Background: Socioeconomic deprivation may be an important determinant of dementia risk, mortality, and access to diagnostic services. Premature mortality from other causes and under-representation of deprived individuals in research may lead to this effect being overlooked. Objective: We assessed the relationship between deprivation and dementia mortality using comprehensive death certificate data for England and Wales from 2001 to 2017. Methods: We used standardized mortality ratios (SMR) and a Poisson model to compare likelihood of dying from dementia in each deprivation decile. We also examined the associations of deprivation with age at death from dementia, and with likelihood of receiving a diagnosis of unspecified dementia. Results: Risk of dying from dementia was higher in more deprived deciles (Mean SMR [95% CI] in decile 1 : 0.528 [0.506 to 0.550], decile 10:0.369 [0.338 to 0.400]). In 2017, 14,837 excess dementia deaths were attributable to deprivation (21.5% of all dementia deaths that year). There were dose-response associations of deprivation with likelihood of being older at death with dementia (odds ratio [95% CI] for decile 10 (least deprived): 1.31 [1.28 to 1.33] relative to decile 1), and with likelihood of receiving a diagnosis of unspecified dementia (odds ratio [95% CI] for decile 10:0.78 [0.76 to 0.80] relative to decile 1). Conclusion: Socioeconomic deprivation in England and Wales is associated with increased dementia mortality, younger age at death with dementia, and poorer access to specialist diagnosis. Reducing social inequality may have a role in the prevention of dementia mortality.

Background. Socioeconomic deprivation is postulated to be an important determinant of dementia risk, mortality, and access to diagnostic services. Nevertheless, premature mortality from other causes and under-representation of deprived individuals in research cohorts may lead to this effect being overlooked. Methods. We obtained Office of National Statistics (ONS) mortality data where dementia was recorded as a cause of death in England and Wales from 2001 to 2017, stratified by age, diagnosis code and UK Index of Multiple Deprivation (IMD) decile. We calculated standardised mortality ratios (SMR) for each IMD decile, adjusting for surviving population size in each IMD decile and age stratum. In those who died of dementia, we used ordinal logistic regression to examine the effect of deprivation on likelihood of being older at death. We used logistic regression to test the effect of deprivation on likelihood of receiving a diagnosis of unspecified dementia, a proxy for poor access to specialist diagnostic care. Results. 578,623 deaths due to dementia in people over the age of 65 were identified between 2001-2017. SMRs were similar across the three most deprived deciles (1-3) but progressively declined through deciles 4-10 (Mean SMR [95%CI] in decile 1: 0.528 [0.506 to 0.550], decile 10: 0.369 [0.338 to 0.400]). This effect increased over time with improving ascertainment of dementia. In 2017, 14,837 excess dementia deaths were attributable to deprivation (21.5% of the total dementia deaths that year). There were dose-response effects of deprivation on likelihood of being older at death with dementia (odds ratio [95%CI] for decile 10 (least deprived): 1.31 [1.28 to 1.33] relative to decile 1), and on likelihood of receiving a diagnosis of unspecified dementia (odds ratio [95%CI] for decile 10: 0.78 [0.76 to 0.80] relative to decile 1). Conclusions. Socioeconomic deprivation in England and Wales is associated with increased dementia mortality, younger age at death with dementia, and poorer access to specialist diagnosis. Reducing social inequality may be an important strategy for prevention of dementia mortality.

BackgroundDepression may be a potentially modifiable risk factor for dementia, but it is not clear whether this is due to a causal effect, or whether depressive symptoms are an early prodromal feature of Alzheimer’s disease.ObjectivesTo investigate whether depressive symptoms are associated with an increased risk of dementia. To establish associations between depressive symptoms and structural neuroanatomy.MethodsA total of 491,603 adults from the UK Biobank study were included. Depression and dementia diagnoses were determined using linked medical records and self-report; depression symptomatology was based on questionnaire data. Brain MRI image-derived phenotypes in 42,471 participants were used to measure regional brain volumes.ResultsThe risk for incident all-cause dementia was increased in participants with depressive symptoms or a recorded depression diagnosis (all OR>2, p<0.01). After excluding those with incident dementia, depressive symptoms were associated with volume reduction in a fronto-insular-cerebellar network.ConclusionDepression is associated with an increased risk of incident dementia. The neuroanatomical correlates of depressive symptoms do not relate to the default mode network degeneration found in prodromal Alzheimer’s disease, suggesting that increased dementia risk in depression may be due to poor brain health and diminished neural reserve more broadly.