Design and procedures for the greenness, cognitive performance and vascular outcomes in the northern Manhattan study (NOMAS-greenness)

The Greenness, Cognitive Performance, and Vascular Outcomes in the Northern Manhattan Study investigates the protective effects of cumulative residential greenness exposure on cognitive performance and vascular outcomes, from 1993-2023. Greenness is quantified using satellite-derived Normalized Difference Vegetation Index (NDVI) within 250-meter residential buffers. For each participant, up to 35 years of greenness exposure data are used, with a median of 15.7 years of vascular follow-up, (i.e. adjudicated stroke, myocardial infarction, and vascular death) and among those with repeated testing, using comprehensive neurocognitive measures a median of 5.1 between the first and second assessments and 12.3 years between the first and third measures. The main sample's median age was 69.2 years at baseline (range=40-107). The study will prospectively examine: (1) associations of cumulative greenness with cognitive and vascular outcomes; (2) mediation through behavioral, cardiometabolic, inflammatory, and vascular brain imaging biomarkers; and (3) effect modification by individual and neighborhood factors. Additional aims include: (4) longitudinal associations of greenness with brain reserve; (5) moderation by brain reserve in greenness-cognition relationships; and (6) associations with adjudicated Mild Cognitive Impairment, Alzheimer's disease, and related dementias.