Reposted from U of U Health.
A new study shows a sharp rise in rates of cognitive disability within the U.S. over the past decade. Adults under the age of 40 experienced the greatest increase in risk, with 2023 rates of nearly 1 in 10.
“I was shocked at first,” said Ka-Ho Wong, research associate of neuroimmunology at University of Utah Health and first author on the paper. “The younger population actually nearly doubled in terms of reporting cognitive disability.”
The study defines cognitive disability as “serious difficulty concentrating, remembering or making decisions, due to a physical, mental or emotional condition.” It’s the most common disability among American adults, but little research has investigated how rates are changing over time. The new study examined 4.5 million survey responses from 2013 to 2023, finding that among people under 40, cognitive disability has jumped from 5.1% to 9.7%.
Key points:
- From 2013 to 2023, rates of cognitive disability nearly doubled among U.S. adults under 40.
- Cognitive disability includes self-reported serious difficulty concentrating, remembering or making decisions.
- Rates are highest among people with chronic diseases or lower household incomes.
Impact:
The results emphasize a need for interventions to address cognitive difficulties early, whether via community health education or individual awareness and treatment.
The results are published in Neurology, the medical journal of the American Academy of Neurology.
Who’s most at risk of cognitive disability?
Adults with household incomes below $35,000 are most likely to experience cognitive disability; rates of cognitive difficulties rose from 8.8% to 12.6% over the course of the study period. Income and cognitive disability may reinforce each other, the authors say. Economic stress makes it harder to think and focus, and cognitive disabilities make it harder to get and keep a well-paying job.
A history of other chronic diseases is also associated with a greater likelihood of cognitive disability. Some conditions—like stroke—can directly cause brain dysfunction. Other conditions, like high blood pressure, raise the risk of cognitive decline and dementia. Chronic health conditions may also have a two-way relationship with cognitive difficulties, because cognitive disability can make it harder to manage chronic disease.
Why are mental difficulties on the rise?
The researchers say that the rise in cognitive disability could stem from an increased mental burden due to changing economic factors. “Economic stressors, like job market uncertainty and changes in work environments, could be a huge factor,” Wong said. “They induce stress, and stress could induce cognitive disability.”
It’s also possible that lower stigma around mental health could have made people more comfortable reporting cognitive difficulties, leading to the apparent rise. Wong said that greater acceptance of mental health challenges may contribute to part of the trend, but he doubts that it’s the only factor.
“The 18- to 39-year-old population might think that it is simply OK to talk about this,” he said. “But does this account for all of this increase? Probably not, but we don’t know. That’s why we need further study.”
It’s unlikely that the rise in cognitive disability is caused by the COVID pandemic, the researchers say. The new study specifically excludes data from 2020 due to the unique stresses of the early pandemic. And overall rates of reported cognitive disability have been on the rise since at least 2016.
What can be done about increased cognitive disability?
The increase in reported cognitive disability has important public health implications regardless of its cause, according to the researchers. Reported cognitive disability reflects respondents’ lived experiences, and it may affect how people interact with the health care system, as well as their engagement with their careers and education.
Community-based education programs to help people manage their chronic diseases are one strategy that might help address rising rates of cognitive disability, the authors say. Poor mental health and poor physical health reinforce each other, which means that better management of chronic conditions could break that cycle and help improve health overall. The new study also recommends that any interventions specifically target the groups of people who are most at risk of cognitive disability.
On an individual level, Wong said, health care providers should pay close attention to reported cognitive disability. “There may be potential ways to intervene early, whether it’s cognitive exercise, diet or treatments that intervene with cardiovascular risk factors such as high blood pressure,” he said. And for patients who are experiencing difficulties with thinking or memory, “Voice that to your health care specialist,” Wong recommends, “whether it’s your family doctor or anybody you see. Take it seriously.”
This work is published in Neurology as “Rising Cognitive Disability as a Public Health Concern Among U.S. Adults: Trends from the Behavioral Risk Factor Surveillance System, 2013–2023.” Researchers from Yale University and Mass General Brigham contributed to this study.
The research was funded by the Sumaira Foundation, the Siegel Rare Neuroimmune Foundation, the American Heart Association and the National Institutes of Health, including the National Institute of Neurological Disorders and Stroke. Content is the responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health.
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