Impact Of Socioeconomic Status On Initial Clinical Presentation

31st Aug 2021

Alzheimer’s disease (AD) is the most common type of dementia and is associated with significant cognitive and functional decline. Mild cognitive impairment (MCI) is a brain syndrome often considered to be the transition stage between normal aging and Alzheimer’s disease. While there is a genetic component to AD, there are many environmental factors that can influence the onset and progression of the disease. Socioeconomic status (SES), defined by some a measure of educational level combined with occupational attainment, is a factor that has been shown to reduce the risk of AD and dementia, although its effects on MCI have not been as extensively investigated. While it appears that the diseases themselves are more common among low SES population, it is not known how SES impacts medical referral to a memory disorders clinic. Initial presentation is of importance because earlier detection and diagnosis of the disease can lead to more effective treatment with cognitive enhancers, medication for treating mild-to-moderate AD patients.

Our study looked at how SES can influence the initial presentation to the Memory Disorders Clinic at St. Michael’s Hospital located in the urban setting of Toronto, Canada (Figure 1). We hypothesized that lower SES would negatively impact medical outcome by delaying the detection and diagnosis of AD. Patients seen at the clinic, which subserves a population with a wide range of SES, are referred from their family physicians. SES was measured using Hollingshead two-factor index, which combines educational and occupational attainments. The index ranges from 11-77 and is negatively correlated with observed SES. Healthcare is fully funded by the provincial government through the Ontario Health Insurance Program (OHIP).