{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"Research Square"}],"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:17:50Z","timestamp":1769213870771,"version":"3.49.0"},"posted":{"date-parts":[[2026,1,23]]},"group-title":"In Review","reference-count":46,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,1,10]]},"abstract":"<title>Abstract<\/title>\n                <p>\n                  Underdiagnosis of cardiometabolic risk factors (CMRFs) may represent an unrecognised biological pathway contributing to dementia risk; yet remains poorly characterised in African and African diaspora populations. We quantified the prevalence and determinants of underdiagnosed hypertension and abnormal glycaemia across four cohorts comprising up to 7,000 adults aged\u2009\u2265\u200940 years from Nigeria, Kenya, and The United States: Indianapolis, and North Texas. Underdiagnosis was defined as absence of self-reported diagnosis despite elevated systolic blood pressure (\u2265\u2009130 mmHg) or fasting blood glucose (\u2265\u2009100 mg\/dL). Cohort-stratified analyses examined demographic, socioeconomic, cognitive, Alzheimer\u2019s genetic, and blood-based biomarker correlates. Underdiagnosis was pervasive in African cohorts. Elevated fasting glucose was associated with cognitive impairment in Kenya and North Texas, while severe hypertension and diabetes were linked to Alzheimer\u2019s disease-related biomarkers [pTau217\/181, NFL and A\u03b242\/40] in North Texas (\n                  <italic>all p\u2009\u2264\u20090.05<\/italic>\n                  ). These findings identify context-specific diagnostic gaps in populations at high dementia risk and highlight cardiometabolic detection as a mechanistic target for prevention.\n                <\/p>","DOI":"10.21203\/rs.3.rs-8570591\/v1","type":"posted-content","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T19:51:43Z","timestamp":1769197903000},"source":"Crossref","is-referenced-by-count":0,"title":["Contextual variability in under-diagnosed cardiometabolic disease and cognitive vulnerability among populations at high risk for Alzheimer\u2019s disease and related dementias"],"prefix":"10.21203","author":[{"given":"Nwanyieze","family":"Jiakponnah","sequence":"first","affiliation":[{"name":"Wake Forest University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Curran","sequence":"additional","affiliation":[{"name":"Wake Forest University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tamlyn","family":"Watermeyer","sequence":"additional","affiliation":[{"name":"Northumbria University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jasmit","family":"Shah","sequence":"additional","affiliation":[{"name":"Aga Khan University Nairobi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Litha","family":"Musili","sequence":"additional","affiliation":[{"name":"Aga Khan University Nairobi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stanley","family":"Onyango","sequence":"additional","affiliation":[{"name":"Aga Khan University Nairobi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benard","family":"Aliwa","sequence":"additional","affiliation":[{"name":"Aga Khan University Nairobi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andy","family":"Mackelfresh","sequence":"additional","affiliation":[{"name":"University of North Carolina at Charlotte"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omonigho Michael","family":"Bubu","sequence":"additional","affiliation":[{"name":"New York University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiadi","family":"Onyike","sequence":"additional","affiliation":[{"name":"Johns Hopkins University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ozioma","family":"Okonkwo","sequence":"additional","affiliation":[{"name":"University of Wisconsin\u2013Madison"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zul","family":"Merali","sequence":"additional","affiliation":[{"name":"Aga Khan University Nairobi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rufus","family":"Akinyemi","sequence":"additional","affiliation":[{"name":"University of Ibadan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Hughes","sequence":"additional","affiliation":[{"name":"Wake Forest University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mansoor","family":"Saleh","sequence":"additional","affiliation":[{"name":"Aga Khan University Hospital Nairobi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Petersen","sequence":"additional","affiliation":[{"name":"University of North Texas Health Science Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Blackmon","sequence":"additional","affiliation":[{"name":"Dartmouth\u2013Hitchcock Medical Center"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adesola","family":"Ogunniyi","sequence":"additional","affiliation":[{"name":"University College Hospital, Ibadan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugh","family":"Hendrie","sequence":"additional","affiliation":[{"name":"Indiana University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chinedu","family":"Udeh-Momoh","sequence":"additional","affiliation":[{"name":"Wake Forest University"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","reference":[{"key":"ref1","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 RO","year":"2022","unstructured":"Akinyemi, R. 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