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

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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