Abstract Dementia is epidemic with a projected cost of $1.2 trillion by 2050. Currently, 2/3 of people with dementia live in low and middle-income countries (LMIC). 30% of dementia cases are preventable by modifying risk factors such as low education. Formal education acquired early in life protects against dementia, but whether acquiring education later in life can decrease dementia risk is less clear. Our previous cross-sectional work conducted in Brazil/UFMG in partnership with the USA/UCSF suggests that even few years of education might improve brain resilience by strengthening the relationship between episodic memory and medial temporal lobe structures, including the hippocampus (HC) and its connections. Whether acquiring education in adulthood could also strengthen those relationships and increase hippocampal efficiency is unknown. We started a pilot one-arm longitudinal study to determine whether a late-life literacy improves episodic memory measured by hippocampal functional and structural connectivity. Despite the historical challenges of enrolling illiterate adults in research, we devised a successful strategy and met the target enrollment and acquired baseline structural and functional MRIs, demonstrating feasibility of our approach. This proposal will build on and expand the collaboration between UFMG and UCSF to implement a two-arm, randomized controlled trial investigating the role of adult education in improving episodic memory and enhancing hippocampal connectivity. This partnership represents a unique opportunity to test this hypothesis given the combined expertise and resources from both centers. If successful in showing a benefit of adult education into memory, brain structure and function, this proposal will be critical for developing strategies to improve brain resilience and subsequently decrease dementia risk using a low-cost intervention. Noteworthy, The proposal will also contribute to build sustainable research capacity in Brazil by transferring the knowledge on advanced longitudinal neuroimaging analysis to UFMG. The learned techniques will be applied in further studies about neurological conditions conducted not only in UFMG but other Brazilian institutions.

PROJECT NARRATIVE This study aims to discover whether acquiring basic-literacy in adulthood can improve episodic memory and brain structural and functional connectivity. In a collaborative project between Brazil and USA, we will use a randomized controlled trial approach to leverage the level of evidence of the benefits of basic adult-education as a possible cognitive reserve builder. If successful, the study’s findings will be important in shaping policies targeting increasing access to late-life education to reduce dementia risk.