The overall objective of this application is to lay the foundation for a sustainable program of population-based research into Alzheimer’s disease and related dementias (ADRD) in Nepal. To that end, the project seeks to initiate a series of research capacity building activities and develop a new, population-based, longitudinal cohort study of ADRD and related age-associated chronic health conditions in this population. Population aging is becoming increasingly more common in many low- and middle-income countries (LMIC). As a result, these countries face the growing burden of common age-associated chronic illnesses, including ADRD. Nepal is a low middle-income country where the population is now aging, putting a rising number of adults at risk of developing ADRD. There is virtually no research capacity in Nepal to investigate the scope and primary determinants of ADRD, and even the most basic information on ADRD is currently lacking. Such information is urgently needed to guide the development of prevention strategies and reduce the burden of ADRD in this country. Capacity building activities will focus on training in survey data collection methods with a primary focus on ascertainment of ADRD and statistical methods for the analysis of complex data from longitudinal panel surveys. The activities will consist of workshops with hands-on experience in the design and administration of cognitive assessments to identify ADRD in the general population, and in statistical analysis methods for longitudinal data from complex surveys. The project will also begin a new, longitudinal cohort study of ADRD designed to fill substantial gaps in information on ADRD and its primary risk factors in Nepal. It will focus on two novel risk factors with particular salience to understand the burden of ADRD in Nepal. The first involves the role of international labor migration: a substantial portion of Nepali adults spend prolonged periods of adulthood working in other countries to earn income for their families, often in challenging situations. The second risk factor involves the long-term effects of exposure to armed conflict that has affected this population for 10 years (1996-2006). The impact of labor migration and armed conflict on ADRD risk is currently unknown. The study will leverage the data collection infrastructure that has been developed for the Chitwan Valley Family Study, a population survey of >10,000 participants aged 15-59 that started in 1996. The cohort is now aging, providing a unique opportunity to begin a new population study of ADRD and other chronic health conditions. The study will include the estimated 4,000 surviving participants who have now become age-eligible (> 50) for this study. This sample will be invited for a baseline interview, including a detailed cognitive assessment, and a follow-up interview two years later. Outcomes from the capacity building and research activities will be shared with relevant stakeholders and organizations in Nepal to inform local solutions and policies for the prevention and treatment of ADRD in this population. We anticipate that much of this work will have relevance for other low-resource, low-income countries that face similar circumstances and challenges as Nepal.

Relevance As a result of population aging, many lower-income countries such as Nepal face a rapidly growing burden of dementia. This proposal represents a collaboration between the Institute for Social and Environmental Research in Nepal and the University of Michigan to develop a program of research capacity building and a population-based study to investigate the scope and primary determinants of dementia in Nepal. Findings from this program are expected to have substantial relevance for a better understanding of dementia risks and associated chronic health conditions in Nepal and other lower-income countries around the world.