{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:43:00Z","timestamp":1791420180262,"version":"4.3.3"},"reference-count":47,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T00:00:00Z","timestamp":1565222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100013227","name":"Health Promotion Administration, Ministry of Health and Welfare","doi-asserted-by":"publisher","award":["MOHW107-HPA-M-114-144703"],"award-info":[{"award-number":["MOHW107-HPA-M-114-144703"]}],"id":[{"id":"10.13039\/100013227","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Little is known about the association between environmental features and the risk of Alzheimer\u2019s dementia (AD). This study aims to investigate the association of physical and social environments with the incidence of AD. We identified 12,401 newly diagnosed AD cases aged \u226565 years in 2010, with the same no. of matched controls from National Health Insurance claims in Taiwan. Environmental data were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was conducted to calculate the odds ratios (OR) of AD in association with environmental features at the township level. Results showed that living in the areas with higher availability of playgrounds and sport venues was associated with a 3% decreased odds of AD (95% CI = 0.96\u20130.99), while higher density of elderly living alone was associated with a 5% increased odds of AD (95% CI = 1.01\u20131.11), after controlling for individual and other environmental factors. In further examination by urbanization level, the above relationships were found only in rural areas but not in urban areas. This study provides evidence that specific physical and social environmental features have different impacts on the risk of AD.<\/jats:p>","DOI":"10.3390\/ijerph16162828","type":"journal-article","created":{"date-parts":[[2019,8,8]],"date-time":"2019-08-08T11:05:32Z","timestamp":1565262332000},"page":"2828","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Association of Environmental Features and the Risk of Alzheimer\u2019s Dementia in Older Adults: A Nationwide Longitudinal Case-Control Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Chih-Ching","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0321-8908","authenticated-orcid":false,"given":"Chung-Yi","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"},{"name":"Department of Public Health, College of Public Health, China Medical University, Taichung 404, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiann-Far","family":"Kung","sequence":"additional","affiliation":[{"name":"Department of Urban Planning, National Cheng Kung University, Tainan 701, Taiwan"},{"name":"Healthy Cities Research Center, Research and Services Headquarters, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4184-4333","authenticated-orcid":false,"given":"Hsien-Wen","family":"Kuo","sequence":"additional","affiliation":[{"name":"Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei 112, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuan-Ching","family":"Huang","sequence":"additional","affiliation":[{"name":"Healthy Cities Research Center, Research and Services Headquarters, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Neurology, En Chu Kong Hospital, New Taipei City 23702, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2437-5918","authenticated-orcid":false,"given":"Susan C.","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"},{"name":"Healthy Cities Research Center, Research and Services Headquarters, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/S1474-4422(16)00062-4","article-title":"Defeating Alzheimer\u2019s disease and other dementias: a priority for European science and society","volume":"15","author":"Winblad","year":"2016","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1111\/joim.12178","article-title":"Advances in the prevention of Alzheimer\u2019s disease and dementia","volume":"275","author":"Solomon","year":"2014","journal-title":"J. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.arr.2015.06.003","article-title":"Environment as \u2018brain training\u2019: A review of geographical and physical environmental influences on cognitive ageing","volume":"23","author":"Cassarino","year":"2015","journal-title":"Ageing Res. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1007\/s00127-014-0945-6","article-title":"The association between community environment and cognitive function: a systematic review","volume":"50","author":"Wu","year":"2015","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1016\/j.jalz.2017.09.015","article-title":"Sex-specific association between neighborhood characteristics and dementia: The Three-City cohort","volume":"14","author":"Letellier","year":"2018","journal-title":"Alzheimers Dement"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.gheart.2016.08.002","article-title":"The Impact of Neighborhoods on CV Risk","volume":"11","author":"Mujahid","year":"2016","journal-title":"Glob. Heart"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Den Braver, N.R., Lakerveld, J., Rutters, F., Schoonmade, L.J., Brug, J., and Beulens, J.W.J. (2018). Built environmental characteristics and diabetes: a systematic review and meta-analysis. BMC Med., 16.","DOI":"10.1186\/s12916-017-0997-z"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1017\/S1041610211002894","article-title":"Neighborhood characteristics and depressive mood among older adults: An integrative review","volume":"24","author":"Julien","year":"2012","journal-title":"Int. Psychogeriatr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.annepidem.2015.07.001","article-title":"Cognitive decline and the neighborhood environment","volume":"25","author":"Clarke","year":"2015","journal-title":"Ann. Epidemiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.amepre.2016.11.020","article-title":"The Built Environment and Cognitive Disorders: Results From the Cognitive Function and Ageing Study II","volume":"53","author":"Wu","year":"2017","journal-title":"Am. J. Prev. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1093\/ageing\/afv137","article-title":"Community environment, cognitive impairment and dementia in later life: results from the Cognitive Function and Ageing Study","volume":"44","author":"Wu","year":"2015","journal-title":"Age Ageing"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"077003","DOI":"10.1289\/EHP2875","article-title":"Residential Surrounding Greenness and Cognitive Decline: A 10-Year Follow-up of the Whitehall II Cohort","volume":"126","author":"Tonne","year":"2018","journal-title":"Environ. Health Perspect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1080\/13607863.2018.1480705","article-title":"Neighborhood social cohesion and cognitive function in U.S. Chinese older adults-findings from the PINE study","volume":"23","author":"Zhang","year":"2019","journal-title":"Aging Ment. Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1159\/000345036","article-title":"Individual and Area Level Socioeconomic Status and Its Association with Cognitive Function and Cognitive Impairment (Low MMSE) among Community-Dwelling Elderly in Singapore","volume":"2","author":"Wee","year":"2012","journal-title":"Dement. Geriatr. Cogn. Dis. Extra"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1111\/j.1532-5415.2007.01557.x","article-title":"Neighborhood deprivation, individual socioeconomic status, and cognitive function in older people: analyses from the English Longitudinal Study of Ageing","volume":"56","author":"Lang","year":"2008","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.2105\/AJPH.2011.300169","article-title":"Neighborhood socioeconomic status and cognitive function in women","volume":"101","author":"Shih","year":"2011","journal-title":"Am. J. Public Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1007\/s12035-014-8720-y","article-title":"Cognitive reserve and Alzheimer\u2019s disease","volume":"51","author":"Xu","year":"2015","journal-title":"Mol. Neurobiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e025274","DOI":"10.1136\/bmjopen-2018-025274","article-title":"Risk of dementia after Parkinson\u2019s disease in Taiwan: a population-based retrospective cohort study using National Health Insurance claims","volume":"9","author":"Liu","year":"2019","journal-title":"BMJ Open"},{"key":"ref_19","unstructured":"National Health Insurance Administration (2018, May 08). Universal Health Coverage in Taiwan, Available online: https:\/\/www.nhi.gov.tw\/English\/Content_List.aspx?n=8FC0974BBFEFA56D&topn=ED4A30E51A609E49."},{"key":"ref_20","unstructured":"Hu, S.C. (2018, May 01). Construction of International Leading Monitoring and Decision-Making System for Active Ageing\u2014Project of Active Ageing Database Integration, Value-Added Analysis and Project Management (2015\u20132018)-2017 Subsequent expansion project, Available online: https:\/\/www.grb.gov.tw\/search\/planDetail?id=12078480&docId=502322."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.4088\/JCP.15m10304","article-title":"Association Between Lithium Use and Risk of Alzheimer\u2019s Disease","volume":"78","author":"Cheng","year":"2017","journal-title":"J. Clin. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"397","DOI":"10.3389\/fpsyt.2018.00397","article-title":"Electroconvulsive Therapy and Risk of Dementia-A Nationwide Cohort Study in Taiwan","volume":"9","author":"Chu","year":"2018","journal-title":"Front Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"387","DOI":"10.2147\/CEOR.S93323","article-title":"The epidemiology and burden of Alzheimer\u2019s disease in Taiwan utilizing data from the National Health Insurance Research Database","volume":"8","author":"Hung","year":"2016","journal-title":"Clinicoecon. Outcomes Res."},{"key":"ref_24","unstructured":"Ministry of the Interior (2019, July 29). Monthly Bulletin of Interior Statistics, Available online: https:\/\/www.moi.gov.tw\/files\/site_stuff\/321\/1\/month\/month.html."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1177\/0898264314531616","article-title":"Prevalence of Social Isolation in Community-Dwelling Elderly by Differences in Household Composition and Related Factors: From a Social Network Perspective in Urban Japan","volume":"26","author":"Shimada","year":"2014","journal-title":"J. Aging Health"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Kooshiar, H., Yahaya, N., Hamid, T.A., Abu Samah, A., and Sedaghat Jou, V. (2012). Living arrangement and life satisfaction in older Malaysians: the mediating role of social support function. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0043125"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Huang, N.C., Kung, S.F., and Hu, S.C. (2018). The Relationship between Urbanization, the Built Environment, and Physical Activity among Older Adults in Taiwan. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15050836"},{"key":"ref_28","unstructured":"Ene, M., Leighton, E.A., Blue, G.L., and Bell, B.A. (2018, August 02). Multilevel Models for Categorical Data Using SAS\u00ae PROC GLIMMIX: The Basics. Available online: https:\/\/support.sas.com\/resources\/papers\/proceedings15\/3430-2015.pdf."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1186\/s12966-017-0558-z","article-title":"Built environmental correlates of older adults\u2019 total physical activity and walking: a systematic review and meta-analysis","volume":"14","author":"Barnett","year":"2017","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Levasseur, M., Genereux, M., Bruneau, J.F., Vanasse, A., Chabot, E., Beaulac, C., and Bedard, M.M. (2015). Importance of proximity to resources, social support, transportation and neighborhood security for mobility and social participation in older adults: results from a scoping study. BMC Public Health, 15.","DOI":"10.1186\/s12889-015-1824-0"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Schuch, F.B., Vancampfort, D., Firth, J., Rosenbaum, S., Ward, P.B., Silva, E.S., Hallgren, M., Ponce De Leon, A., Dunn, A.L., and Deslandes, A.C. (2018). Physical Activity and Incident Depression: A Meta-Analysis of Prospective Cohort Studies. Am. J. Psychiatry, 631\u2013648.","DOI":"10.1176\/appi.ajp.2018.17111194"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s00127-017-1339-3","article-title":"Loneliness and depression in the elderly: the role of social network","volume":"52","author":"Lara","year":"2017","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.healthplace.2008.01.004","article-title":"Associations of neighborhood problems and neighborhood social cohesion with mental health and health behaviors: the Multi-Ethnic Study of Atherosclerosis","volume":"14","author":"Echeverria","year":"2008","journal-title":"Health Place"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1097\/EDE.0b013e3181772cb2","article-title":"Neighborhood characteristics and hypertension","volume":"19","author":"Mujahid","year":"2008","journal-title":"Epidemiology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1136\/jech.2006.056960","article-title":"Neighbourhood social interactions and risk of acute myocardial infarction","volume":"62","author":"Chaix","year":"2008","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1080\/0361073X.2014.956618","article-title":"Not just scenery: viewing nature pictures improves executive attention in older adults","volume":"40","author":"Gamble","year":"2014","journal-title":"Exp. Aging Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1614","DOI":"10.1016\/S0140-6736(08)61669-4","article-title":"Green space, psychological restoration, and health inequality","volume":"372","author":"Hartig","year":"2008","journal-title":"Lancet"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.jad.2017.05.001","article-title":"Micro-scale environment and mental health in later life: Results from the Cognitive Function and Ageing Study II (CFAS II)","volume":"218","author":"Wu","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/S0277-9536(01)00214-3","article-title":"Place effects on health: how can we conceptualise, operationalise and measure them?","volume":"55","author":"Macintyre","year":"2002","journal-title":"Soc. Sci. Med."},{"key":"ref_40","unstructured":"Commission for Rural Communities (2019, March 01). Social isolation experienced by older people in rural communities. Available online: http:\/\/cdn.basw.co.uk\/upload\/basw_111815-1.pdf."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.arr.2015.04.006","article-title":"Social relationships and risk of dementia: A systematic review and meta-analysis of longitudinal cohort studies","volume":"22","author":"Kuiper","year":"2015","journal-title":"Ageing Res. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1111\/j.1440-1819.2004.01311.x","article-title":"Prevalence and incidence of schizophrenia among national health insurance enrollees in Taiwan, 1996\u20132001","volume":"58","author":"Chien","year":"2004","journal-title":"Psychiatry Clin. Neurosci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2047","DOI":"10.2147\/NDT.S172933","article-title":"Schizophrenia and risk of dementia: a meta-analysis study","volume":"14","author":"Cai","year":"2018","journal-title":"Neuropsychiatr. Dis. Treat."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.healthpol.2011.08.007","article-title":"Urbanization and the utilization of outpatient services under National Health Insurance in Taiwan","volume":"103","author":"Lin","year":"2011","journal-title":"Health Policy"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Yaya, S., Uthman, O.A., Amouzou, A., Ekholuenetale, M., and Bishwajit, G. (2018). Inequalities in maternal health care utilization in Benin: a population based cross-sectional study. BMC Pregnancy Childbirth, 18.","DOI":"10.1186\/s12884-018-1846-6"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Holtzman, D.M., Morris, J.C., and Goate, A.M. (2011). Alzheimer\u2019s disease: The challenge of the second century. Sci. Transl. Med., 3.","DOI":"10.1126\/scitranslmed.3002369"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1212\/01.wnl.0000271090.28148.24","article-title":"Mixed brain pathologies account for most dementia cases in community-dwelling older persons","volume":"69","author":"Schneider","year":"2007","journal-title":"Neurology"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/16\/2828\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:09:29Z","timestamp":1760188169000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/16\/2828"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,8]]},"references-count":47,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2019,8]]}},"alternative-id":["ijerph16162828"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16162828","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,8]]}}}