Structural inequality linked to brain volume and network dynamics in aging and dementia across the Americas

Agustina Legaz, Florencia Altschuler, Raul Gonzalez-Gomez, Hernán Hernández, Sandra Baez, Joaquín Migeot, Sol Fittipaldi, Vicente Medel, Marcelo Adrián Maito, María E. Godoy, Sebastián Moguilner, Josephine Cruzat, Carlos Coronel-Oliveros, Enzo Tagliazuchi, Hernando Santamaria Garcia, Francesca R. Farina, Pablo Reyes, Shireen Javandel, Adolfo M. García, Álvaro DelegliseDiana L. Matallana, José Alberto Avila-Funes, Andrea Slachevsky, María I. Behrens, Nilton Custodio, Catalina Trujillo-Llano, Juan F. Cardona, Pablo Barttfeld, Ignacio L. Brusco, Martín A. Bruno, Ana L. Sosa Ortiz, Stefanie D. Pina-Escudero, Leonel T. Takada, Elisa de Paula França Resende, Katherine L. Possin, Maira Okada de Oliveira, Kun Hu, Francisco Lopera, Brian Lawlor, Victor Valcour, Jennifer S. Yokoyama, Bruce Miller, Agustin Ibañez

Research output: Contribution to journalArticlepeer-review

Abstract

Structural inequality, the uneven distribution of resources and opportunities, influences health outcomes. However, the biological embedding of structural inequality in aging and dementia, especially among underrepresented populations, is unclear. We examined the association between structural inequality (country-level and state-level Gini indices) and brain volume and connectivity in 2,135 healthy controls, and individuals with Alzheimer’s disease and frontotemporal lobe degeneration from Latin America and the United States. Greater structural inequality was linked to reduced brain volume and connectivity, with stronger effects in Latin America, especially in the temporo-cerebellar, fronto-thalamic and hippocampal regions. In the United States, milder effects were observed in the insular-cingular and temporal areas. Results were more pronounced in Alzheimer’s disease and were independent of age, sex, education, cognition and other confounding factors. The findings highlight the critical role of structural inequality in aging and dementia, emphasizing the biological embedding of macrosocial factors and the need for targeted interventions in underserved populations.

Original languageEnglish
Article numbere2306076120
JournalNature Aging
DOIs
StateAccepted/In press - 2024
Externally publishedYes

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