Association of neighborhood deprivation with Alzheimer's Disease pathology, brain structure, and cognition by race and ethnicity, sex, and APOE ε4 status

BACKGROUNDWe investigated associations of neighborhood disadvantage with Alzheimers Disease (AD)-related outcomes by biological and social factors in at-risk older adults. METHODS1,880 U.S. POINTER participants with Area Deprivation Index (ADI) and cognition (PACC) were included. 868 had amyloid, tau PET, white matter hyperintensities (WMH), and/or gray matter volumes. We conducted exploratory, linear models testing ADI interactions with sex, race and ethnicity, and APOE {varepsilon}4, adjusting for age and education. RESULTS"White/European American", "Hispanic/Latinx/Spanish" and "Others" showed lower cognitive scores with higher ADI, while "White/European American" showed the highest cognitive scores across ADI levels. APOE {varepsilon}4 carriers from high-ADI areas showed higher WMH and tau, and "Hispanic/Latinx/Spanish" from more deprived areas showed higher WMH. Females from moderate-ADI areas showed higher tau. Amyloid burden was higher in APOE {varepsilon}4 carriers from low-ADI areas. CONCLUSIONDifferential associations of ADI with AD-related outcomes across biological and social factors may reflect systemic health disparities and study design.