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Probing effect modification by socioeconomic status in associations between blood biomarkers of neuropathology and cognitive outcomes in the United States and India

Year: 2026
Type: article
Abstract: INTRODUCTION: Socioeconomic factors influence cognitive outcomes and may modify associations between neuropathologies and cognitive outcomes, yet evidence from low- and middle-income contexts remains scarce. METHODS: We used harmonized data from nationally representative studies in the United States (Health and Retirement Study - Harmonized Cognitive Assessment Protocol [HRS-HCAP]; N = 1956) and India (Longitudinal Aging Study in India - Diagnostic Assessment of Dementia [LASI-DAD]; N = 1485) and multivariable-adjusted linear regression models to examine effect modification of associations between blood biomarkers of neuropathology (amyloid beta [Aβ]42/40, phosphorylated tau [p-tau-181], glial fibrillary acidic protein [GFAP], and neurofilament light chain [NfL]) and dementia-related outcomes (cognitive functioning, dementia) by socioeconomic factors (educational attainment, paternal education, and total household wealth and assets). RESULTS: Neuropathology biomarkers were associated with cognitive outcomes in both samples; however, no consistent evidence of effect modification by socioeconomic factors was observed across included biomarkers or cognitive measures. DISCUSSION: These findings suggested limited modification of blood biomarker-cognition relationships by socioeconomic status in diverse settings, potentially influenced by random measurement error, regression dilution bias, and low power. Further comparisons across biomarker modalities are warranted to clarify expected associations.
DOI: 10.1002/alz.71729
Authors: Emma Nichols, Jung Ki Kim, Leon M. Aksman, Alden L. Gross, Peifeng Hu, Lindsay C. Kobayashi, Bharat Thyagarajan, Jinkook Lee, Eileen M. Crimmins
Institutions: University of Southern California, Johns Hopkins University, University of California, Los Angeles, University of Michigan, Institute for Social Research, University of Minnesota
Language: English
Field: Medicine
Open Access status: hybrid
Estimated APC paid: $4,200
Awards: Harmonized Diagnostic Assessment of Dementia (DAD) for Longitudinal Aging Study of India (LASI)-Genomic study., Biomarkers of neurodegeneration in the US and India: A cross-national evaluation of the biological underpinnings of ADRD, Non-educational sources of later-life cognitive reserve and resilience among older adults with and without formal education in India, Modifiable Protective and Risk Factors of Late-Life Cognitive Health and Dementia, Harmonized Diagnostic Assessment of Dementia (DAD) for Longitudinal Aging Surveys in India (LASI), Health and Retirement Study: Yrs 35-40, Integrating Information about Aging Surveys: Novel Integration of Contextual Data to Study Late-Life Cognition and Alzheimer’s Disease and Related Dementia and Dementia Care
OpenAlex ID: W7202194603
FWCI:
Cites: 35
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Related to: 10