{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:36:20Z","timestamp":1790109380351,"version":"4.0.1"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>We investigated heterogeneity in cognitive aging trajectories in rural Malawi\u2014a low-income country in sub-Saharan Africa in which the current understanding of cognitive aging is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We used longitudinal data on 1214 adults aged \u226545 years from the Mature Adults Cohort of the Malawi Longitudinal Study of Families and Health from 2012 to 2022 and employed latent-class trajectory models to identify distinct trajectories of cognition. We estimated associations between sociodemographic variables and group membership probabilities by using fractional multinomial logit regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three cognitive trajectory groups were identified: 36% of the respondents belonged to the \u201chigh\u201d cognition group characterized by a stable relative decline in cognition over time, 46% belonged to the \u201cmedium\u201d cognition group experiencing intermediate relative decline by age 80 years, and 18% of respondents belonged to the \u201clow\u201d cognition group experiencing the largest relative decline in cognition by age 80 years. Individuals on higher cognition trajectories were more likely to be men, have completed a primary or secondary level of schooling, be living in a house with a metal roof, and have been born in younger cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Heterogeneity exists in cognitive aging trajectories in Malawi\u2014while some individuals experience healthy cognitive aging, a nontrivial subgroup also experience accelerated cognitive decline over the life course. The results provide guidance for policymakers and practitioners in developing targeted programs to prevent or reduce the burden of cognitive decline among high-risk groups and seek to enhance healthy cognitive aging among older adults in Malawi, where resources for treatment and care are limited.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ije\/dyaf220","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T12:55:28Z","timestamp":1765630528000},"source":"Crossref","is-referenced-by-count":1,"title":["Cognitive aging across the life course in a low-income context: evidence from Malawi"],"prefix":"10.1093","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8869-1130","authenticated-orcid":false,"given":"Namrata","family":"Ray","sequence":"first","affiliation":[{"name":"Population Aging Research Center (PARC), University of Pennsylvania , Philadelphia,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Peter","family":"Kohler","sequence":"additional","affiliation":[{"name":"Population Aging Research Center (PARC), University of Pennsylvania , Philadelphia,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cung T","family":"Hoang","sequence":"additional","affiliation":[{"name":"Population Aging Research Center (PARC), University of Pennsylvania , Philadelphia,","place":["United States"]},{"name":"Department of Economics, University of Pennsylvania , Philadelphia,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helene","family":"Purcell","sequence":"additional","affiliation":[{"name":"Population Aging Research Center (PARC), University of Pennsylvania , Philadelphia,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazione","family":"Kulisewa","sequence":"additional","affiliation":[{"name":"Kamuzu University of Health Sciences (KUHeS) Department of Psychiatry, , Blantyre,","place":["Malawi"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Zulu","sequence":"additional","affiliation":[{"name":"Compelling Works , Blantyre,","place":["Malawi"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iliana V","family":"Kohler","sequence":"additional","affiliation":[{"name":"Population Aging Research Center (PARC), University of Pennsylvania , Philadelphia,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"2026012200060662600_dyaf220-B1","author":"Prince","year":"2015"},{"key":"2026012200060662600_dyaf220-B2","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1002\/alz.12432","article-title":"Dementia in Africa: current evidence, knowledge gaps and future directions","volume":"18","author":"Akinyemi","year":"2022","journal-title":"Alzheimers Dement"},{"key":"2026012200060662600_dyaf220-B3","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1016\/S2468-2667(21)00249-8","article-title":"Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019","volume":"7","author":"Nichols","year":"2022","journal-title":"Lancet Public Health"},{"key":"2026012200060662600_dyaf220-B4","volume-title":"Malawi Poverty and Equity Brief: October 2024 (English). 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