Socioeconomic differences in dementia risk, lifestyle, and relevant determinants of behavior

Background: Healthy lifestyles support cognitive aging while reducing dementia risk. Multidomain interventions promote healthy behavior, but are often unsuccessful in reaching those with a low socio-economic position (SEP), who face additional challenges with changing behavior. Objective: This cross-sectional study explores differences between SEP-groups in dementia risk, lifestyle, and the socio-cognitive determinants of behavior. Method: 3,341 Dutch adults (aged 40-79) were divided into low, medium, or high SEP groups. Using Chi-squared tests and ANOVA, SEP-related differences were explored for dementia risk, lifestyle behaviors, and health conditions. SEP-related differences in socio-cognitive determinants were examined using a modified version of Confidence Interval-Based Estimation of Relevance (CIBER).Results: Participants in the low SEP group had a significantly higher prevalence of all health conditions and engaged in more unhealthy behaviors, translating into a significantly higher dementia risk score. Many had misperceptions about the room for lifestyle improvement, but those in the low SEP group were slightly more aware of not adhering to lifestyle recommendations. Additionally, they perceived less self-confidence towards engaging in sports, considered healthy food as more expensive, perceived alcohol less pleasurable, experienced habits as less influential on alcohol intake, and had less confidence in their ability to quit smoking while pleasure and habits were strongly associated with smoking. Conclusion: Adults with a low SEP are at higher risk for dementia and have more potential for lifestyle-based risk reduction. Tailored, co-designed interventions that also consider the broader environment are needed to enhance perceived behavioral control, support behavior change, and reduce inequalities in dementia.