# Effects of pension eligibility expansion on men’s memory decline and dementia probability: Findings from the HAALSI cohort in rural South Africa, 2014–2021

## TL;DR

This study finds that expanding pension eligibility in rural South Africa is linked to slower memory decline and lower dementia risk in men.

## Contribution

The study demonstrates a novel link between pension eligibility and cognitive health outcomes in low- and middle-income countries.

## Key findings

- Expanded pension eligibility was associated with slower memory decline in men eligible 5 years earlier (β = 0.027 SD).
- Pension eligibility was linked to a 5.2 percentage point lower dementia probability for men eligible 5 years earlier.
- Men eligible 1–4 years earlier also showed a 4.8 percentage point lower dementia probability.

## Abstract

Alzheimer’s disease and related dementias (ADRD) are a growing global health concern, with burdens projected to expand rapidly in the coming decades. Since cognitive decline typically precedes ADRD, it is crucial to identify interventions that may help slow cognitive decline and reduce ADRD risk. We used a quasi-experimental design, exploiting exogenous expansions of South Africa’s Older Persons Grant for men, to estimate its impact on memory decline and ADRD risk in the rural Mpumalanga province of South Africa. We found that expanded pension eligibility was associated with slower memory decline for men who were eligible to receive the pension 5 years earlier [β = 0.027 SD, 95% CI = 0.023, 0.031], as well as for men who were eligible to receive the pension 1−4 years earlier [β = 0.009 SD, 95% CI = 0.004, 0.013]. We also found a 5.2 percentage point lower probability of dementia for men who were eligible for pension 5 years earlier [95% CI = −0.062, −0.032] and a 4.8 percentage point lower probability of dementia for men who became eligible to receive pension 1−4 years earlier [95% CI = −0.062, −0.032]. These findings demonstrate that beyond the policy intent of cash transfers to strengthen individual and household livelihoods, an important further benefit lies in promoting healthy cognitive aging in low- and middle- income countries.