# Socioeconomic and Cardiovascular Sources of Cross-National Variation in Cognitive Health Among Older Adults

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2022 · $484,621

## Abstract

PROJECT SUMMARY
Although nearly 75% of global Alzheimer’s disease and related dementias (ADRD) cases will occur in lower- and
middle-income countries (LMICs) by 2050, little ADRD research includes data from these regions. This is a major
missed opportunity to identify individual-level and contextual influences on later-life cognitive function. Evidence
from high-income countries suggests ADRD is partly attributable to socioeconomic factors, such as education,
and cardiovascular factors, such as hypertension. Whether these same factors contribute to cognitive health
outcomes to a similar degree in LMICs with rapidly aging populations is unknown. Comparative research across
LMICs and high-income countries could help to unlock important drivers of ADRD and identify key differences
between countries that could be leveraged for prevention strategies to reduce the global ADRD burden. The
NIA-funded Harmonized Cognitive Assessment Protocol (HCAP) was recently introduced into the US Health and
Retirement Study (HRS) and its International Partner Studies (IPS) as a comparable cross-national cognitive
assessment. Critically, no work has demonstrated that HCAP data from the various countries are in fact directly
comparable. Any observation of country-level differences may thus be an unknown mixture of actual differences
in the distribution of cognitive function and bias attributable to incommensurate measurement. Our overarching
goal is to estimate the contributions of key socioeconomic and cardiovascular ADRD risk factors to later-life
cognitive function between individuals and between countries in the US HRS and IPS in South Africa, Mexico,
India, and England. We have assembled HCAP and main HRS/IPS survey data on N=10,642 older adults from
these five countries. To accomplish our goal, we aim to: 1) statistically harmonize HCAP measures across
HRS/IPS countries using modern psychometrics to enable us to identify and address any differential item
functioning of HCAP measures across countries in order to facilitate valid cross-national comparisons; 2)
investigate and quantify the contributions of life course socioeconomic factors to variation in later-life cognitive
function between individuals and between countries; and, 3) investigate and quantify the contributions of
cardiovascular factors to variation in later-life cognitive function between individuals and between countries. Key
innovations are: 1) adaptation of sophisticated psychometric methods to harmonize HCAP data across
economically, socially, and culturally diverse country contexts; 2) inclusion of cross-national data to diversify and
expand representation of global populations in the ADRD evidence base; and, 3) use of multi-level models to
partition variance in later-life cognitive function to differences between individuals and differences between
countries. We will make our harmonized data available through the established Gateway to Global Aging Data
website. Our results will set the stage t...

## Key facts

- **NIH application ID:** 10379328
- **Project number:** 5R01AG070953-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** Alden L. Gross
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $484,621
- **Award type:** 5
- **Project period:** 2021-04-01 → 2026-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10379328

## Citation

> US National Institutes of Health, RePORTER application 10379328, Socioeconomic and Cardiovascular Sources of Cross-National Variation in Cognitive Health Among Older Adults (5R01AG070953-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10379328. Licensed CC0.

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