Regional variability in the associations between social and health-related risk factors and memory across Europe

Interventions targeting social and health-related risk factors are thought to reduce the risk of cognitive decline and dementia in older age. Despite well-known social, economic, and cultural differences across European countries, little is known about how these factors influence associations with memory function in different geographical contexts. This study examined the relationship between five social and health-related risk factors, namely living alone, physical inactivity, obesity, depression, and cardiometabolic and cardiovascular conditions, and memory function across Europe. Data came from the Survey of Health, Ageing, and Retirement in Europe (SHARE), a cross-national study of older adults. The sample included cross-sectional data for 102,851 adults aged 50-102 years from 20 European countries, grouped into four regions: Northern, Western, Eastern, and Southern Europe. Memory function was assessed using a sum score of immediate and delayed recall tests. A flexible Bayesian machine learning approach for multilevel data was applied to assess heterogeneity of associations in the total sample and in analyses stratified by education and age. All five social and health-related risk factors were negatively associated with memory overall, but the strength and, for some factors, the direction of these associations varied across regions. In particular, the associations for living alone, obesity, and physical inactivity differed between Eastern and Southern Europe compared with Northern and Western Europe. These findings highlight substantial geographical heterogeneity in the associations between social and health-related risk factors and memory, which should be considered when designing and implementing public health interventions.