We examined associations between three geographic areas (urban, suburban, rural) and cognition (memory, reasoning, processing speed) over a 10-year period. Methods: Data were obtained from 2539 participants in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial. Multilevel, mixed-effects linear regression was used to estimate cognitive trajectories by geographical areas over 10 years, after adjusting for social determinants of health. Results: Compared to urban and suburban participants, rural participants fared worse on all cognitive measures—memory (B = −1.17 (0.17)), reasoning (B = −1.55 (0.19)), and processing speed (B = 0.76 (0.19)) across the 10-year trajectory. Across geographic areas, greater economic stability, health care access and quality, and neighborhood resources were associated with better cognition over time. Discussion: Findings highlight the importance of geographical location when examining cognition later in life. More research examining place-based life experiences is needed to make the greatest impact on geographically diverse communities.
AndelR.KåreholtI.ParkerM. G.ThorslundM.GatzM. (2007). Complexity of primary lifetime occupation and cognition in advanced old age. Journal of Aging and Health, 19(3), 397–415. https://doi.org/10.1177/0898264307300171
2.
BallK.BerchD. B.HelmersK. F.JobeJ. B.LeveckM. D.MarsiskeM.MorrisJ. N.RebokG. W.SmithD. M.TennstedtS. L.UnverzagtF. W.WillisS. L.Advanced Cognitive Training for Independent and Vital Elderly Study Group (2002). Effects of cognitive training interventions with older adults: A randomized controlled trial. JAMA, 288(18), 2271–2281. https://doi.org/10.1001/jama.288.18.2271
3.
BennettK. J.BordersT. F.HolmesG. M.KozhimannilK. B.ZillerE. (2019). What is rural? Challenges and implications of definitions that inadequately encompass rural people and places. Health Affairs, 38(12), 1985–1992. https://doi.org/10.1377/hlthaff.2019.00910
4.
BesserL. M.McDonaldN. C.SongY.KukullW. A.RodriguezD. A. (2017). Neighborhood environment and cognition in older adults: A systematic review. American Journal of Preventive Medicine, 53(2), 241–251. https://doi.org/10.1016/j.amepre.2017.02.013
5.
BlomG. (1958). Statistical estimates and transformed beta-variables. Wiley.
BrandtJ. (1991). The hopkins verbal learning test: Development of a new memory test with six equivalent forms. The Clinical Neuropsychologist, 5(2), 125–142. https://doi.org/10.1080/13854049108403297
8.
CassarinoM.O'SullivanV.KennyR. A.SettiA. (2016). Environment and cognitive aging: A cross-sectional study of place of residence and cognitive performance in the Irish longitudinal study on aging. Neuropsychology, 30(5), 543–557. https://doi.org/10.1037/neu0000253
9.
CassarinoM.O'SullivanV.KennyR. A.SettiA. (2018). Disabilities moderate the association between neighbourhood urbanity and cognitive health: Results from the Irish longitudinal study on ageing. Disability and Health Journal, 11(3), 359–366. https://doi.org/10.1016/j.dhjo.2017.12.002
10.
ClayO. J.BallK. K.WheelerK. M.MarsiskeM.DeanL.CroweM.ThorpeR. J.Jr.JonesR.OwensJ. H.RebokG. W.WillisS. L.. (under review). Evaluating social determinants of health domains and their predictive validity within the ACTIVE trial. Journal of Aging and Health, ACTIVE Special Issue.
11.
CohenS. A.CookS. K.KelleyL.FoutzJ. D.SandoT. A. (2017). A closer look at rural-urban health disparities: Associations between obesity and rurality vary by geospatial and sociodemographic factors. The Journal of Rural Health, 33(2), 167–179. https://doi.org/10.1111/jrh.12207
12.
CohenS. A.CookS. K.SandoT. A.SabikN. J. (2018). What aspects of rural life contribute to rural-urban health disparities in older adults? Evidence from a national survey. The Journal of Rural Health, 34(3), 293–303. https://doi.org/10.1111/jrh.12287
13.
CroweM.AndelR.PedersenN. L.JohanssonB.GatzM. (2003). Does participation in leisure activities lead to reduced risk of Alzheimer’s disease? A prospective study of Swedish twins. The Journals of Gerontology Series B, Psychological Sciences and Social Sciences, 58(5), 249–255. https://doi.org/10.1093/geronb/58.5.P249
14.
Dankwa-MullanI.Pérez-StableE. J. (2016). Addressing health disparities is a place-based issue. American Journal of Public Health, 106(4), 637–639. https://doi.org/10.2105/AJPH.2016.303077
15.
DeckersK.van BoxtelM. J. P.SchiepersO. J. G.de VugtM.MunozJ. L.AnsteyK. J.BrayneC.DartiguesJ.-F.EngedalK.KivipeltoM.RitchieK.StarrJ. M.YaffeK.IrvingK.VerheyF. R. J.KöhlerS. (2015). Target risk factors for dementia prevention: A systematic review and Delphi consensus study on the evidence from observational studies. International Journal of Geriatric Psychiatry, 30(3), 234–246. https://doi.org/10.1002/gps.4245
16.
EberhardtM. S.FreidV. M.HarperS.IngramD. D.MakucD. M.PamukE.PragerK. (2001). Urban and rural health chartbook. Health, United States, 2001. National Center for Health Statistics.
17.
EberhardtM. S.PamukE. R. (2004). The importance of place of residence: Examining health in rural and nonrural areas. American Journal of Public Health, 94(10), 1682–1686. https://doi.org/10.2105/AJPH.94.10.1682
FinlayJ.EspositoM.TangS.Gomez-LopezI.SylversD.JuddS.ClarkeP. (2020). Fast-food for thought: Retail food environments as resources for cognitive health and well-being among aging Americans?Health & Place, 64(3), 102379. https://doi.org/10.1016/j.healthplace.2020.102379
20.
FolsteinM. F.FolsteinS. E.McHughP. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6
21.
FriedlandR. P.FritschT.SmythK. A.KossE.LernerA. J.ChenC. H.PetotG. J.DebanneS. M. (2001). Patients with Alzheimer’s disease have reduced activities in midlife compared with healthy control-group members. Proceedings of the National Academy of Sciences of the United States of America, 98(6), 3440–3445. https://doi.org/10.1073/pnas.061002998
22.
GondaJ.SchaieK. (1985). Schaie-thurstone mental abilities test: Word series test. Consulting Psychologists Press.
23.
GrossA. L.InouyeS. K.RebokG. W.BrandtJ.CraneP. K.ParisiJ. M.TommetD.Bandeen-RocheK.CarlsonM. C.JonesR. N. (2012). Parallel but not equivalent: Challenges and solutions for repeated assessment of cognition over time. Journal of Clinical and Experimental Neuropsychology, 34(7), 758–772. https://doi.org/10.1080/13803395.2012.681628
24.
HaqK. S.PenningM. J. (2020). Social determinants of racial disparities in cognitive functioning in later life in Canada. Journal of Aging and Health, 32(7-8), 817–829. https://doi.org/10.1177/0898264319853137
25.
HarrisJ. K.BeattyK.LeiderJ. P.KnudsonA.AndersonB. L.MeitM. (2016). The double disparity facing rural local health departments. Annual Review of Public Health, 37(1), 167–184. https://doi.org/10.1146/annurev-publhealth-031914-122755
26.
HelmesE.Van GervenP. W. M. (2017). Urban residence and higher education do not protect against cognitive decline in aging and dementia: 10-year follow-up of the Canadian study of health and aging. Educational Gerontology, 43(11), 552–560. https://doi.org/10.1080/03601277.2017.1372951
27.
HendrieH. C.Smith-GambleV.LaneK. A.PurnellC.ClarkD. O.GaoS. (2018). The association of early life factors and declining incidence rates of dementia in an elderly population of African Americans. The Journals of Gerontology Series B, Psychological Sciences and Social Sciences, 73(Suppl 1), S82–S89. https://doi.org/10.1093/geronb/gbx143
28.
HiscockR.BauldL.AmosA.FidlerJ. A.MunafoM. (2012). Socioeconomic status and smoking: A review. Annals of the New York Academy of Sciences, 1248(1), 107–123. https://doi.org/10.1111/j.1749-6632.2011.06202.x
29.
IngramD. D.FrancoS. J. (2014). 2013 NCHS urban-rural classification scheme for counties (No. 2014). US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics.
30.
JamesC. V.MoonesingheR.Wilson-FrederickS. M.HallJ. E.Penman-AguilarA.BouyeK. (2017). Racial/ethnic health disparities among rural adults—United States, 2012–2015. MMWR Surveillance Summaries, 66(23), 1–9. https://doi.org/10.15585/mmwr.ss6623a1externalicon
31.
JamesW.CossmanJ. S. (2017). Long-term trends in black and white mortality in the rural United States: Evidence of a race-specific rural mortality penalty. The Journal of Rural Health, 33(1), 21–31. https://doi.org/10.1111/jrh.12181
32.
JensenL.MonnatS. M.GreenJ. J.HunterL. M.SliwinskiM. J. (2020). Rural population health and aging: Toward a multilevel and multidimensional research agenda for the 2020s. American Journal of Public Health, 110(9), 1328–1331. https://doi.org/10.2105/AJPH.2020.305782
33.
JobeJ. B.SmithD. M.BallK.TennstedtS. L.MarsiskeM.WillisS. L.RebokG. W.MorrisJ. N.HelmersK. F.LeveckM. D.KleinmanK. (2001). ACTIVE: A cognitive intervention trial to promote independence in older adults. Controlled Clinical Trials, 22(4), 453–479. https://doi.org/10.1016/S0197-2456(01)00139-8
34.
KareholtI.LennartssonC.GatzM.ParkerM. G. (2011). Baseline leisure time activity and cognition more than two decades later. International Journal of Geriatric Psychiatry, 26(1), 65–74. https://doi.org/10.1002/gps.2490
35.
KoohsariM. J.BadlandH.SugiyamaT.MavoaS.ChristianH.Giles-CortiB. (2015). Mismatch between perceived and objectively measured land use mix and street connectivity: associations with neighborhood walking. Journal of Urban Health, 92(2), 242–252. https://doi.org/10.1007/s11524-014-9928-x
36.
KumarV.AcanforaM.HennessyC. H.KalacheA. (2001). Health status of the rural elderly. The Journal of Rural Health, 17(4), 328–331. https://doi.org/10.1111
37.
LangaK. M.LarsonE. B.CrimminsE. M.FaulJ. D.LevineD. A.KabetoM. U.WeirD. R. (2017). A comparison of the prevalence of Dementia in the United States in 2000 and 2012. JAMA Internal Medicine, 177(1), 51–58. https://doi.org/10.1001/jamainternmed.2016.6807
LevasseurM.GénéreuxM.BruneauJ. F.VanasseA.ChabotÉ.BeaulacC.BédardM. M. (2015). Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: Results from a scoping study. BMC Public Health, 15(1), 503. https://doi.org/10.1186/s12889-015-1824-0
40.
LiF.HarmerP.CardinalB. J.BosworthM.Johnson-SheltonD.MooreJ. M.AcockA.VongjaturapatN. (2009). Built environment and 1-year change in weight and waist circumference in middle-aged and older adults: Portland neighborhood environment and health study. American Journal of Epidemiology, 169(4), 401–408. https://doi.org/10.1093/aje/kwn398
41.
Lorenzo-LópezL.Millán-CalentiJ. C.López-LópezR.Diego-DiezC.LaffonB.PásaroE.ValdiglesiasV.MasedaA. (2017). Effects of degree of urbanization and lifetime longest-held occupation on cognitive impairment prevalence in an older Spanish population. Frontiers in Psychology, 8, 162. https://doi.org/10.3389/fpsyg.2017.00162
42.
MairC.Diez RouxA. V.GaleaS. (2008). Are neighbourhood characteristics associated with depressive symptoms? A review of evidence. Journal of Epidemiology and Community Health, 62(11), 940–946. https://doi.org/10.1136/jech.2007.066605
43.
MatthewsK. A.CroftJ. B.LiuY.LuH.KannyD.WheatonA. G.CunninghamT. J.Kettel KhanL.CaraballoR. S.HoltJ. B.EkeP. I.GilesW. H. (2017). Health-related behaviors by urban-rural county classification-United States, 2013. MMWR, Surveillance Summaries, 66(5), 1–8. https://doi.org/10.15585/mmwr.ss6605a1
44.
MattosM. K.SnitzB. E.LinglerJ. H.BurkeL. E.NovoselL. M.SereikaS. M. (2017). Older rural- and urban-dwelling Appalachian adults with mild cognitive impairment. The Journal of Rural Health, 33(2), 208–216. https://doi.org/10.1111/jrh.12189
45.
MeyerO. L.SiscoS. M.HarveyD.ZahodneL. B.GlymourM. M.ManlyJ. J.MarsiskeM. (2017). Neighborhood predictors of cognitive training outcomes and trajectories in ACTIVE. Research on Aging, 39(3), 443–467. https://doi.org/10.1177/0164027515618242
46.
NakamuraK.KitamuraK.WatanabeY.ShinodaH.SatoH.SomeyaT. (2016). Rural-urban differences in the prevalence of cognitive impairment in independent community-dwelling elderly residents of Ojiya city, Niigata Prefecture, Japan. Environmental Health and Preventative Medicine, 21(6), 422–429. https://doi.org/10.1007/s12199-016-0542-2
47.
NunesB.SilvaR. D.CruzV. T.RorizJ. M.PaisJ.SilvaM. C. (2010). Prevalence and pattern of cognitive impairment in rural and urban populations from Northern Portugal. BMC Neurology, 10(1), 42. https://doi.org/10.1186/1471-2377-10-42
48.
O’ConnorA.WelleniusG. (2012). Rural-urban disparities in the prevalence of diabetes and coronary heart disease. Public Health, 126(10), 813–820. https://doi.org/10.1016/j.puhe.2012.05.029
OwsleyC.SloaneM.McGwinG.BallK. (2002). Timed instrumental activities of daily living tasks: Relationship to cognitive function and everyday performance assessments in older adults. Gerontology, 48(4), 254–265. https://doi.org/10.1159/000058360
51.
PacasJ. D.RothwellD. W. (2020). Why is poverty higher in rural America according to the supplemental poverty measure? An investigation of the geographic adjustment. Population Research and Policy Review, 39(5), 941–975. https://doi.org/10.1007/s11113-020-09612-9
52.
PeltzerK.Phaswana-MafuyaN.PengpidS. (2019). Rural–urban health disparities among older adults in South Africa. African Journal of Primary Health Care and Family Medicine, 11(1), Article a1890. https://doi.org/10.4102/phcfm.v11i1.1890
53.
PetrosiniL.De BartoloP.FotiF.GelfoF.CutuliD.LeggioM.G.MandolesiL. (2009). On whether the environmental enrichment may provide cognitive and brain reserves. Brain Research Reviews, 61(2), 221–239. https://doi.org/10.1016/j.brainresrev.2009.07.002
54.
PotterG. G.PlassmanB. L.HelmsM. J.FosterS. M.EdwardsN. W. (2006). Occupational characteristics and cognitive performance among elderly male twins. Neurology, 67(8), 1377–1382. https://doi.org/10.1212/01.wnl.0000240061.51215
ReyA. (1964). L’examen clinique en psychologie. Presses Universitaires de France.
57.
RobbinsR. N.ScottT.JoskaJ. A.GouseH. (2019). Impact of urbanization on cognitive disorders. Current Opinion in Psychiatry, 32(3), 210–217. https://doi.org/10.1097/YCO.0000000000000490
58.
RussT. C.BattyG. D.HearnshawG. F.FentonC.StarrJ. M. (2012). Geographical variation in dementia: Systematic review with meta-analysis. International Journal of Epidemiology, 41(4), 1012–1032. https://doi.org/10.1093/ije/dys103
59.
SaenzJ. L.BeamC. R.ZelinskiE. M. (2020). The association between spousal education and cognitive ability among older Mexican adults. The Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 75(7), e129–e140. https://doi.org/10.1093/geronb/gbaa002
60.
SaenzJ. L.DownerB.GarciaM. A.WongR. (2018). Cognition and context: Rural-urban differences in cognitive aging among older Mexican adults. Journal of Aging and Health, 30(6), 965–986. https://doi.org/10.1177/0898264317703560
SallisJ. F.SaelensB. E.FrankL. D.ConwayT. L.SlymenD. J.CainK. L.ChapmanJ. E.KerrJ. (2009). Neighborhood built environment and income: Examining multiple health outcomes. Social Science & Medicine, 68(7), 1285–1293. https://doi.org/10.1016/j.socscimed.2009.01.017
63.
Sampedro-PiqueroP.BegegaA. (2017). Environmental enrichment as a positive behavioral intervention across the lifespan. Current Neuropharmacology, 15(4), 459–470. https://doi.org/10.2174/1570159X14666160325115909
64.
SchoolerC.MulatuM. S.OatesG. (1999). The continuing effects of substantively complex work on the intellectual functioning of older workers. Psychology and Aging, 14(3), 483–506. https://doi.org/10.1037//0882-7974.14.3.483
65.
SiscoS.GrossA. L.ShihR. A.SachsB. C.GlymourM. M.BangenK. J.BenitezA.SkinnerJ.SchneiderB. C.ManlyJ. J. (2015). The role of early-life educational quality and literacy in explaining racial disparities in cognition in late life. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 70(4), 557–567. https://doi.org/10.1093/geronb/gbt133
66.
SiscoS. M (2012). Neighborhood influences on cognitive level and training gains in the active study. [Doctoral dissertation, University of Florida].
67.
SiscoS. M.MarsiskeM. (2012). Neighborhood influences on late life cognition in the ACTIVE study. Journal of Aging Research, 2012, 435826. https://doi.org/10.1155/2012/435826
68.
StataCorp (2019). Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC.
69.
SmithA. S.TrevelyanE. (2019). The older population in rural America: 2012-2016. US Department of Commerce, Economics and Statistics Administration, US Census Bureau.
ThurstoneL.ThurstoneT. (1949). Examiner manual for the SRA primary mental abilities test (form 10–14). Science Research Associates.
73.
WedenM. M.ShihR. A.KabetoM. U.LangaK. M. (2018). Secular trends in dementia and cognitive impairment of U.S. rural and urban older adults. American Journal of Preventive Medicine, 54(2), 164–172. https://doi.org/10.1016/j.amepre.2017.10.021
74.
WellsM. (2010). Resilience in older adults living in rural, suburban, and urban areas. Online Journal of Rural Nursing and Health Care, 10(2), 45–54. https://doi.org/10.14574/ojrnhc.v10i2.55
75.
WenM.FanJ. X.Kowaleski-JonesL.WanN. (2018). Rural-urban disparities in obesity prevalence among working age adults in the United States: Exploring the mechanisms. American Journal of Health Promotion, 32(2), 400–408. https://doi.org/10.1177/0890117116689488
76.
WestL. A.ColeS.GoodkindD.HeW. (2014). 65+ in the United States: 2010 (pp. 23–212). US Census Bureau.
77.
WightR. G.AneshenselC. S.Miller-MartinezD.BotticelloA. L.CummingsJ. R.KarlamanglaA. S.SeemanT. E. (2006). Urban neighborhood context, educational attainment, and cognitive function among older adults. American Journal of Epidemiology, 163(12), 1071–1078. https://doi.org/10.1093/aje/kwj176
78.
WillisS. L (1996). Everyday cognitive competence in elderly persons: Conceptual issues and empirical findings. The Gerontologist, 36(5), 595–601. https://doi.org/10.1093/geront/36.5.595
79.
WilsonB.CockburnJ.BaddeleyA. (1985). The Rivermead behavioural memory test. BuryThames Valley Test Company.
80.
WisterA. V. (1996). The effects of socioeconomic status on exercise and smoking: Age-related differences. Journal of Aging and Health, 8(4), 467–488. https://doi.org/10.1177/089826439600800401
81.
WuY. T.PrinaA. M.BrayneC. (2015). The association between community environment and cognitive function: A systematic review. Social Psychiatry and Psychiatric Epidemiology, 50(3), 351–362. https://doi.org/10.1007/s00127-014-0945-6
82.
WuY. T.PrinaA. M.JonesA.MatthewsF. E.BrayneC.Medical Research Council Cognitive Function and Ageing Study Collaboration (2017). The built environment and cognitive disorders: Results from the cognitive function and ageing study II. American Journal of Preventive Medicine, 53(1), 25–32. https://doi.org/10.1016/j.amepre.2016.11.020
83.
XuH.DupreM. E.GuD.WuB. (2017). The impact of residential status on cognitive decline among older adults in China: Results from a longitudinal study. BMC Geriatrics, 17(1), 107. https://doi.org/10.1186/s12877-017-0501-9
84.
XuM. (2020). Spousal education and cognitive functioning in later life. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 75(7), e141–e150. https://doi.org/10.1093/geronb/gbz014
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
