Not having reliable access to enough food can affect much more than what ends up on the dinner table. New research suggests it may also be tied to cognitive health later in life.
In a study of 2,051 U.S. adults followed over many years, people who experienced food insecurity later in life were more likely to screen positive for probable dementia than those who remained food secure. Food insecurity during midlife alone, however, was not significantly associated with probable dementia.
The study, published in The American Journal of Clinical Nutrition, used data from the Panel Study of Income Dynamics, a nationally representative survey that has followed U.S. families for decades. Researchers examined food insecurity during two periods: roughly ages 44 to 62 in 1999 to 2003 and ages 60 to 79 in 2015 to 2019. Cognitive health was assessed in 2019 and 2021.
Food insecurity meant households reported difficulty getting enough food because of limited financial resources. Researchers used the U.S. Department of Agriculture’s standard food security questionnaire, which asks about experiences such as cutting the size of meals or not having enough money for food.
Most participants, about 86%, were food secure during both periods. About 3% experienced food insecurity only in midlife, 5% only in later life and another 5% during both periods.
The strongest patterns appeared among people who experienced food insecurity as they grew older.
After researchers accounted for factors including income, education, employment, home ownership, marital status and several health conditions, people who experienced food insecurity only in later life had 85% higher odds of probable dementia than those who were food secure during both periods.
Those who experienced food insecurity during both midlife and later life had a little more than twice the odds of probable dementia. Food insecurity limited to midlife was not significantly associated with the outcome.
The study also looked at how often people reported food insecurity. Experiencing it two or three times during the later-life period was associated with higher odds of probable dementia, while repeated food insecurity during midlife was not.
The results do not mean food insecurity causes dementia.
Researchers measured “probable dementia” using the AD8, an eight-question screening tool that asks about changes in memory, judgment, orientation and the ability to carry out everyday activities. A score of 2 or higher was considered probable dementia.
The AD8 is a validated screening tool, but it is not the same as a clinical diagnosis. Participants were not given comprehensive neurological evaluations to determine whether they had Alzheimer’s disease or another specific form of dementia.
There is also an important question about which came first.
Dementia often develops gradually over many years. Early problems with memory, planning or judgment could make it harder for an older adult to manage money, shop for groceries, prepare meals or navigate food assistance programs. That means emerging cognitive problems could potentially contribute to food insecurity.
The researchers could not fully rule out that possibility because cognitive screening was not available during the earlier years of the study. They specifically noted that underlying cognitive impairment could have preceded some of the later food insecurity they observed.
At the same time, there are plausible reasons food insecurity itself could matter for cognitive health.
People struggling to afford enough food may have lower-quality diets, experience chronic stress or have greater difficulty managing conditions such as diabetes and high blood pressure. Previous research has connected food insecurity with poorer diet quality, psychological distress and several chronic diseases that can also affect brain health.
But this study did not test which of those pathways, if any, explains the association.
The researchers also found substantial differences between participants who did and did not experience food insecurity.
Those facing food insecurity tended to have lower incomes and less education and were less likely to own a home or live with a spouse or partner. They were also more likely to have certain health conditions. Researchers adjusted for many of those differences, but observational studies cannot account for every factor that could influence both food security and cognitive health.
Another limitation involves who remained in the study. Adults excluded because of missing information tended to have lower socioeconomic status and were more likely to have diabetes or hypertension than those included in the final analysis. That could affect how well the results represent adults facing the greatest economic and health challenges.
Still, the study has an unusual strength: food insecurity was measured repeatedly over many years rather than asking older adults to remember whether they struggled to afford food decades earlier.
That allowed researchers to distinguish food insecurity experienced in midlife from food insecurity experienced much closer to the period when cognitive problems were measured.
The finding that later-life food insecurity showed the clearest association adds to earlier research linking unreliable food access with poorer memory, faster cognitive decline and dementia risk in older adults.
It also suggests that food insecurity may deserve attention as part of the broader picture of healthy aging.
The study does not show that increasing food assistance would prevent dementia. Nor can it establish that improving diet quality alone would erase the association.
What it does show is that older adults struggling to consistently afford enough food were also more likely to show signs of serious cognitive decline. Understanding why those two problems so often appear together, and whether addressing food insecurity can improve cognitive outcomes, will require further research.
The research was supported by the National Institute on Aging, part of the National Institutes of Health.