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Life-Course Socioeconomic Position and Hippocampal Atrophy in a Prospective Cohort of Older Adults

Elbejjani, Martine PhD; Fuhrer, Rebecca PhD; Abrahamowicz, Michal PhD; Mazoyer, Bernard MD, PhD; Crivello, Fabrice PhD; Tzourio, Christophe MD, PhD; Dufouil, Carole PhD

doi: 10.1097/PSY.0000000000000365
Original Articles

Objective Low socioeconomic position (SEP) has been linked to an increased risk of dementia and cognitive decline. However, little is known about the association between SEP and morphologic brain changes in older age. This study examines the relationships between indicators of life-course SEP with both hippocampal volume (HcV) and HcV loss in a population-based cohort of 1328 older adults aged 65 to 80 years.

Methods Multivariable linear regression models were used to estimate the associations of SEP with baseline HcV and the annual rate of HcV atrophy according to three life-course conceptual models: the sensitive/critical periods model (which explored SEP in specific periods: in childhood [using parental education], early adulthood [based on participants' education], and midlife [based on participants' socioprofessional group]); the accumulation-of-risk model (life-course cumulative SEP), and the social mobility model (life-course SEP trajectories).

Results Participants with lower midlife SEP had smaller HcV (−0.08 cm3; 95% confidence interval, −0.15 to −0.01) and 0.17% (95% confidence interval, 0.04%–0.30%) faster hippocampal atrophy than participants with higher midlife SEP. Childhood and early adulthood SEPs were not related to hippocampal measures. The accumulation-of-risk and the social mobility models revealed that the accumulation of socioeconomic disadvantage and declining socioeconomic trajectories were related to faster hippocampal atrophy.

Conclusions In this cohort of older adults, lower socioprofessional attainment in midlife and disadvantageous life-course socioeconomic position were associated with faster hippocampal atrophy, a cerebral change linked to cognitive disorders. Results support the hypothesized links between socioenvironmental exposures related to stress and/or cognitive enrichment and brain/cognitive reserve capacities.

Supplemental digital content is available in the text.

From the Department of Epidemiology, Biostatistics, and Occupational Health (Elbejjani, Fuhrer, Abrahamowicz), McGill University, Montreal, Quebec, Canada; CNRS (Mazoyer, Crivello), GIN UMR5296, Bordeaux, France; CEA (Mazoyer, Crivello), GIN UMR5296, Bordeaux, France; University of Bordeaux (Mazoyer, Crivello, Tzourio, Dufouil), Bordeaux, France; and INSERM U897 and CIC-1401 (Tzourio, Dufouil), Bordeaux School of Public Health, Bordeaux, France.

Supplemental Content

Address correspondence and reprint requests to Rebecca Fuhrer, PhD, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Faculty of Medicine, 1020 Pine Ave W, Montreal, Quebec H3A 1A2, Canada. E-mail:

Received for publication July 26, 2015; revision received April 11, 2016.

Copyright © 2017 by American Psychosomatic Society
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