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Peer-reviewedCC BYAlzheimer's & dementia : the journal of the Alzheimer's Association

Lifestyle interventions on Alzheimer's disease and related dementias: Social and structural determinants of implementation effectiveness and sustainability.

  • Ganga S Bey1
  • Sheina Emrani2
  • Erin R Kulick3
  • Cristina A F Román4,5
  • Ileana De Anda-Duran6
  • Miriam T Ashford7
  • Rory Boyle8
  • Omonigho Michael Bubu9
  • Jasmine Dixon10
  • Sanne Franzen11
  • Pei-Yang Gao12
  • Kristen George13
11 more authors
  • M Aaron Guest14
  • Margo B Heston15
  • Patricia Heyn16,17,18
  • Daija Jackson19
  • Sudarshan Krishnamurthy20
  • Jeffrey S Phillips8
  • Awaale F Rirash11
  • Jayalakshmi Viswanathan21,22
  • Preeti Pushpalata Zanwar23,24
  • Megan Zuelsdorff25,26
  • Shana D Stites2
26 affiliations
  1. 1Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
  2. 2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  3. 3Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, Pennsylvania, USA.
  4. 4Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
  5. 5Kessler Foundation, West Orange, New Jersey, USA.
  6. 6Department of Epidemiology, Celia Scott Weatherhead School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA.
  7. 7Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA.
  8. 8Penn Frontotemporal Degeneration Center, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
  9. 9Departments of Psychiatry, Neurology, and Population Health, NYU Grossman School of Medicine, New York University, New York, New York, USA.
  10. 10Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
  11. 11Department of Neurology and Alzheimer Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
  12. 12Department of Neurology and Innovation Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, China.
  13. 13Department of Public Health Sciences, University of California Davis, Davis, California, USA.
  14. 14Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, Arizona, USA.
  15. 15Edward and Pearl Fein Memory and Aging Center, Department of Neurology, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, California, USA.
  16. 16Virginia Geriatric Education Center, Virginia Center on Aging, Virginia Commonwealth University, Richmond, Virginia, USA.
  17. 17School of Public Health, George Mason University, Fairfax, Virginia, USA.
  18. 18University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
  19. 19Department of Behavioral Health, Brooke Army Medical Center, San Antonio, Texas, USA.
  20. 20Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
  21. 21Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA.
  22. 22Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA.
  23. 23Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy, Texas A&M University Health Science Center, Kingsville, Texas, USA.
  24. 24Hopkins Economics of Alzheimer's Disease and Services Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
  25. 25School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA.
  26. 26Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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Abstract

Alzheimer's disease and related dementias (ADRD) pose a global public health challenge, and epidemiological evidence underscores profound disparities in ADRD risk and outcomes that are rooted in social/structural determinants of health (S/SDOH). Yet, these determinants are seldom integrated into intervention design or implementation strategies. In this review, we identify S/SDOH that influence the equitable implementation of evidence-based ADRD lifestyle interventions across diverse groups and explore implications. Guided by Bronfenbrenner's ecological model, we: (1) examined theoretical foundations, focusing on how macrosystem and microsystem factors modulate implementation effectiveness across multiple intervention modalities; (2) synthesized empirical literature, highlighting successful and suboptimal intervention outcomes in marginalized populations; (3) identified critical gaps, especially where evidence on implementation across socially defined groups is lacking; and (4) discussed implications for enhancing design and policy for equitable ADRD intervention delivery. Our goal is to produce a conceptual and empirical synthesis that offers actionable guidance for clinicians, researchers, and policy makers.

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Cite

BibTeXRIS
BibTeX
@article{bey2026lifestyle,
  title = {{Lifestyle interventions on Alzheimer's disease and related dementias: Social and structural determinants of implementation effectiveness and sustainability.}},
  author = {Ganga S Bey and Sheina Emrani and Erin R Kulick and Cristina A F Román and Ileana De Anda-Duran and Miriam T Ashford and Rory Boyle and Omonigho Michael Bubu and Jasmine Dixon and Sanne Franzen and Pei-Yang Gao and Kristen George and M Aaron Guest and Margo B Heston and Patricia Heyn and Daija Jackson and Sudarshan Krishnamurthy and Jeffrey S Phillips and Awaale F Rirash and Jayalakshmi Viswanathan and Preeti Pushpalata Zanwar and Megan Zuelsdorff and Shana D Stites},
  journal = {Alzheimer's \& dementia : the journal of the Alzheimer's Association},
  year = {2026},
  month = nov,
  doi = {10.1002/alz.71957},
  url = {https://europepmc.org/article/MED/43010124},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Lifestyle interventions on Alzheimer's disease and related dementias: Social and structural determinants of implementation effectiveness and sustainability.
AU  - Ganga S Bey
AU  - Sheina Emrani
AU  - Erin R Kulick
AU  - Cristina A F Román
AU  - Ileana De Anda-Duran
AU  - Miriam T Ashford
AU  - Rory Boyle
AU  - Omonigho Michael Bubu
AU  - Jasmine Dixon
AU  - Sanne Franzen
AU  - Pei-Yang Gao
AU  - Kristen George
AU  - M Aaron Guest
AU  - Margo B Heston
AU  - Patricia Heyn
AU  - Daija Jackson
AU  - Sudarshan Krishnamurthy
AU  - Jeffrey S Phillips
AU  - Awaale F Rirash
AU  - Jayalakshmi Viswanathan
AU  - Preeti Pushpalata Zanwar
AU  - Megan Zuelsdorff
AU  - Shana D Stites
PY  - 2026
DA  - 2026/11/01
JO  - Alzheimer's & dementia : the journal of the Alzheimer's Association
DO  - 10.1002/alz.71957
UR  - https://europepmc.org/article/MED/43010124
AB  - Alzheimer's disease and related dementias (ADRD) pose a global public health challenge, and epidemiological evidence underscores profound disparities in ADRD risk and outcomes that are rooted in social/structural determinants of health (S/SDOH). Yet, these determinants are seldom integrated into intervention design or implementation strategies. In this review, we identify S/SDOH that influence the equitable implementation of evidence-based ADRD lifestyle interventions across diverse groups and explore implications. Guided by Bronfenbrenner's ecological model, we: (1) examined theoretical foundations, focusing on how macrosystem and microsystem factors modulate implementation effectiveness across multiple intervention modalities; (2) synthesized empirical literature, highlighting successful and suboptimal intervention outcomes in marginalized populations; (3) identified critical gaps, especially where evidence on implementation across socially defined groups is lacking; and (4) discussed implications for enhancing design and policy for equitable ADRD intervention delivery. Our goal is to produce a conceptual and empirical synthesis that offers actionable guidance for clinicians, researchers, and policy makers.
SN  - 1552-5260
SN  - 1552-5279
ER  -