Social determinants of health associated with neuropsychiatric symptoms of dementia and mild cognitive impairment: A narrative review.

Abstract

Objective: To understand the relationship between social determinants of health (SDoH) and neuropsychiatric symptoms (NPS) of dementia and mild cognitive impairment (MCI) such as depression, agitation, psychosis, and apathy.

Methods: The study extracted data from papers published before January 27, 2025, from PubMed, PsycINFO, and Embase. A total of 2034 articles were identified, and after critical assessment, 18 articles were included in our narrative review.

Results: Of the 18 studies, 14 assessed the relationship between NPS and SDoH in participants with dementia, one studied participants with MCI, and three studied those with either dementia or MCI. The majority of the studies (n = 10) had a cross-sectional design, while others had a longitudinal design. Most studies (n = 13) used the Neuropsychiatric Inventory (NPI) or its variants for measuring NPS. Education (n = 8) was the most studied SDoH, with studies overall showing that more education is associated with less NPS (n = 4), although some studies showed mixed (n = 1), null (n = 1), and reverse (n = 2) associations. Studies showed that increased social connectedness and marriage overall was associated with decreased NPS (4 out of 6 studies). Two studies showed that increased religiosity and spirituality was associated with decreased NPS. Poor nutrition, and immigrant status/speaking English as a second language were associated with increased NPS.

Conclusion: This narrative review shows that while several studies report an association between SDoHs and NPS in dementia and MCI, more studies are needed to understand the relationship, particularly elucidating how it affects different symptoms of NPS. That could inform clinical practice and public policy. Future studies also need to focus on understanding the causality of the relationship and possible interventions.