ABSTRACT
Aim
As Türkiye’s population ages, the prevalence of Alzheimer’s Disease (AD) and its associated risk factors is a growing public health concern. Previous research suggests that rural populations may face disproportionately higher rates of chronic diseases, limited healthcare access, and lower socioeconomic status, which could contribute to elevated AD risk. This study aimed to investigate and compare AD risk levels among older adults residing in rural versus urban areas of a province in Türkiye.
Methods
This cross-sectional comparative study was conducted in Düzce province, located in the Western Black Sea region of Türkiye, encompassing both urban (Düzce city center and its districts) and rural (forest villages) settlements. A total of 759 older adults (365 rural, 394 urban) were recruited using a multi-stage sampling method. Participants completed the Turkish Australian National University Alzheimer’s Disease Risk Index Short Form (TR-ANU-ADRI-SF) to determine AD risk factors and the Dementia Screening Form (AD8) to determine self-reported cognitive status. Data were analysed using descriptive statistics, Independent Samples t-tests, Chi-square tests, and Multivariate Linear Regression Analysis.
Results
Significant differences were observed between rural and urban older adults across several socio-demographic and health characteristics. Rural older adults had a significantly higher mean TR-ANU-ADRI-SF score (9.03 ± 9.89 for rural vs. 1.12 ± 7.49 for urban, p < 0.001). Based on AD8 scores, the rate of self-reported cognitive concerns (SCC) was also significantly higher in rural older adults (35.6%) (p < 0.01). However, after adjusting for age, gender, and years of education, residence status was no longer found to be independently associated with TR-ANU-ADRI-SF scores (B = −0.134; p > 0.05).
Conclusion
In conclusion, the higher risk of AD observed in older adults living in rural areas appears to stem primarily from differences in age and education level, rather than from residential status. These findings highlight the importance of addressing educational inequalities and promoting lifelong cognitive engagement as key strategies to reduce the risk of AD, particularly in rural populations.