The role of inflammation, chronic pain, and hypertension on cognitive functioning in an underserved, rural population: a Project FRONTIER study.

Background: Inflammation, chronic pain, and hypertension have been identified as risk factors for cognitive decline; few studies have examined the interplay between multiple risk factors and even fewer have considered these factors in underserved rural populations.

Objective: This study analyzed the relationships between inflammation, chronic pain, and hypertension with cognitive functioning in an underserved, primarily Hispanic, rural population from Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education, & Research).

Methods: This epidemiological study enrolled 1,864 participants (M_age = 59.68 years, SD_age = 12.21) living in five rural counties in West Texas. Consented participants disclosed medical diagnoses (e.g. chronic pain), completed five cognitive evaluations (i.e. the Repeatable Battery for the Assessment of Neuropsychological Status, the Trails Making Test A and B, and Clock Drawing 1 and 2), and attended a medical examination during which a physician confirmed existing medical conditions (e.g. hypertension) and collected a blood sample for further analysis (e.g. inflammation markers).

Results: Analysis via MANOVA revealed a multivariate effect of inflammation (V = .02, F(4, 969) = 3.72, p = .006) and a multivariate effect of hypertension (V = .03, F(4, 969) = 6.69, p < .001). There was no multivariate effect for chronic pain (V = .01, F(4,969) = 2.18, p = .07) and no significant two way or three way interaction. Post-hoc ANOVAs further illustrated the relationships between specific cognitive functioning domains and inflammation or hypertension.

Conclusions: The current study findings suggest that underserved rural populations have unique epidemiological experiences that are distinct from prior findings in urban populations. Inflammation and hypertension are important clinical considerations as risk factors for cognitive decline. Future research should explore interventions that support rural-dwelling individuals impacted by provider shortages.