Future Directions for the HRS Harmonized Cognitive Assessment Protocol

Abstract

In the absence of effective pharmacological treatment to halt or reverse the course of Alzheimer’s disease and related dementias (ADRDs), population-level research on the modifiable determinants of dementia risk and outcomes for those living with ADRD is critical. The Harmonized Cognitive Assessment Protocol (HCAP), fielded in 2016 as part of the U.S. Health and Retirement Study (HRS) and multiple international counterparts, has the potential to play an important role in such efforts. The stated goals of the HCAP are to improve our ability to understand the determinants, prevalence, costs, and consequences of cognitive impairment and dementia in the U.S. and to support cross-national comparisons. The first wave of the HCAP demonstrated the feasibility and value of the more detailed cognitive assessments in the HCAP compared to the brief cognitive assessments in the core HRS interviews. To achieve its full potential, we provide eight recommendations for improving future iterations of the HCAP. Our highest priority recommendation is to increase the representation of historically marginalized racial/ethnic groups disproportionately affected by ADRDs. Additional recommendations relate to the timing of the HCAP assessments; clinical and biomarker validation data, including to improve cross-national comparisons; dropping lower performing items; enhanced documentation; and the addition of measures related to caregiver impact. We believe that the capacity of the HCAP to achieve its stated goals will be greatly enhanced by considering these changes and additions.

Associations of Food Insecurity and Memory Function Among Middle to Older–Aged Adults in the Health and Retirement Study

“…Thus, over time, the respondents contributing to the analyses were likely a relatively healthier sample, which could mute study estimates. In addition, the composite memory score outcome used in this analysis may produce unreliable estimates of memory function for respondents from historically marginalized racial and ethnic groups (in particular, Hispanic individuals), 31 , 66 who are also disproportionately burdened by food insecurity, which could bias study estimates in ways difficult to predict. In light of these concerns, caution is warranted in the interpretation of associations as causal.…”

Statistical harmonization of everyday functioning and dementia‐related behavioral measures across nine surveys and trials

“…Differences across measures hinder comparisons of populations across studies. To facilitate cross‐study research from studies that used differing measures, it is important to integrate different measures of everyday function and dementia‐related behaviors 10 . Data harmonization, specifically statistical co‐calibration of secondary data, is a general approach that combines data from different measures which represent a common underlying construct.…”