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  • 2024
  • Research to prevent cognitive decline in rural South Africa

Renewed support and illuminating results for faculty-led research on cognitive decline in rural South Africa

By: Holly Thrasher

Wednesday, October 02, 2024

Alzheimer's disease and related dementias (ADRD) are steadily increasing in low- and middle-income communities worldwide.

Even after global setbacks from COVID-19, the average life expectancy continues to increase for humans everywhere. This is generally regarded as good news: Longer life typically correlates with access to wellness resources, social connections, and similar aspects of a healthy life. But a longer life doesn't necessarily translate to a better life—particularly if aging persons develop cognitive conditions that affect their ability to care for themselves and others. This important distinction drives ongoing research by Molly Rosenberg, Ph.D. of the Indiana University School of Public Health-Bloomington (SPH-B).

Molly Rosenberg
Molly Rosenberg, Ph.D.

An associate professor in the Department of Epidemiology and Biostatistics, Rosenberg has spent the last several years exploring the relationship between socio-economic conditions and the development of Alzheimer's disease and related dementias (ADRD) in rural South Africa. Despite general gains in life expectancy, a grim statistic casts a shadow over this region: By 2050, about three-quarters of ADRD cases will occur in low- and middle-income areas such as these.


Rosenberg began investigating these issues in 2020 with more than $2 million in funding from the National Institute on Aging of the National Institutes of Health (NIH). The project tested whether cash transfer interventions affected memory decline and ADRD risk. The researchers suspected that when aging adults lived in households with more cash on hand, they would experience slower or less severe cognitive decline.

What does the research demonstrate? 

"Our findings so far have shown that cash transfers can improve the health of vulnerable older adults," Rosenberg says, pointing to a non-technical summary of their results published earlier this year. "In our study site, we found that those who receive extra income from cash transfers end up doing better cognitively in later life. In some groups, we also observed an impact of reduced risk of mortality." 

These are bold claims, which is why Rosenberg describes "Effect of a cash transfer intervention on memory decline and dementia probability in older adults in rural South Africa," published in the September 19 issue of Proceedings of the National Academy of Sciences of the United States of America, "the biggest publication of my career."

This work is co-led by Dr. Lindsay Kobayashi at the University of Michigan, in research collaboration with South African partners at the University of the Witwatersrand, partners at Harvard University and the University of North Carolina, and with key contributions from Indiana University researchers Erika Beidelman, Maria Klein, Meredith Phillips, Rishika Chakraborty, Janet Jock, and Coady Wing.

Grace Sembajwe, Ph.D.
Grace Sembajwe, Ph.D.

"These are remarkable findings," says Grace Sembajwe, Ph.D., interim chair of the Department of Epidemiology and Biostatistics. "They highlight tangible ways in which public health actions that may complement clinical interventions, can independently and definitively improve individual level health outcomes."

Meanwhile, the NIH recently funded a five-year renewal of the project, enabling Rosenberg and collaborators to leverage their initial findings into deeper understanding: "We want our work to tell us how cash transfers can protect cognitive health in older ages," Rosenberg says. "What are people investing their money in that could potentially be cognitively stimulating?"

There are implications beyond this rural setting, as well. Rosenberg explains that while most countries use some sort of cash transfer program to support people's financial well-being, "We want to understand the best way to structure cash transfer programs [for] the biggest impact on cognitive health. Are there certain life course periods that are more sensitive to the income? Certain members of households who are 'better' investments?"

The recent NIH renewal of funding for this study guarantees that Rosenberg and her colleagues will have important resources to examine these questions—and perhaps more. This means that the results of their investigation have the potential to inform both the development and administration of similar cash transfer programs in communities around the world.

Pamela Whitten
IU President Pamela Whitten

"Groundbreaking research produced by dedicated faculty like you has a major influence," IU President Pamela Whitten said in a congratulatory letter to Dr. Rosenberg. "We are grateful for your dedication...to expanding knowledge that will have a positive, innovative impact on society—today and for generations to come."

For more stories about SPH-B making a big difference both locally and worldwide, visit go.iu.edu/48bx.

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