Measurement and Analysis of Aging, Cognition and Alzheimer's Disease and Related Dementia (ADRD) Risk Factors at Midlife in the Kenya Life Panel Survey (KLPS)

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Project Summary/Abstract Alzheimer’s disease is severely under-studied in Sub-Saharan Africa: the few existing estimates suggest that prevalence is currently low but changing risk factors predict that it could double in the next 20 years. We propose to study risk factors for Alzheimer’s disease and related dementias (AD/ADRD) in the Kenya Life Panel Survey (KLPS), a unique, richly phenotyped cohort of Kenyan adults who have been followed since childhood, and who were participants in a randomized child health intervention (school-based deworming). The existing dataset contains information on health, cognition, educational, demographic, social attitudes, and labor market outcomes for over 6,500 Kenyans first surveyed in 1998 (at ages 8-15) through 2021 (ages 31-39). KLPS thus provides an unusual opportunity to study cognition, and the determinants of AD/ADRD and related risk factors, over the life course, with direct measurement during childhood, young adulthood, and midlife. This project proposes an additional field interview in the KLPS Round 5 Aging Module (KLPS-5A) to collect detailed “midlife baseline” cognition and aging-related health data, as well as information on AD/ADRD risk factors, among participants, who will be 35 to 43 years old at the time of survey. One novel aspect is the ability to link these midlife measures to rich existing longitudinal data from childhood and early adulthood, including cognitive assessments (achievement and cognitive test scores), as well as educational outcomes, health status and behaviors, and economic outcomes (e.g., earnings, migration, occupational complexity) collected contemporaneously rather than via recall in later life. By combining state-of-the-art cognitive measures at this new midlife timepoint with the extensive cognitive measures and exposures already collected, we hope to establish KLPS as the premier African study of life-course dementia determinants. There are very few surveys globally that include such detailed data from childhood to old age, and these data would open up multiple avenues for investigating dementias tied to life-course disadvantages. We will make all data publicly available to researchers across disciplines. Another notable feature is the ability to utilize experimental variation from a randomized child health intervention that has been documented to meaningfully affect adult living standards and several risk factors for dementia, to better understand pathways over the life course and the scope for public health interventions to reduce AD/ADRD risk. The Primary School Deworming Program provided deworming medication to randomly-selected schools starting in 1998 in a region with high worm prevalence (>90%): 10 to 20 years after treatment, the intervention had positive effects on self-reported health, educational attainment; adult living standards; urban residential status, and occupation in the non-agricultural sector. This setting offers an unusual opportunity to experimentally test the extent to which an effective child health intervention can affect AD/ADRD risks and midlife health and cognition, as much of the associational literature suggests.