Unraveling the Threads: Sleep Difficulties, Neighborhood Physical Disorder, and Subjective Cognitive Decline in Older Americans

Article type: Research Article

Authors: Esiaka, Darlingtina^{a; b; *} | Odo, Obinna^{c; d} | Luth, Elizabeth^{e; f}

Affiliations: [a] Department of Behavioral Sciences, University of Kentucky College of Medicine, Lexington, KY, USA | [b] Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY, USA | [c] Department of Sociology and Gerontology, Miami University, Oxford, OH, USA | [d] Scripps Gerontology Center, Miami University, Oxford, OH, USA | [e] Department of Family Medicine and Community Health, Rutgers University, New Brunswick, NJ, USA | [f] Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA

Correspondence: [*] Correspondence to: Darlingtina Esiaka, PhD, Center for Health Equity Transformation, University of Kentucky College of Medicine, 760 Press Avenue, Suite 426, Rm 472, Lexington, KY 40536, USA. E-mail: dkesiaka@uky.edu; ORCID: 0000-0001-9214-5677.

Abstract: Background:Research suggests that the neighborhood in which people live can be a risk or protective factor for various health outcomes, including cognitive decline to Alzheimer’s disease. Similar to the impact of neighborhood on health outcomes, sleep difficulties have been linked to cognitive function in older adults. However, few studies have examined how neighborhood physical disorders moderate the effects of sleep on subjective cognitive decline (SCD). Objective:The study examined the moderating effect of neighborhood factors on the relationship between sleep difficulties and SCD. Methods:Data were obtained from 2,494 respondents (1,065 males and 1,429 females) from Wave 11 of the National Health and Aging Trends (NHATS) data. Sleep difficulties were operationalized as the presence of difficulties in falling and staying asleep. Neighborhood physical disorder (e.g., vandalism, graffiti) was based on interviewer observations of respondents’ neighborhoods. SCD was operationalized as subjective reports of increasing or worse memory loss in the past 12 months and present memory rating. We utilized Linear regression to test neighborhood physical disorder as a moderator of the relationship between sleep difficulties and SCD. Results:We found a significant interaction between sleep difficulties and neighborhood physical disorder on SCD (β=0.046, p = 0.031, 95% CI[0.00,0.51], p < 0.001). Participants who reported higher average sleep difficulties and higher levels of neighborhood physical disorder were more likely to report SCD. Conclusions:Our findings add to inform future health interventions and policy recommendations that address modifiable sources of cognitive decline and risk of Alzheimer’s disease.

Keywords: ADRD risk, Alzheimer’s disease, cognitive decline, dementia, neighborhood, sleep

DOI: 10.3233/JAD-240142

Journal: Journal of Alzheimer's Disease, vol. 100, no. 4, pp. 1345-1354, 2024