Item Details

title

INVESTIGATING THE RELATIONSHIPS OF PLACE-BASED SOCIAL DETERMINANTS OF HEALTH AND STRUCTURAL RACISM WITH MEASURES OF ALZHEIMER’S DISEASE AND RELATED DEMENTIAS

author

Krishnamurthy, Sudarshan

abstract

An estimated 6.7 million Americans live with Alzheimer’s disease (AD) dementia in 2023, with more than 55 million people living with AD worldwide. However, stark disparities exist in the prevalence of AD among older adults based on race (or rather, racism) and place, with Black and Hispanic individuals as well as adults from under-resourced areas being more likely to develop dementia during their lifetime. Resources, opportunities, and the environment where you live, work, play, and age, also known as the social determinants of health (SDoH) vary greatly by place. Place-based SDoH and the corresponding structural determinants of health, such as structural racism, have been posited as significant predictors of numerous risk factors associated with dementia and remain underexplored in association with AD and related dementias (ADRD). This dissertation project investigated the relationships of place-based SDoH and structural racism with measures of cardiometabolic health and cognitive function, neuroimaging biomarkers, and plasma biomarkers associated with ADRD, utilizing clinical, biomarker, and functional data from the Wake Forest (WF) Alzheimer’s Disease Research Center (ADRC) Clinical Core Cohort that was crosslinked with index measures that reflect the influence of place through SDoH and structural racism: Area Deprivation Index, Social Vulnerability Index, Environmental Justice Index, and Structural Racism Effect Index. The three studies conducted in this project begin to highlight the specific aspects of ADRD that are most closely related to place-based SDoH and structural racism, where interventions may be beneficial. Lastly, this project underscores the rationale for, and importance of, place-based structural and reparative interventions that are community-driven, and how these strategies may ultimately help to remedy inequities and improve ADRD outcomes and brain health.

subject

Alzheimer's disease and related dementias

Dementia

Place-based Determinants of Health

Social Determinants of Health

Spatial Health Justice

Structural Racism

contributor

Hughes, Timothy M (advisor)

Forrester, Sarah N (committee member)

Ma, Da (committee member)

Quillen, Ellen (committee member)

Whitlow, Christopher (committee member)

date

2025-06-24T08:36:29Z (accessioned)

2025 (issued)

degree

Molecular Medicine and Translational Science (discipline)

embargo

2026-06-23 (terms)

2026-06-23 (liftdate)

identifier

http://hdl.handle.net/10339/111011 (uri)

language

en (iso)

publisher

Wake Forest University

type

Dissertation