SciELO - Scientific Electronic Library Online

vol.5 issue1In the March 2011 issueEffects of stress hormones on the brain and cognition: Evidence from normal to pathological aging author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand




Related links


Dementia & Neuropsychologia

Print version ISSN 1980-5764

Dement. neuropsychol. vol.5 no.1 São Paulo Jan./Mar. 2011 

Views & reviews

Path dependence in social and psychological risk factors for dementia

Dependência da trajetória nos fatores de risco social e psicológico da demência

Hiroko Matsuoka 1  

Hidehiko Yamaguchi 2  

1MA, School of Nursing & Health, Aichi Prefectural University, Nagoya, Japan.

2MA, Volunteer Group "Transpacífico", Mexico City, Mexico.


This article focuses on social and psychological risk factors for Alzheimer's disease, dementia, and cognitive impairment and presents some key points for prevention in developing countries based on previous studies, a social science theory, and our preliminary survey. Previous population-based studies found that educational and occupational attainment, income, participation in social and mental activities, and psychological distress were associated with dementia risk. According to the theory of path dependence, earlier factors largely determine successive ones, where education is one of these early experiences in life. Our preliminary survey suggested that education sets a path that several psychosocial risk factors are dependent on. The expansion of basic education is indispensable. Resources for prevention should be concentrated on individuals with a low level of education. In order to break from a path creating self-reinforcement of risk factors, it is necessary to implement early and active interventions.

Key words: Alzheimer's disease; dementia; risk factors; prevention; developing countries


Este artigo foca nos fatores de risco social e psicológico para doença de Alzheimer, demência e comprometimento cognitivo e apresenta alguns pontos chave para prevenção em países em desenvolvimento baseado em estudos prévios, uma teoria da ciência social e nossa pesquisa preliminar. Estudos populacionais prévios encontraram que educação, ocupação, ganhos, participação em atividades mentais e sociais, e estresse psicológico associaram-se com o risco. De acordo com a teoria da dependência da trajetória, fatores precoces determinam os fatores sucessivos e nós podemos afirmar que educação é uma das experiências mais precoces na vida. Nossa pesquisa preliminar sugere que a educação determina uma via em que vários fatores de risco psicossociais são dependentes. A ampliação da educação básica é indispensável. Fontes para prevenção devem ser concentradas nos indivíduos com baixo nível educacional. A fim de desviar da via que cria um auto-reforço de fatores de risco, é necessário implementar intervenções precoces e ativas.

Palavras-chave: doença de Alzheimer; demência; fatores de risco; prevenção; países em desenvolvimento

Texto completo disponível apenas em PDF.

Full text available only in PDF format.


United Nations. Report of the Second World Assembly on Ageing: Madrid, 8-12 April 2002. New York: United Nations; 2002. [ Links ]

Alzheimer's Disease International. The prevalence of dementia worldwide. Factsheet 2008; Dec. [ Links ]

Stern Y, Gurland B, Tatemichi TK, Tang MX, Wilder D, Mayeux R. Influence of education and occupation on the incidence of Alzheimer's disease. JAMA 1994;271:1004-1010. [ Links ]

De Ronchi D, Fratiglioni L, Rucci P, Paternicò A, Graziani S, Dalmonte E. The effect of education on dementia occurrence in an Italian population with middle to high socioeconomic status. Neurology 1998;50:1231-1238. [ Links ]

Qiu C, Bäckman L, Winblad B, Agüero-Torres H, Fratiglioni L. The influence of education on clinically diagnosed dementia incidence and mortality data from the Kungsholmen Project. Arch Neurol 2001;58:2034-2039. [ Links ]

Karp A, Kåreholt I, Qiu C, Bellander T, Winblad B, Fratiglioni L. Relation of education and occupation-based socioeconomic status to incident Alzheimer's disease. Am J Epidemiol 2004;159:175-183. [ Links ]

Cagney KA, Lauderdale DS. Education, wealth, and cognitive function in later life. J Gerontol B Psychol Sci Soc Sci 2002; 57:163-172. [ Links ]

Lièvre A, Alley D, Crimmins EM. Educational differentials in life expectancy with cognitive impairment among the elderly in the United States. J Aging Health 2008;20:456-477. [ Links ]

Turrell G, Lynch JW, Kaplan GA, et al. Socioeconomic position across the lifecourse and cognitive function in late middle age. J Gerontol B Psychol Sci Soc Sci 2002;57:S43-S51. [ Links ]

McDowell I, Xi G, Lindsay J, Tierney M. Mapping the connections between education and dementia. J Clin Exp Neuropsychol 2007;29:127-141. [ Links ]

Zhang Z, Gu D, Hayward MD. Early life influences on cognitive impairment among oldest old Chinese. J Gerontol B Psychol Sci Soc Sci 2008;63:S25-S33. [ Links ]

Nguyen CT, Couture MC, Alvarado BE, Zunzunegui MV. Life course socioeconomic disadvantage and cognitive function among the elderly population of seven capitals in Latin America and the Caribbean. J Aging Health 2008;20:347-362. [ Links ]

Nitrini R, Bottino CMC, Albala C, et al. Prevalence of dementia in Latin America: a collaborative study of population-based cohorts. Int Psychogeriatr 2009;21:622-630. [ Links ]

Jorm AF, Rodgers B, Henderson AS, et al. Occupation type as a predictor of cognitive decline and dementia in old age. Age Ageing 1998;27:477-483. [ Links ]

Li CY, Wu SC, Sung FC. Lifetime principal occupation and risk of cognitive impairment among the elderly. Ind Health 2002;40:7-13. [ Links ]

Kröger E, Andel R, Lindsay J, Benounissa Z, Verreault R, Laurin D. Is complexity of work associated with risk of dementia?: The Canadian Study of Health and Aging. Am J Epidemiol 2008;167:820-830. [ Links ]

Bootsma-van der Wiel A, de Craen AJM, Van Exel E, Macfarlane PW, Gussekloo J, Westendorp RGJ. Association between chronic diseases and disability in elderly subjects with low and high income: the Leiden 85-plus Study. Eur J Public Health 2005;15:494-497. [ Links ]

Ngandu T. Lifestyle-related risk factors in dementia and mild cognitive impairment: A population-based study. Stockholm: Karolinska Institutet, 2006. [ Links ]

Bassuk SS, Glass TA, Berkman LF. Social disengagement and incident cognitive decline in community-dwelling elderly persons. Ann Int Med 1999;13:165-173. [ Links ]

Wilson RS, Bennett DA, Gilley DW, Beckett LA, Barnes LL, Evans DA. Premorbid reading activity and patterns of cognitive decline in Alzheimer disease. Arch Neurol 2000;57:1718-1723. [ Links ]

Scarmeas N, Levy G, Tang MX, Manly J, Stern Y. Influence of leisure activity on the incidence of Alzheimer's disease. Neurology 2001;57:2236-2242. [ Links ]

Wang HX, Karp A, Winblad B, Fratiglioni L. Late-life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen Project. Am J Epidemiol 2002;155:1081-1087. [ Links ]

Wilson RS, Mendes de Leon CF, Barnes LL, et al. Participation in cognitively stimulating activities and risk of incident Alzheimer disease. JAMA 2002;287:742-748. [ Links ]

Verghese J, Lipton RB, Katz MJ, et al. Leisure activities and the risk of dementia in the elderly. New Engl J Med 2003;348: 2508-2516. [ Links ]

Glei DA, Landau DA, Goldman N, Chuang YL, Rodríguez G, Weinstein M. Participating in social activities helps preserve cognitive function: an analysis of a longitudinal, population-based study of the elderly. International J Epidemiol 2005;34:864-871. [ Links ]

Katzman R. Education and the prevalence of dementia and Alzheimer's disease. Neurology 1993;43:13-20. [ Links ]

Gatz M, Svedberg P, Pedersen NL, Mortimer JA, Berg S, Johansson B. Education and the risk of Alzheimer's disease: findings from the study of dementia in Swedish twins. J Gerontol B Psychol Sci Soc Sci 2001;56B:292-300. [ Links ]

Scarmeas N, Stern Y. Cognitive reserve and lifestyle. J Clin Exp Neuropsychol 2003;25:625-633. [ Links ]

Richards M, Deary IJ. A life course approach to cognitive reserve: a model for cognitive aging and development? Ann Neurol 2005;58:617-622. [ Links ]

Baldivia B, Andrade VM, Amodeo Bueno OF. Contribution of education, occupation and cognitively stimulating activities to the formation of cognitive reserve. Dement Neuropsychol 2008;2:173-182. [ Links ]

Buntinx F, Kester A, Bergers J, Knottnerus JA. Is depression in elderly people followed by dementia?: a retrospective cohort study based in general practice. Age Ageing 1996;25:231-233. [ Links ]

Geerlings MI, Schoevers RA, Beekman ATF, et al. Depression and risk of cognitive decline and Alzheimer's disease: results of two prospective community-based studies in The Netherlands. Br J Psychiatry 2000;176:568-575. [ Links ]

Green RC, Cupples LA, Kurz A, et al. Depression as a risk factor for Alzheimer disease: The MIRAGE Study. Arch Neurol 2003;60:753-759. [ Links ]

Wilson RS, Evans DA, Bienias JL, Mendes de Leon CF, Schneider JA, Bennett DA. Proneness to psychological distress is associated with risk of Alzheimer's disease. Neurology 2003; 61:1479-1485. [ Links ]

Wilson RS, Mendes de Leon CF, Bennett DA, Bienias JL, Evans DA. Depressive symptoms and cognitive decline in a community population of older persons. J Neurol Neurosurg Psychiatry 2004;75:126-129. [ Links ]

Karp A. Psychosocial factors in relation to development of dementia in late-life: a life course approach within the Kungsholmen Project. Stockholm: Karolinska Institutet , 2005. [ Links ]

Wilson RS, Krueger KR, Arnold SE, et al. Loneliness and risk of Alzheimer disease. Arch Gen Psychiatry 2007;64:234-240. [ Links ]

Fernández Martínez M, Castro Flores J, Pérez de las Heras S, Mandaluniz Lekumberri A, Gordejuela Menocal M, Zarranz Imirizaldu JJ. Risk factors for dementia in the epidemiological study of Munguialde County (Basque Country, Spain). BMC Neurology 2008;8:39. [ Links ]

Jorm AF, Van Duijn CM, Chandra V, et al. Psychiatric history and related exposures as risk factors for Alzheimer's disease: a collaborative re-analysis of case-control studies. Int J Epidemiol 1991;20(2 Suppl.2):S43-S47. [ Links ]

Mitchell AJ. Depression as a risk factor for later dementia: a robust relationship? Age Ageing 2005;34:207-209. [ Links ]

Wright SL, Persad C. Distinguishing between depression and dementia in older persons: Neuropsychological and neuropathological correlates. J Geriatr Psychiatry Neurol 2007;20: 189-198. [ Links ]

Simard M, Hudon C, van Reekum R. Psychological distress and risk for dementia. Curr Psychiatry Rep 2009;11:41-47. [ Links ]

Krasner SD. Approaches to the state: alternative conceptions and historical dynamics. Comparative Politics 1984;16:223-246. [ Links ]

David PA. Clio and the economics of QWERTY. Am Econ Rev 1985;75:332-337. [ Links ]

Pierson P. Increasing returns, path dependence, and the study of politics. Am Pol Sci Rev 2000;94:251-267. [ Links ]

Mahoney J. Path dependence in historical sociology. Theory Soc 2000;29:507-548. [ Links ]

Aoki R, Ohno Y, Tamakoshi A, et al. Lifestyle determinants for social activity level among the Japanese elderly. Arch Gerontol Geriatr 1996;22:271-286. [ Links ]

Consejo Nacional de Población (CONAPO). Índices de marginación, 2005. México DF: CONAPO; 2006. [ Links ]

Lawton MP. The dimensions of morale. In: Kent DP, Kastenbaum R, Sherwood S (Eds). Research planning and action for the elderly: The power and potential of social science. New York: Behavioral Publications 1972:144-165. [ Links ]

Lawton MP. The Philadelphia Geriatric Center Morale Scale: a revision. J Gerontol 1975;30:85-89. [ Links ]

Rosenberg M. Society and the adolescent self-image. Princeton: Princeton University Press, 1965. [ Links ]

Neugarten BL, Havighurst RJ, Tobin SS. The measurement of life satisfaction. J Gerontol 1961;16:134-143. [ Links ]

Adams DL. Analysis of a life satisfaction index. J Gerontol 1969;24:470-474. [ Links ]

Kilander L, Nyman H, Boberg M, Lithell H. Cognitive function, vascular risk factors and education: a cross-sectional study based on a cohort of 70-year-old men. J Int Med 1997; 242:313-321. [ Links ]

Kubzansky LD, Berkman LF, Glass TA, Seeman TE. Is educational attainment associated with shared determinants of health in the elderly?: findings from the MacArthur studies of successful aging. Psychosom Med 1998;60:578-585. [ Links ]

Consejo Nacional de Población (CONAPO). Envejecimiento de la población de México: Reto del siglo XXI. México DF: CONAPO , 2004. [ Links ]

Received: December 15, 2010; Accepted: February 17, 2011

Hiroko Matsuoka - School of Nursing & Health, Aichi Prefectural University, Togoku, Kamishidami, Moriyama-ku, Nagoya-shi, Aichi, 463-8502, Japan. E-mail address:;

Disclosure: The authors report no conflits of interest

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License