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medRxiv PreprintsInternational28 October 2026

Geographic Heterogeneity in the Association Between Schooling and Cognitive Change Among Older Adults in India

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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
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