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Midlife cognitive testing in Africa: validity of the Harmonised Cognitive Assessment Protocol in the Kenya Life Panel Survey
Alden L. Gross, Madeline Duhon, Eric Ochieng, Jean N. Ikanga, William H. Dow, Jinkook Lee, Michael Walker, Michelle Layvant et al.. BMJ Open, 2025-08-01
Topic: Risk, prevention and care in population studies
Fit of the models to the data was adequate for general cognitive performance (root mean squared error of approximation (RMSEA)=0.03; comparative fit index (CFI)=0.94; standardised root mean residual (SRMR)=0.05), language (RMSEA=0.02; CFI=0.95; SRMR=0.05) and good for memory (RMSEA=0.05; CFI=0.99; SRMR=0.02) and executive functioning (RMSEA=0.03; CFI=0.98; SRMR=0.03). The CFA indicate that the factor structure is consistent with findings from other countries and that reliability for the general cognitive performance score was high. Statistical models also suggest invariance at the scalar level for leading demographic (gender, age) and socioeconomic (education, occupational complexity) characteristics. This study demonstrates that the cognitive functioning of mid-age Kenyans appears to be well captured by the adapted protocol. While there is a moderate decline in cognitive performance among older individuals, this relationship appears to be mediated by education, indicating that this KLPS HCAP provides a valuable baseline for studying future cognitive decline.
Key findings
- Fit of the models to the data was adequate for general cognitive performance (root mean squared error of approximation (RMSEA)=0.03; comparative fit index (CFI)=0.94; standardised root mean residual (SRMR)=0.05), language (RMSEA=0.02; CFI=0.95; SRMR=0.05) and good for memory (RMSEA=0.05; CFI=0.99; SRMR=0.02) and executive functioning (RMSEA=0.03; CFI=0.98; SRMR=0.03).
- The CFA indicate that the factor structure is consistent with findings from other countries and that reliability for the general cognitive performance score was high.
- Statistical models also suggest invariance at the scalar level for leading demographic (gender, age) and socioeconomic (education, occupational complexity) characteristics.
- This study demonstrates that the cognitive functioning of mid-age Kenyans appears to be well captured by the adapted protocol.
- While there is a moderate decline in cognitive performance among older individuals, this relationship appears to be mediated by education, indicating that this KLPS HCAP provides a valuable baseline for studying future cognitive decline.
Why it matters
This study found that the adapted cognitive assessment protocol was valid for measuring cognitive functioning in mid-age Kenyans, with factor structure consistent with findings from other countries. The protocol provides a valuable baseline for studying future cognitive decline in this population.
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Study details
- Study designcohort study
- Participants5,878
- Evidence strengthModerate
How this study scored 58/100
Published in a peer-reviewed journal, and it is a cohort study following people over time. Scored zero for effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (BMJ Open) |
| Journal's citation record | 2 / 4 | BMJ Open: journal h-index 240 (OpenAlex, 2026-10-29) |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 5,878 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 | 2 / 7 | Cited 6 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 2.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 3.8× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 1 / 4 | Cited 6 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Edward A. Miguel: h-index 72 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Johns Hopkins University: institution h-index 2,306 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 8 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40764072) |
| Free to read | 2 / 2 | Free to read |
| Total | 58 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Gross, A. L., Duhon, M., Ochieng, E., Ikanga, J. N., Dow, W. H., Lee, J., et al. (2025). Midlife cognitive testing in Africa: validity of the Harmonised Cognitive Assessment Protocol in the Kenya Life Panel Survey. BMJ Open. https://doi.org/10.1136/bmjopen-2024-096619
Vancouver
Gross AL, Duhon M, Ochieng E, Ikanga JN, Dow WH, Lee J, et al. Midlife cognitive testing in Africa: validity of the Harmonised Cognitive Assessment Protocol in the Kenya Life Panel Survey. BMJ Open. 2025. doi:10.1136/bmjopen-2024-096619. PMID: 40764072.
BibTeX
@article{gross2025-40764072,
author = {Gross, Alden L. and Duhon, Madeline and Ochieng, Eric and Ikanga, Jean N. and Dow, William H. and Lee, Jinkook and Walker, Michael and Layvant, Michelle and others},
title = {{Midlife cognitive testing in Africa: validity of the Harmonised Cognitive Assessment Protocol in the Kenya Life Panel Survey}},
journal = {BMJ Open},
year = {2025},
doi = {10.1136/bmjopen-2024-096619},
pmid = {40764072},
url = {https://doi.org/10.1136/bmjopen-2024-096619}
}
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