Abstract As the aging population is growing worldwide, identifying factors that may confer protection for Alzheimer’s disease and related dementias (ADRD) is a global public health priority. Yet, several key social determinants of ADRD, such as years of education, are completed earlier in the lifecourse and are thus unamenable to change in older age. In parallel, growing evidence suggests that engaging in cognitively stimulating activities across the lifecourse is associated with improved cognition and overall health. These data put forward a compelling hypothesis that late life learning (LLL, non-formal educational activities outside formal credentialed learning) may provide a window of opportunity, in older age, to mitigate ADRD risk by providing prospects for intellectual stimulation and social engagement. Yet, very few studies have evaluated the benefits of LLL. The long-term goal of our research is to pinpoint how we can intervene to prevent or delay ADRD, especially in low-resourced settings where opportunities for engaged aging are limited such as in Lebanon, a low to middle income country (LMIC). Lebanon has the largest proportion of older adults in the Arab region, and Lebanese older adults are exposed to a host of lifecourse psychosocial adversities (e.g., war stressors, financial hardship) all of which would be expected to increase ADRD risk. The current project moves towards our long-term goal by proposing an innovative study in which we capitalize on an ongoing LLL program at the American University of Beirut, The University for Seniors (UfS), to evaluate the influence of LLL on cognitive and overall health. The UfS has been running for the last 11 years and its registry includes 1,300 participants, providing a well-established platform from which to launch our study. Information on LLL will be abstracted from UfS records. Assessments at the baseline and follow-up visits will include a life history questionnaire, a cognitive battery, among other measures. This research application, which builds on existing collaborations between investigative teams in the US and Lebanon, (Aim 1) is embedded within a detailed capacity building program aimed at enhancing research capacity in several needed areas such as cognitive aging and ADRD, social and lifecourse epidemiology, and quantitative methods, while also providing a networking and support base for researchers in Lebanon and the region. For this project, we propose to (Aim 2) design a community-based study, the 3LC (Late Life Learning, Cognition and Aging), by including 500 previously enrolled UfS participants, 200 newly enrolled UfS participants, and 700 age- and sex-matched non-UfS-participating community residents; and (Aim 3) apply rigorous analytical techniques to determine the strength of associations of LLL with cognition and related outcomes, examine mediating mechanisms, and whether LLL may modify the influence of prior psychosocial exposures on cognition and other health measures. Given the role of biological sex in dementia risk, we will allow for distinct models for men and women. This application will build research and infrastructure capacities to delineate opportunities for dementia prevention in Lebanon and other low-resourced settings.

Project Narrative This project will capitalize on an ongoing and well-established late life learning (LLL) program, the University for Seniors (UfS), in Beirut, Lebanon and will include 500 previously enrolled UfS participants, 200 participants to be newly enrolled in UfS, and 700 age- and sex- matched non-UfS-participating community residents. The resulting cohort will be prospectively followed and will include two waves of data collection to rigorously evaluate the relationships of LLL with cognitive function, Alzheimer’s Disease and Related Dementias (ADRD), and other related outcomes in older age, whether these relationships are mediated by educational and social engagement, and whether LLL would modify the influence of earlier and lifecourse psychosocial exposures. Through a detailed capacity building program, this application will build research and infrastructure capacities to delineate opportunities for dementia prevention in Lebanon and other low-resourced settings.