Neighborhood Socioeconomic Deprivation is Associated with Worse Cognitive Performance and in vivo Amyloid Accumulation

INTRODUCTION Socioeconomic disadvantage (SED) has been associated with poorer brain health, yet its underlying pathology remains incompletely understood. We examined whether neighborhood-level SED, measured using the Area Deprivation Index (ADI), relates to amyloid deposition assessed with amyloid positron emission tomography (PET). METHODS Participants (n = 1,110) underwent cognitive assessment using the mini mental state examination (MMSE) and PET scanning with amyloid-specific tracers. Associations between national and state ADI and MMSE and global amyloid burden were evaluated using linear models adjusting for age, sex, and APOE-ε4 carrier status. RESULTS In 1,110 participants, higher neighborhood socioeconomic deprivation was associated with lower MMSE scores, with both national and state ADI measures showing significant inverse associations independent of age and sex (all p < 0.001). Higher ADI was significantly associated with greater amyloid burden among cognitively unimpaired participants (β = 0.18, p  = 0.006, d  = 0.27), indicating early AD-related pathology. DISCUSSION Neighborhood socioeconomic disadvantage is associated with worse cognitive performance and for the first time were shown to be associated with amyloid accumulation during the preclinical phase of AD. These findings underscore the need to consider socioeconomic context in early-stage risk assessment and may help inform targeted prevention strategies aimed at reducing disparities in dementia outcomes.