A cross-national comparative study on cardiometabolic risk, education, and cognitive aging

PROJECT SUMMARY Alzheimer's Diseases and Alzheimer's Disease-Related Dementias (AD/ADRD) impose significant global challenges that necessitate research to identify critical protective and risk factors of cognitive health. Research from developing countries shows that the decline in age-specific prevalence and incidence of severe cognitive impairment and dementia since the 1980s parallels the rise in educational attainment and improvements in the control of cardiometabolic risk (CMR). However, the complex dynamics of education, CMR, and cognitive health complicate efforts to pinpoint specific pathways from education or CMR to cognitive outcomes. The proposed research will use representative longitudinal data from the United States Health and Retirement Study and its international sister studies in England, China, and Indonesia, as well as new data obtained from the Harmonized Cognitive Assessment Protocol studies to systematically and rigorously describe and compare the CMR and educational patterns of cognitive function, cognitive aging, and dementia in four countries. These countries comprise about 25 percent of the world's population, are at different levels of economic development and stages of nutritional transition, and represent a wide range of historical, cultural, social, epidemiological, and medical contexts. This research is important because the cross-national comparison of key patterns of cognitive health will enhance the understanding of how broad social- environmental contexts, coupled with their embedded individual characteristics and experiences, affect cognitive health in old age. To accomplish this research goal, the K99 phase will involve training in neuropsychology, the international context of health and aging, and advanced techniques in comparative analysis using longitudinal data. This training will take place at the Carolina Population Center (CPC) at the University of North Carolina at Chapel Hill (UNC). CPC is an ideal location to receive the training necessary for the proposed research, given the interdisciplinary nature of the CPC in terms of global studies of health and wellbeing, and interdisciplinary mentorship, and the access to a wide range of coursework that UNC offers. Building on the training gleaned during the K99 phase, the goal of the R00 phase will be to (1) examine the CMR and educational patterns of cognitive aging and dementia by modeling the longitudinal relationships and using the fixed-effect framework; and (2) contrast these patterns across countries. Cognitive aging is a highly complex process that is influenced by factors at the individual and societal levels. This comparative research will provide a comprehensive picture of cognitive health that cannot be observed in more homogenous populations, enhance the understanding of ways that broad social- environmental contexts, coupled with their embedded individual characteristics and experiences, affect cognitive aging, and, in so doing, provide key insights that can be used to respond to the challenges posed by AD/ADRD worldwide.