Associations Between Neighborhood Park Access and Longitudinal Change in Cognition in Older Adults: The Multi-Ethnic Study of Atherosclerosis

Article type: Research Article

Authors: Besser, Lilah M.^{a; *} | Chang, Lun-Ching^b | Evenson, Kelly R.^c | Hirsch, Jana A.^d | Michael, Yvonne L.^e | Galvin, James E.^f | Rapp, Stephen R.^g | Fitzpatrick, Annette L.^h | Heckbert, Susan R.ⁱ | Kaufman, Joel D.^j | Hughes, Timothy M.^k

Affiliations: [a] Institute for Human Health and Disease Intervention (I-HEALTH), Department of Urban and Regional Planning, Florida Atlantic University, Boca Raton, FL, USA | [b] Department of Mathematical Sciences, Florida Atlantic University, Boca Raton, FL, USA | [c] Department of Epidemiology, Gillings School of Global Public Health, University of NC-Chapel Hill, Chapel Hill, NC, USA | [d] Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA | [e] Urban Health Collaborative and Department of Epidemiology and Biostatistics, Dornslife School of Public Health, Drexel University, Philadelphia, PA, USA | [f] Comprehensive Center for Brain Health, Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA | [g] Department of Psychiatry & Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA | [h] Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle, WA, USA | [i] Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA | [j] Departments of Environmental and Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA | [k] Departments of Internal Medicine and Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA

Correspondence: [*] Correspondence to: Lilah Besser, PhD, 777 Glades Rd, SO-44 Room 284H, Department of Urban and Regional Planning, Florida Atlantic University, Boca Raton, FL 33431, USA. Tel.: +1 561 316 0628; E-mail: [email protected].

Abstract: Background:Preliminary evidence suggests associations between neighborhood park access and better late-life cognition and reduced Alzheimer’s disease (AD) risk. Objective:Examine associations between neighborhood park access and longitudinal change in cognition among U.S. older adults without dementia. Methods:We used 2000–2018 observational data from the population-based, multi-site Multi-Ethnic Study of Atherosclerosis (n = 1,733). Measures included proportion of neighborhood park space (park access), distance to nearest park, and 6-year dichotomous and continuous change in scores on the Cognitive Abilities Screening Instrument (CASI; global cognition) and Digit Symbol Coding task (processing speed). Multivariable random intercept models tested main associations and mediation by depressive symptoms, physical activity, and PM2.5 exposure. Effect modification by race (African Americans/Blacks versus Whites) was tested using interaction terms. Results:Greater park access (equivalent to 10%more in 1/2-mile around home) was associated with maintained/improved CASI score over six years independent of several covariates including individual- and neighborhood-level socioeconomic status (Odds ratio: 1.04; 95%confidence interval: 1.00–1.08). No other associations were observed with the dichotomous or continuous measures of cognitive change and no mediators were found. While a borderline association was seen between greater park access and maintained/improved CASI for African Americans/Blacks but not for Whites, effect modification was not confirmed by testing interaction terms. Conclusion:Neighborhood park access may help maintain/improve late-life global cognition. However, our findings need replication in other population-based studies and regions. Additionally, studies are needed to determine if associations between park access and change in cognition vary by race/ethnicity to inform intervention efforts.

Keywords: Aging, Alzheimer’s disease, cognition, epidemiology, environment, lifestyle, residence characteristics

DOI: 10.3233/JAD-210370

Journal: Journal of Alzheimer's Disease, vol. 82, no. 1, pp. 221-233, 2021