A – 76 Regional Brain Health Disparities in Older Adults Presenting for Outpatient Neuropsychological Evaluation

Abstract Objective Older adults from socioeconomically disadvantaged communities often face brain health disparities, including limited healthcare access, higher rates of chronic illness, and accelerated cognitive decline. To better understand such disparities in our Rhode Island-based clinic, we investigated differences in neuropsychological functioning and emotional symptoms by neighborhood disadvantage in older patients presenting for outpatient neuropsychological evaluation. We hypothesized that neighborhood disadvantage would be associated with clinically relevant brain health disparities. Method Patients (N=529, Mage=73.5±8.0, Meducation=13.5±3.2, %female=61.8, %White=86.8, %non-Hispanic=83.9) presented to our clinic between 2010 and 2024. Using home addresses, state-level Area Deprivation Index (ADI) deciles were calculated; we compared patients from the 20% most disadvantaged neighborhoods (deciles 9-10; N=61) to those in the 80% least disadvantaged neighborhoods (deciles 1-8; N=468). Chi-square and independent samples t-tests examined group differences among variables of interest, including demographic characteristics, neuropsychological scores, and self-reported depressive symptoms. Results Patients from the most disadvantaged neighborhoods were significantly younger, less educated, more often non-White, and more often required an interpreter to complete the evaluation. Neuropsychologically, their estimated premorbid baseline was lower, their average performance on a cognitive screen was in the dementia range, they performed worse on several processing speed and executive functioning measures, and expressed more depressive symptoms (all p’s<.05). Conclusion Patients from more disadvantaged regions may present for neuropsychological evaluation with lower cognitive reserve, more cognitive impairment, and/or psychiatric comorbidity, as well as more complex care needs (e.g., requiring a medical interpreter). Expanding community-based dementia resources and treatment access may foster cognitive resilience and equitable care for at-risk older adults.