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remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>We analyzed 2016 to 2019 Japan Gerontological Evaluation Study data, including 57,178 dementia\u2010free, independent adults (\u2265 65) residing \u2265 30 years in the same municipality. Dementia and mortality were identified through public long\u2010term care insurance. Extreme heat exposure was defined as cumulative (sum over 1\u20133 years, capturing the combined effect of multiple years) or point (days in a single year, estimating each year's independent effect) above the 90th or 99th percentile of local climate. Three\u2010level random\u2010effects logistic regression was applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Cumulative exposure to extreme heat over 1 to 3 years increased the odds of dementia and the combined outcome of dementia or mortality. Time\u2010lagged analyses showed significant effects for 1\u2010year and 3\u2010year prior exposures but inconsistent or reverse effects for 2\u2010year exposure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>DISCUSSION<\/jats:title>\n                    <jats:p>Extreme heat may accelerate dementia onset or death. Heat adaptation policies for older adults are warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Evidence is scarce on the impact of repeated extreme heat exposure on dementia onset.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Extreme heat relative to local climate norms was associated with higher odds of dementia onset and all\u2010cause mortality in older adults.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Adverse effects appear rapidly, within 1 to 3 years of exposure.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Heat adaptation strategies should be incorporated into dementia prevention frameworks.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/alz.71057","type":"journal-article","created":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T14:48:58Z","timestamp":1767538138000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Effects of extreme heat on the onset of dementia and all\u2010cause mortality: A 3\u2010year follow\u2010up study in a large population\u2010based cohort in Japan"],"prefix":"10.1002","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9764-6067","authenticated-orcid":false,"given":"Ayako","family":"Morita","sequence":"first","affiliation":[{"name":"Department of Public Health Institute of Science Tokyo  Tokyo 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