Examining Neighborhood Disadvantage, Brain Healthcare Access, and Neuropsychological Disparities in Underserved Older Adults

OBJECTIVE: To understand community-based brain health disparities, we investigated demographic and neuropsychological differences by neighborhood disadvantage in older patients presenting for neuropsychological evaluation. METHOD: This retrospective chart review calculated patients' (N = 529, Mage = 73.5 ± 8.0, Meducation = 13.5 ± 3.2, %female = 61.8, %White = 86.8, %non-Hispanic = 95.3) state-level Area Deprivation Index (ADI) to compare patients from the 20% most disadvantaged (n = 61) to the 80% least disadvantaged areas (n = 468). RESULTS: Patients from disadvantaged areas were less likely to access care (11.5% of sample), had lower educational attainment (p < .001, Cohen's d = 0.60), and were more likely to require a medical interpreter (p < .001, Cramer's V = 0.17). They had lower premorbid baselines (p < .001, Cohen's d = 0.52), had lower performances on tests of processing speed (p = .039, Cohen's d = .30), attention (p < .001, Cohen's d = 0.48), and executive functioning (p = .039, Cohen's d = 0.34), and endorsed more depressive symptoms (p = .026, Cohen's d = 0.33). CONCLUSIONS: Findings highlight the need for targeted outreach, culturally responsive care, and community-based brain health initiatives to foster cognitive resilience and equitable care access.