Engaging Aging Minds: Labor Force Participation, Stimulating Activities, and Cognitive Aging Across Diverse International Settings.

PROJECT SUMMARY Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) present profound global challenges, particularly for rapidly aging populations in low- and middle-income countries (LMICs). An important approach to mitigating dementia risk is strategies to promote cognitive function throughout life. Research suggests that beyond formal education in childhood and early adulthood, labor force participation and stimulating activities could provide stimulation in the middle and later years and reduce cognitive decline and AD/ADRD. However, these findings are mostly from Western high-income countries (HICs) and may not apply to LMICs, where prospects for older people, especially older women, are largely lacking, with few opportunities to remain active and intellectually stimulated throughout life. Comparable data from LMICs and HICs are needed to provide the necessary variability to observe different experiences in labor engagement and opportunities for stimulating activities and to examine their effects on cognitive aging processes in racially, ethnically, educationally, and culturally diverse populations. Such data could offer insights that cannot be observed in more homogenous populations and could inform tailored policies to prevent cognitive decline and AD/ADRD worldwide. This proposed project will address critical gaps in global cognitive aging research by investigating the impact of labor force participation and key stimulating activities in middle and later life on cognitive aging outcomes by gender and across sociocultural contexts. We will use data from three LMICs— China, India, and Mexico—that represent a significant portion of the global aging population with variable gender norms and roles and opportunities in education, work, and stimulating activities. We will contrast these data with two developed countries, England and the US. We will leverage novel comprehensive neuropsychological batteries in >20,000 participants from the global Harmonized Cognitive Assessment Protocol (HCAP) studies and longitudinal data from their parent studies from diverse sociocultural contexts. We will pursue three specific aims: 1) evaluate cross-country differences in both labor force participation and engagement in stimulating activities and their relationships with cognitive functioning and cognitive decline by gender; 2) evaluate cross-country differences in the relationships between labor force participation and stimulating activities with subsequent dementia by gender; and 3) investigate within-country gender differences in types of work and stimulating activities and their impact on cognitive decline and dementia. Results from the proposed project will provide critical insights to inform global prevention of AD/ADRD risk—especially in LMIC populations that are growing rapidly but most vulnerable to the challenges posed by AD/ADRD—by informing tailored interventions and policies in the US and globally to improve population health.