title: The Built Environment and Cognitive Disorders: Results From the Cognitive Function and Ageing Study II.
abstract: BACKGROUND
  Built environment features have been related to behavior modification and might stimulate cognitive activity with a potential impact on cognitive health in later life. This study investigated cross-sectional associations between features of land use and cognitive impairment and dementia, and also explored urban and rural differences in these associations.
  
  
  METHODS
  Postcodes of the 7,505 community-based participants (aged ≥65 years) in the Cognitive Function and Ageing Study II (collected in 2008-2011) were linked to environmental data from government statistics. Multilevel logistic regression investigated associations between cognitive impairment (defined as Mini-Mental State Examination score ≤25) and dementia (Geriatric Mental Status and Automatic Geriatric Examination for Computer-Assisted Taxonomy organicity level ≥3) and land use features, including natural environment availability and land use mix, fitting interaction terms with three rural/urban categories. Data were analyzed in 2015.
  
  
  RESULTS
  Associations between features of land use and cognitive impairment were not linear. After adjusting for individual-level factors and area deprivation, living in areas with high land use mix was associated with a nearly 30% decreased odds of cognitive impairment (OR=0.72, 95% CI=0.58, 0.89). This was similar, yet non-significant, for dementia (OR=0.70, 95% CI=0.46, 1.06). In conurbations, living in areas with high natural environment availability was associated with 30% reduced odds of cognitive impairment (OR=0.70, 95% CI=0.50, 0.97).
  
  
  CONCLUSIONS
  Non-linear associations between features of land use and cognitive impairment were confirmed in this new cohort of older people in England. Both lack of and overload of environmental stimulation may be detrimental to cognition in later life.
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom. Electronic address: y.wu3@exeter.ac.uk.
authors.forename: Yu-Tzu
authors.initials: YT
authors.lastname: Wu
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Global Mental Health, Health Service and Population Research Department, London, United Kingdom.
authors.forename: A Matthew
authors.initials: AM
authors.lastname: Prina
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, Norfolk, United Kingdom.
authors.forename: Andy
authors.initials: A
authors.lastname: Jones
authors.affiliation: Medical Research Council Biostatistics Unit, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom.
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Matthews
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, Forvie Site, University of Cambridge, School of Clinical Medicine, Cambridge, United Kingdom.
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D004779:Environment Design; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012423:Rural Health / Q000706:statistics & numerical data; D014504:Urban Health / Q000706:statistics & numerical data