Global rural health disparities in Alzheimer's disease and related dementias: State of the science

Lisa Ann Kirk Wiese; Allison Gibson; Marc Aaron Guest; Amy R. Nelson; Raven Weaver; Aditi Gupta; Owen Carmichael; Jordan P. Lewis; Allison Lindauer; Samantha Loi; Rachel Peterson; Kylie Radford; Elizabeth K. Rhodus; Christina G. Wong; Megan Zuelsdorff; Ladan Ghazi Saidi; Esmeralda Valdivieso-Mora; Sanne Franzen; Caitlin N. Pope; Timothy S. Killian; Hom L. Shrestha; Patricia C. Heyn; Ted Kheng Siang Ng; Beth Prusaczyk; Samantha John; Ambar Kulshreshtha; Julia L. Sheffler; Lilah Besser; Valerie Daniel; Magdalena I. Tolea; Justin Miller; Christine Musyimi; Jon Corkey; Veronica Yank; Christine L. Williams; Zahra Rahemi; Ju Young Park; Sheryl Magzamen; Robert L. Newton; Candace Harrington; Jason D. Flatt; Sonakshi Arora; Sarah Walter; Percy Griffin; Ganesh M. Babulal

doi:10.1002/alz.13104

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

Lisa Ann Kirk Wiese, Allison Gibson, Marc Aaron Guest, Amy R. Nelson, Raven Weaver, Aditi Gupta, Owen Carmichael, Jordan P. Lewis, Allison Lindauer, Samantha Loi, Rachel Peterson, Kylie Radford, Elizabeth K. Rhodus, Christina G. Wong, Megan Zuelsdorff, Ladan Ghazi Saidi, Esmeralda Valdivieso-Mora, Sanne Franzen, Caitlin N. Pope, Timothy S. KillianHom L. Shrestha, Patricia C. Heyn, Ted Kheng Siang Ng, Beth Prusaczyk, Samantha John, Ambar Kulshreshtha, Julia L. Sheffler, Lilah Besser, Valerie Daniel, Magdalena I. Tolea, Justin Miller, Christine Musyimi, Jon Corkey, Veronica Yank, Christine L. Williams, Zahra Rahemi, Ju Young Park, Sheryl Magzamen, Robert L. Newton, Candace Harrington, Jason D. Flatt, Sonakshi Arora, Sarah Walter, Percy Griffin, Ganesh M. Babulal

Research output: Contribution to journal › Review article › peer-review

51 Scopus citations

Abstract

INTRODUCTION: Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators. METHODS: An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: “What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?” In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings. RESULTS: A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions. DISCUSSION: A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities. HIGHLIGHTS: Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel “location dynamics” model guides assessment of rural-specific ADRD issues.

Original language	English
Pages (from-to)	4204-4225
Number of pages	22
Journal	Alzheimer's and Dementia
Volume	19
Issue number	9
DOIs	https://doi.org/10.1002/alz.13104
State	Published - Sep 2023

Bibliographical note

Publisher Copyright:
© 2023 the Alzheimer's Association.

Funding

Lisa Ann Kirk Wiese received funding from National Institute of Health/National Institute on Aging (K01AG064047) and Florida Department of Health, Ed and Ethel Moore Research Foundation. Christine L. Williams was supported by NIH/NIA (R01 56AG064094). Allison Gibson received funding from National Institute of Health/National Institute on Aging (P30AG072946) and University of Kentucky, Sanders‐Brown Center on Aging. Amy R. Nelson received funding from NIH/NINDS (U19NS120384). Frederick P. Whiddon was supported by National Institute on Health/National Institutes of Aging (R00AG058780) and AlzOut. Aditi Gupta was supported by funding K23AG055555 and R61/33AG068483. Owen Carmichael was supported by NIH (grants AG078533, AG078558, AG07425801, AG077497, AG077000, AG067765, AG041200, AG062309, AG062200, AG069476). Allison Lindauer was supported by funding from NIH/NIA (R01AG067596; P30AG066518; P30AG042978). Rachel Peterson received funding from National Institute of Health/National Institute on Aging (4R00AG073457‐02). Elizabeth K. Rhodus was funded by National Institute of Health/National Institute on Aging (P30AG072946) and NIH/NIA (K23AG075262). Christina G. Wong was funded by Nevada Exploratory Alzheimer's Disease Research Center (under Award Number P20 AG068053) and the National Institute of General Medical Science (NIGMS) (under Award Number P20 GM109025). Megan Zuelsdorff was supported by funding (AARF‐18‐562958 and R03AG063303). Justin Miller received funding from Nevada Exploratory Alzheimer's Disease Research Center (under Award Number P20 AG068053) and the National Institute of General Medical Sciences (NIGMS) (under Award Number P20 GM109025). Sanne Franzen has received consulting fees from Biogen (paid to her organization). She has also received honoraria for lectures and speaking at panels. SF receives support through the ABOARD project, a public–private partnership funded by ZonMW (#73305095007) and Health‐Holland, Topsector Life Sciences & Health (PPP‐allowance; #LSHM20106). Caitlin N. Pope was supported by a research career development award (K12DA035150: Building Interdisciplinary Research Careers in Women's Health Program‐BIRCWH) from the National Institutes of Health Office of Research on Women's Health and the National Institute on Drug Abuse. Patricia C. Heyn was supported by National Institute of Health (5TR13AG072884‐02, NIH 1R13AT011146‐01, HHS, ACL, 90FPSG0063). Beth Prusaczyk was supported by NIH/NIA (K01AG071749). Ambar Kulshreshtha was supported by funding from NIH/NIA (K23 AG066931‐01A1). Veronica Yank received grants from National Institute of Health/National Institute on Aging (R01AG057855 and NIA R01AG072057). Lilah was supported by funding from NIH/NIA K01AG063895, NIH/NIA R21AG075291, and an Alzheimer's Association Research Grant (AARG‐21‐850963). Jon Corkey Amissa Corporation was supported by funding from the NIH /National Institute on Aging (1R43AG072981‐01A1) and National Science Foundation (#2127407). Ganesh M. Babulal was supported by the National Institute of Health/National Institute on Aging (grant numbers: R01 AG074302, R01 AG068183, R01 AG067428, R01 AG056466) and by the BrightFocus Foundation (A2021142S). Sheryl Magzamen was supported by funding from the NASA Health and Air Quality Applied Sciences Team. This manuscript was facilitated by the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART), through the Diversity and Disparities Professional Interest Area (PIA). The views and opinions expressed by authors in this publication represent those of the authors and do not necessarily reflect those of the PIA membership, ISTAART, or the Alzheimer's Association. Lisa Ann Kirk Wiese received funding from National Institute of Health/National Institute on Aging (K01AG064047) and Florida Department of Health, Ed and Ethel Moore Research Foundation. Christine L. Williams was supported by NIH/NIA (R01 56AG064094). Allison Gibson received funding from National Institute of Health/National Institute on Aging (P30AG072946) and University of Kentucky, Sanders-Brown Center on Aging. Amy R. Nelson received funding from NIH/NINDS (U19NS120384), National Institute on Health/National Institutes of Aging (R00AG058780) and AlzOut. Aditi Gupta was supported by funding K23AG055555 and R61/33AG068483. Owen Carmichael was supported by NIH (grants AG078533, AG078558, AG07425801, AG077497, AG077000, AG067765, AG041200, AG062309, AG062200, AG069476). Allison Lindauer was supported by funding from NIH/NIA (R01AG067596; P30AG066518; P30AG042978). Rachel Peterson received funding from National Institute of Health/National Institute on Aging (4R00AG073457-02). Elizabeth K. Rhodus was funded by National Institute of Health/National Institute on Aging (P30AG072946) and NIH/NIA (K23AG075262). Christina G. Wong was funded by Nevada Exploratory Alzheimer's Disease Research Center (under Award Number P20 AG068053) and the National Institute of General Medical Science (NIGMS) (under Award Number P20 GM109025). Megan Zuelsdorff was supported by funding (AARF-18-562958 and R03AG063303). Justin Miller received funding from Nevada Exploratory Alzheimer's Disease Research Center (under Award Number P20 AG068053) and the National Institute of General Medical Sciences (NIGMS) (under Award Number P20 GM109025). Sanne Franzen has received consulting fees from Biogen (paid to her organization). She has also received honoraria for lectures and speaking at panels. SF receives support through the ABOARD project, a public–private partnership funded by ZonMW (#73305095007) and Health-Holland, Topsector Life Sciences & Health (PPP-allowance; #LSHM20106). Caitlin N. Pope was supported by a research career development award (K12DA035150: Building Interdisciplinary Research Careers in Women's Health Program-BIRCWH) from the National Institutes of Health Office of Research on Women's Health and the National Institute on Drug Abuse. Patricia C. Heyn was supported by National Institute of Health (5TR13AG072884-02, NIH 1R13AT011146-01, HHS, ACL, 90FPSG0063). Beth Prusaczyk was supported by NIH/NIA (K01AG071749). Ambar Kulshreshtha was supported by funding from NIH/NIA (K23 AG066931-01A1). Veronica Yank received grants from National Institute of Health/National Institute on Aging (R01AG057855 and NIA R01AG072057). Lilah was supported by funding from NIH/NIA K01AG063895, NIH/NIA R21AG075291, and an Alzheimer's Association Research Grant (AARG-21-850963). Jon Corkey Amissa Corporation was supported by funding from the NIH /National Institute on Aging (1R43AG072981-01A1) and National Science Foundation (#2127407). Ganesh M. Babulal was supported by the National Institute of Health/National Institute on Aging (grant numbers: R01 AG074302, R01 AG068183, R01 AG067428, R01 AG056466) and by the BrightFocus Foundation (A2021142S). Sheryl Magzamen was supported by funding from the NASA Health and Air Quality Applied Sciences Team. [Correction added on May 25, 2023, after first online publication: Acknowledgments have been corrected for Amy. R. Nelson].

Funders	Funder number
Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment
Building Interdisciplinary Research Careers in Women's Health Program-BIRCWH
Ethel Moore Research Foundation
Mental Health Services North-Holland North
ISTAART
NASA Health and Air Quality Applied Sciences Team
National Institutes of Health Office of Research on Women's Health
Nevada Exploratory Alzheimer's Disease Research Center	P20 AG068053
Sanders-Brown Center on Aging
Topsector Life Sciences & Health	K12DA035150, 20106
Sanders-Brown Center on Aging, University of Kentucky
National Science Foundation Arctic Social Science Program	2127407, R01 AG074302, R01 AG068183, R01 AG067428, R01 AG056466
National Institutes of Health (NIH)
U.S. Department of Health and Human Services
Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse	5TR13AG072884‐02, 1R13AT011146‐01
National Institute on Aging	AG069476, R01 56AG064094, AG041200, K01AG064047, AG062309, AG067765, AG07425801, P30AG042978, P30AG066518, 4R00AG073457‐02, AG062200, R61/33AG068483, AG077000, AG077497, AG078533, K23AG055555, K23AG075262, R00AG058780, R01AG067596, AG078558, P30AG072946
National Institute of General Medical Sciences DP2GM119177 Sophie Dumont National Institute of General Medical Sciences	P20 GM109025, R03AG063303, AARF‐18‐562958
Institute of Neurological Disorders and Stroke National Advisory Neurological Disorders and Stroke Council	U19NS120384
Alzheimer's Association
Administration for Community Living	AARG‐21‐850963, R21AG075291, 1R43AG072981‐01A1, K01AG063895, 90FPSG0063, K01AG071749, R01AG057855, R01AG072057, K23 AG066931‐01A1
BrightFocus Foundation	A2021142S
Florida Department of Health
University of Kentucky
ZonMw Memorabel	73305095007

Keywords

community engagement
community-based action
facilitators and barriers to ADRD diagnosis and treatment
global disparities
health disparities
location dynamics
modifiable ADRD risk factors
rural
rural culture
under-represented
underserved

ASJC Scopus subject areas

Epidemiology
Health Policy
Developmental Neuroscience
Clinical Neurology
Geriatrics and Gerontology
Cellular and Molecular Neuroscience
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1002/alz.13104

Cite this

Wiese, L. A. K., Gibson, A., Guest, M. A., Nelson, A. R., Weaver, R., Gupta, A., Carmichael, O., Lewis, J. P., Lindauer, A., Loi, S., Peterson, R., Radford, K., Rhodus, E. K., Wong, C. G., Zuelsdorff, M., Saidi, L. G., Valdivieso-Mora, E., Franzen, S., Pope, C. N., ... Babulal, G. M. (2023). Global rural health disparities in Alzheimer's disease and related dementias: State of the science. Alzheimer's and Dementia, 19(9), 4204-4225. https://doi.org/10.1002/alz.13104

@article{923c9e19dd7341a8bf10f289a605ab6d,

title = "Global rural health disparities in Alzheimer's disease and related dementias: State of the science",

abstract = "INTRODUCTION: Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators. METHODS: An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: “What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?” In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings. RESULTS: A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions. DISCUSSION: A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities. HIGHLIGHTS: Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel “location dynamics” model guides assessment of rural-specific ADRD issues.",

keywords = "community engagement, community-based action, facilitators and barriers to ADRD diagnosis and treatment, global disparities, health disparities, location dynamics, modifiable ADRD risk factors, rural, rural culture, under-represented, underserved",

author = "Wiese, \{Lisa Ann Kirk\} and Allison Gibson and Guest, \{Marc Aaron\} and Nelson, \{Amy R.\} and Raven Weaver and Aditi Gupta and Owen Carmichael and Lewis, \{Jordan P.\} and Allison Lindauer and Samantha Loi and Rachel Peterson and Kylie Radford and Rhodus, \{Elizabeth K.\} and Wong, \{Christina G.\} and Megan Zuelsdorff and Saidi, \{Ladan Ghazi\} and Esmeralda Valdivieso-Mora and Sanne Franzen and Pope, \{Caitlin N.\} and Killian, \{Timothy S.\} and Shrestha, \{Hom L.\} and Heyn, \{Patricia C.\} and Ng, \{Ted Kheng Siang\} and Beth Prusaczyk and Samantha John and Ambar Kulshreshtha and Sheffler, \{Julia L.\} and Lilah Besser and Valerie Daniel and Tolea, \{Magdalena I.\} and Justin Miller and Christine Musyimi and Jon Corkey and Veronica Yank and Williams, \{Christine L.\} and Zahra Rahemi and Park, \{Ju Young\} and Sheryl Magzamen and Newton, \{Robert L.\} and Candace Harrington and Flatt, \{Jason D.\} and Sonakshi Arora and Sarah Walter and Percy Griffin and Babulal, \{Ganesh M.\}",

note = "Publisher Copyright: {\textcopyright} 2023 the Alzheimer's Association.",

year = "2023",

month = sep,

doi = "10.1002/alz.13104",

language = "English",

volume = "19",

pages = "4204--4225",

number = "9",

}

Wiese, LAK, Gibson, A, Guest, MA, Nelson, AR, Weaver, R, Gupta, A, Carmichael, O, Lewis, JP, Lindauer, A, Loi, S, Peterson, R, Radford, K, Rhodus, EK, Wong, CG, Zuelsdorff, M, Saidi, LG, Valdivieso-Mora, E, Franzen, S, Pope, CN, Killian, TS, Shrestha, HL, Heyn, PC, Ng, TKS, Prusaczyk, B, John, S, Kulshreshtha, A, Sheffler, JL, Besser, L, Daniel, V, Tolea, MI, Miller, J, Musyimi, C, Corkey, J, Yank, V, Williams, CL, Rahemi, Z, Park, JY, Magzamen, S, Newton, RL, Harrington, C, Flatt, JD, Arora, S, Walter, S, Griffin, P & Babulal, GM 2023, 'Global rural health disparities in Alzheimer's disease and related dementias: State of the science', Alzheimer's and Dementia, vol. 19, no. 9, pp. 4204-4225. https://doi.org/10.1002/alz.13104

TY - JOUR

T1 - Global rural health disparities in Alzheimer's disease and related dementias

T2 - State of the science

AU - Wiese, Lisa Ann Kirk

AU - Gibson, Allison

AU - Guest, Marc Aaron

AU - Nelson, Amy R.

AU - Weaver, Raven

AU - Gupta, Aditi

AU - Carmichael, Owen

AU - Lewis, Jordan P.

AU - Lindauer, Allison

AU - Loi, Samantha

AU - Peterson, Rachel

AU - Radford, Kylie

AU - Rhodus, Elizabeth K.

AU - Wong, Christina G.

AU - Zuelsdorff, Megan

AU - Saidi, Ladan Ghazi

AU - Valdivieso-Mora, Esmeralda

AU - Franzen, Sanne

AU - Pope, Caitlin N.

AU - Killian, Timothy S.

AU - Shrestha, Hom L.

AU - Heyn, Patricia C.

AU - Ng, Ted Kheng Siang

AU - Prusaczyk, Beth

AU - John, Samantha

AU - Kulshreshtha, Ambar

AU - Sheffler, Julia L.

AU - Besser, Lilah

AU - Daniel, Valerie

AU - Tolea, Magdalena I.

AU - Miller, Justin

AU - Musyimi, Christine

AU - Corkey, Jon

AU - Yank, Veronica

AU - Williams, Christine L.

AU - Rahemi, Zahra

AU - Park, Ju Young

AU - Magzamen, Sheryl

AU - Newton, Robert L.

AU - Harrington, Candace

AU - Flatt, Jason D.

AU - Arora, Sonakshi

AU - Walter, Sarah

AU - Griffin, Percy

AU - Babulal, Ganesh M.

PY - 2023/9

Y1 - 2023/9

N2 - INTRODUCTION: Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators. METHODS: An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: “What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?” In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings. RESULTS: A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions. DISCUSSION: A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities. HIGHLIGHTS: Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel “location dynamics” model guides assessment of rural-specific ADRD issues.

AB - INTRODUCTION: Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators. METHODS: An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: “What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?” In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings. RESULTS: A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions. DISCUSSION: A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities. HIGHLIGHTS: Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel “location dynamics” model guides assessment of rural-specific ADRD issues.

KW - community engagement

KW - community-based action

KW - facilitators and barriers to ADRD diagnosis and treatment

KW - global disparities

KW - health disparities

KW - location dynamics

KW - modifiable ADRD risk factors

KW - rural

KW - rural culture

KW - under-represented

KW - underserved

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DO - 10.1002/alz.13104

M3 - Review article

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SN - 1552-5260

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JO - Alzheimer's and Dementia

JF - Alzheimer's and Dementia

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ER -

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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