Home › Research › Risk factors
Geographic Heterogeneity in the Association Between Schooling and Cognitive Change Among Older Adults in India
Rajagopalan P.. medRxiv, 2026-10-28
Topic: Brain imaging, connectivity and assessment
Higher educational attainment is associated with steeper measured cognitive decline among older adults in India, but whether this association is uniform across the country is unknown. Using the Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (wave 1, 2017–2019; wave 2, 2022–2024), this study examined whether the association between years of schooling and cognitive change varied across 18 states and union territories among 2,510 adults aged 60 years or older who were assessed at both waves. Models adjusted for age, sex, household wealth, and rural or urban residence. Change-score models related inter-wave change to schooling, and analysis of covariance additionally conditioned on baseline cognition. The schooling-by-geography interaction was significant in both specifications (change score, F = 2.97, P < .001; analysis of covariance, F = 4.11, P < .001). State-specific change-score estimates ranged from −0.056 SD per year of schooling in Odisha to +0.021 SD in Kerala. The pooled association reversed sign with baseline adjustment, from −0.022 SD (95% confidence interval: −0.027, −0.016) to +0.031 SD (95% confidence interval: 0.024, 0.038). A single national coefficient conceals substantial geographic variation in how schooling relates to cognitive aging in India.
Key findings
- Higher educational attainment is associated with steeper measured cognitive decline among older adults in India, but whether this association is uniform across the country is unknown.
- The schooling-by-geography interaction was significant in both specifications (change score, F = 2.97, P < .001; analysis of covariance, F = 4.11, P < .001).
New to this subject? Start with our plain-English guide: Risk factors, ranked →
Study details
- Study designlongitudinal study
- Participants2,510
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 45 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for effect reported and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 28 of the 62 points we could judge it on, which is 45 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 7 / 12 | A longitudinal study following the same people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 3 / 4 | 2,510 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 28 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 28 of the 62 points we could judge it on is 45 out of 100. |
| Total | 45 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
Read the original
Free copy unknown: no free-copy check has an answer for this record yet. That does not mean it is paywalled.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Rajagopalan, P. (2026). Geographic Heterogeneity in the Association Between Schooling and Cognitive Change Among Older Adults in India. medRxiv. https://doi.org/10.64898/2026.10.27.26366607
Vancouver
Rajagopalan P. Geographic Heterogeneity in the Association Between Schooling and Cognitive Change Among Older Adults in India. medRxiv. 2026. doi:10.64898/2026.10.27.26366607.
BibTeX
@article{rajagopalan2026-fa2e46ae,
author = {Rajagopalan, P.},
title = {{Geographic Heterogeneity in the Association Between Schooling and Cognitive Change Among Older Adults in India}},
journal = {medRxiv},
year = {2026},
doi = {10.64898/2026.10.27.26366607},
url = {https://doi.org/10.64898/2026.10.27.26366607}
}
Related studies in Risk factors
Also tagged “reserve”
208 studies in the library carry the topic tag “reserve”; these are this study's neighbours in a fixed, alphabetical-by-hash tour of them, not the closest in content. All 208 tagged studies.