian Longitudinal Study on Aging (CLSA) is an ongoing investigation of adult development, in which data on numerous biological, psychological, and social health measures are collected. Baseline data (from 2011 to 2015) and initial follow-up data (from 2015 to 2018) from the CLSA were used in the current analysis. More than 50,000 community-dwelling Canadians between 45 and 85 years of age were recruited into the CLSA in 2015, with plans to follow all participants until 2023. All participants were recruited into a Comprehensive cohort (n=30,097) or a Tracking cohort (n=21,241).

Through community engagement, cognitive aging research should ensure representation from members of diverse communities of older adults to promote equitable aging experiences.

The primary analysis of CLSA comprised a multivariable linear regression model of 30,475 individuals. Health, demographic, education and occupation, social support, social identity, and social positioning variables (ie, predictors) all were calculated at baseline. A reliable change index (the study outcome) was computed via use of the Rey Auditory Verbal Learning Test (RAVLT).

Over the 3-year study period, the researchers found that older age and certain health considerations, such as higher body mass index (BMI) and having poor hearing, were associated with an increase in memory decline. In contrast, better self-rated general health and some physical activity were linked to memory improvements. Better perceived social standing and having a hobby were both associated with greater memory improvement as well. Further, minority social identities that are more likely to experience minority-related stress (eg, sexual orientation, gender identity, social status, and race) were not predictive of changes in memory.

Participants in the tracking cohort had significantly greater attrition than the Comprehensive cohort (11.7% vs 4.7%, respectively; P <.001). When respondents with missing data (n=5889) and without missing data (n=30,475) were compared, the Tracking cohort had a significantly higher proportion of “missingness” compared with the Comprehensive cohort (20.6% vs 13.4%, respectively; P <.001). Additionally, significantly more women participants than men participants had missing data (18.6% vs 13.6%, respectively; P <.001). Participants with missing data were also significantly more likely to be older than those without missing data (65.87 years vs 61.70 years, respectively; P <.001).

Limitations of the present study should be noted. Some differences existed in the approach to data collection between the Tracking cohort and the Comprehensive cohort (ie, phone vs in-person). Further, the researchers were limited to 2 data time points; however, the use of 3 or more cognitive assessments would permit the application of longitudinal models (eg, growth modeling) to best identify trajectories of cognitive aging.

The researchers stated that “Through community engagement, cognitive aging research should ensure representation from members of diverse communities of older adults to promote equitable aging experiences.”

“From this perspective, social determinants and, specifically, minoritized identities may in part affect participants’ cognitive function as they enter older age but may be less tied to rate of cognitive change,” they concluded.

Disclosure: Neither of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.  


Stinchcombe A, Hammond NG. Social determinants of memory change: a three-year follow-up of the Canadian Longitudinal Study on Aging (CLSA)Arch Gerontol Geriatr. Published online October 3, 2022. doi:10.1016/j.archger.2022.104830