Evidence map›Paper›PMID 40764072›Full record

ArticleBMJ open2025

Midlife cognitive testing in Africa: validity of the Harmonised Cognitive Assessment Protocol in the Kenya Life Panel Survey.

Alden L Gross, Madeline Duhon, Eric Ochieng, Jean N Ikanga, William H Dow, Jinkook Lee, Michael W Walker, Michelle Layvant, Anthony Ngugi, Joshua R Ehrlich and 1 more

Abstract readValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Cohort Profile: Kenya Life Panel Survey.International journal of epidemiology · 2026
    Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Alden L GrossDepartment of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.ORCID http://orcid.org/0000-0002-4678-0562
Madeline DuhonDepartment of Economics, Pepperdine University, Malibu, California, USA.
Eric OchiengDepartment of Economics, Maseno University, Maseno, Kenya.
Jean N IkangaEmory University, Atlanta, Georgia, USA.
William H DowSchool of Public Health, University of California, Berkeley, California, USA.
Jinkook LeeUniversity of Southern California Dana and David Dornsife College of Letters Arts and Sciences, Los Angeles, California, USA.
Michael W WalkerDepartment of Economics, University of California, Berkeley, California, USA.
Michelle LayvantAgricultural and Resource Economics, University of California, Berkeley, California, USA.
Anthony NgugiAga Khan University, Nairobi, Kenya.
Joshua R EhrlichDepartment of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA.ORCID http://orcid.org/0000-0002-0607-3564
Edward A MiguelDepartment of Economics, University of California, Berkeley, California, USA emiguel@berkeley.edu.ORCID http://orcid.org/0000-0001-6927-709X

Funding

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)R01AG077001 · NIA · UNIVERSITY OF CALIFORNIA BERKELEY · PI EDWARD ANDREW MIGUEL · 2022 to 2026
$5.2M
Longitudinal Study of Health and Ageing in Kenya (LOSHAK)R21AG077042 · NIA · AGA KHAN UNIVERSITY (KENYA) · PI EHRLICH, JOSHUA ROBERT, NGUGI, ANTHONY KARANJA · 2022 to 2022
$339k
NIA NIH HHS R01 AG077001NIA NIH HHS R21 AG077042
6 · The paper itself

Abstract

objectivesCohort studies of ageing and cognitive decline typically do not begin fielding comprehensive cognitive assessments until older adulthood. However, for identifying preventable dementia risk factors, there is strong value in beginning at earlier ages. The case is especially compelling in sub-Saharan Africa, where the number of older individuals is expected to triple in the next three decades, and where risk factors may operate more intensively at earlier ages. This study reports on the adaptation and validity of the Harmonised Cognitive Assessment Protocol (HCAP) approach in the Kenya Life Panel Survey (KLPS), collected among middle-aged respondents.

designTo evaluate the validity of the HCAP approach in Kenya, this study assesses model fit statistics from confirmatory factor analyses (CFA) and tests measurement invariance by respondent characteristics.

settingBoth rural and urban areas in Kenya.

participantsA sample of n=5878 individuals from the KLPS, who have been surveyed regularly since they were schoolchildren in the 1990s. The HCAP assessment was administered in 2023 at an average age of 37 years (10-90 range 34 to 41). PRIMARY AND SECONDARY OUTCOME MEASURES: For each individual, the CFA generates a general cognitive performance score, and cognitive performance scores for five distinct domains, including memory, executive functioning, language, orientation to time and place, and visuospatial functioning.

resultsFit of the models to the data was adequate for general cognitive performance (root mean squared error of approximation (RMSEA)=0.03; comparative fit index (CFI)=0.94; standardised root mean residual (SRMR)=0.05), language (RMSEA=0.02; CFI=0.95; SRMR=0.05) and good for memory (RMSEA=0.05; CFI=0.99; SRMR=0.02) and executive functioning (RMSEA=0.03; CFI=0.98; SRMR=0.03). The CFA indicate that the factor structure is consistent with findings from other countries and that reliability for the general cognitive performance score was high. Statistical models also suggest invariance at the scalar level for leading demographic (gender, age) and socioeconomic (education, occupational complexity) characteristics.

conclusionsThis study demonstrates that the cognitive functioning of mid-age Kenyans appears to be well captured by the adapted protocol. While there is a moderate decline in cognitive performance among older individuals, this relationship appears to be mediated by education, indicating that this KLPS HCAP provides a valuable baseline for studying future cognitive decline.

Indexed as

Cognitive AgingMental Status and Dementia TestsAdultCognitionCohort StudiesEmploymentFemaleHumansKenyaMaleMiddle AgedReference StandardsAgingCognitionSurveys and Questionnaires

Identifiers

PMID40764072
PMCPMC12336551

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.