High School Diploma Lowers Risk of Dementia and Cognitive Impairment in Rural Areas, Study Finds

Rural residents with high school diplomas are at lower risk of developing dementia and cognitive impairment than those with less education, a study indicates.

The study has healthcare policy implications, including providing more care to those in rural areas with dementia and cognition-related disorders such as Alzheimer’s and ALS.

Researchers published their study, “Secular Trends in Dementia and Cognitive Impairment of U.S. Rural and Urban Older Adults,” in the American Journal of Preventative Medicine.

Medical experts have known for some time that residents of rural areas have poorer health than city dwellers. Those in rural areas age faster than those in cities, for example. Rural residents  also have less access to healthcare, making treatment more challenging.

No research has dealt with whether there are cognitive differences between people living in urban and rural areas. But scientists have known that rural residents have higher rates of chronic conditions and disease. And they know that rural residents have higher levels of risks factors associated with cognitive impairment, such as a sedentary lifestyle, high blood pressure and diabetes.

A California-led research team decided to study whether rural residents are more prone to developing dementia and cognitive impairment than city dwellers.

The team used Census data to obtain a sample of adults living in rural and urban areas. Then they interviewed those in the sample by telephone to see how many displayed cognitive impairment. The tool they used was the 27-point modified Telephone Interview for Cognitive Status. They did the interviews between 2000 and 2010.

In the initial year of their study, 2000, they discovered that both dementia and cognitive impairment were much more prevalent in rural than urban areas. In rural areas, 7.1 percent of the population had dementia and 19.8 percent cognitive impairment, compared with 5.4 percent and 15.9 percent of the urban population.

A decade later, the balance between the rates of dementia and cognitive impairment in rural and urban populations was roughly the same.

Although rates of dementia and cognitive impairment decreased in both groups between 2000 and 2010, the decreases were not large enough to change the percentages of rural and urban residents with the two conditions.

Another finding was that rural residents’ higher risk of developing either of the two conditions held steady between 2000 and 2010.

In 2000, the risk of rural residents developing dementia was 60 percent higher than the risk of city dwellers developing it. Meanwhile, the risk of rural residents developing cognitive impairment was 44 percent higher than for urban residents. The percentages were similar in 2010.

When researchers adjusted for factors that could be contributing to the higher risk in rural areas, they came up with an intriguing finding.

Rural residents with a high school diploma were 83 percent less susceptible to developing dementia and 89 percent less prone to developing cognitive impairment than rural residents without a diploma. This meant that rural residents with a diploma were at roughly the same risk of developing each condition as city dwellers.

“Our findings linking rural adults’ recent gains in cognitive functioning with the improved rates of high school graduation provides a new example of how public investment in education can narrow population health disparities,” Dr. Margaret M. Weden, the study’s lead investigator, said in a press release.

Weden, who is with the RAND Corporation in Santa Monica, California, said rural communities can use the study’s results to argue for better healthcare services in their area. RAND is a research organization and think tank.

The researchers noted that the results highlight “the importance of public health planning for more rapidly aging rural communities.”