Neighborhood physical activity facilities predict risk of incident mixed and vascular dementia: The Cardiovascular Health Cognition Study

Abstract INTRODUCTION Neighborhood environments may promote neurocognitive health in part by providing amenities that encourage physical activity. We examined associations between quantity of walkable facilities, including specifically physical activity facilities (e.g., gyms, recreation centers), with risk of incident dementia. METHODS Participants included 2923 adults ≥ 65 years old from the Cardiovascular Health Cognition Study (1992–1999), with clinically adjudicated dementia classified over a median 6.0 years of follow‐up. Walkable facilities were measured within 1 km (Euclidean) of home. Self‐reported baseline physical activity was considered a moderator. RESULTS In adjusted Cox models, participants with ≥ 2 (vs. 0) physical activity facilities had reduced risk of mixed/vascular dementia, but not Alzheimer's disease, particularly after excluding individuals in the bottom 20th percentile of physical activity (hazard ratio = 0.56, 95% confidence interval: 0.35–0.89). DISCUSSION Neighborhood amenities that encourage physical activity may mitigate dementia risk via improved vascular health, especially for individuals with sufficient baseline mobility to use these resources. Highlights We examined associations between nearby walkable facilities and incident dementia. Facilities within 1 km were counted via the National Establishment Time Series Database. More physical activity facilities predicted lower risk of mixed/vascular dementia. No associations were found between walkable facilities and incident Alzheimer's disease.