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Summary

Dementia imposes significant global challenges that necessitate novel approaches to its prevention, detection, and treatment. Research from developing countries shows that the decline in age-specific prevalence and incidence of severe cognitive impairment and dementia that has been trending since the 1980s is parallel to and likely attributable to the rise in educational attainment and improvements in the treatment and control of cardiometabolic risk (CMR) factors. However, the complex dynamics of education, CMR, and cognitive health complicate efforts to pinpoint specific pathways from education or CMR to cognitive outcomes. This research uses 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 (HCAP) 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 more than 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. 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. Including populations from diverse contexts in cognitive aging research will help increase the variance of environmental exposure and allow the full distributions of risk and protective factors to be considered, thereby providing a more comprehensive understanding of the determinants of cognitive aging. This project will provide critical insights that can be used to understand and respond to the challenges posed by dementia.

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