JMIR Publications

ABSTRACT

Background:

The rapid integration of information technology into daily life has exacerbated the digital divide (DD), particularly among older adults, who often face barriers to technology adoption. While prior research has linked technology use to cognitive benefits, the long-term neurostructural and cognitive consequences of the digital divide remain poorly understood.

Objective:

This study employs large-scale neuroimaging data to examine how the digital divide affects long-term brain structure and cognitive aging in older adults. It specifically investigates: (1) structural and cognitive differences between older adults with and without digital divide engagement; (2) predictive relationships between group-distinctive brain regions and cognitive outcomes; (3) longitudinal impacts of digital divide exposure on accelerated aging trajectories of neural substrates and cognitive functions.

Methods:

The study included 1,280 community-dwelling older adults (aged 65-90 years) who completed comprehensive cognitive assessments and structural MRI scans at baseline. Longitudinal data were available for 689 participants (mean follow-up 3.2 years). Participants were classified into Overcoming Digital Divide (ODD; n=640) and Digital Divide (DD; n=640) groups using rigorous propensity score matching(PSM) to control for age, education, gender, and baseline health conditions. A computational framework employing the searchlight technique and cross-validation classification model investigated group differences in structural features and cognitive representation. The aging rate of each voxel's structural feature was calculated to explore the long-term influence of the digital divide.

Results:

The DD group showed significant deficits in executive function (t=4.75, P<.001, Cohen’s d=0.38) and processing speed (t=4.62, P<.001, Cohen’s d=0.37) compared to the ODD group. Reduced GMV in the DD group spanned the fusiform gyrus, hippocampus, parahippocampal gyrus, and superior temporal sulcus (FDR-corrected P<0.05). The computational framework identified the key structural substrates related to executive functions and processing speed, excluding the ventro-orbitofrontal lobe (classification accuracy < 0.6). Longitudinal findings highlighted the long-term impact of the digital divide .The DD group exhibited faster GMV decline in the middle frontal gyrus (t = 3.95 of peak voxel in this cluster, FDR-corrected P<0.05), which mediated 17% of episodic memory decline (P=0.02).

Conclusions:

Elderly individuals who overcome the digital divide demonstrate preserved gray matter structure and slower cognitive decline, particularly in frontotemporal regions critical for executive function. Our findings underscore mobile digital interventions should be explored as potential cognitive decline prevention strategies.