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Health Literacy and Cognitive Function among Middle-Aged Adults: The MidCog Study


08/15/2021 – 04/30/2026

Funding Source:

National Institute on Aging (NIA)

Grant Number:



Middle Age is an influential, understudied life stage often omitted from adult development and aging research. This period of life is when age-related diseases start to emerge and meaningful cognitive changes start to occur. Coupled with the unique life demands placed on middle-aged adults, the trajectory for cognitive decline and the aging process may start earlier in the life course than previously understood. This study aims to identify unique characteristics of middle-aged adults tied to lifestyle and self-management that may inform and mitigate adverse health outcomes, particularly Alzheimer’s disease, and related dementias, in later life. A more in-depth understanding of these factors may inform the design of individual and systems-level health interventions targeting behavior change in mid-life.


The objective of the MidCog study is to investigate how health literacy (HL), self-management (SM) skills, and psychosocial factors may evolve over the adult life course and affect cognitive and health outcomes in older age. We will do this by recruiting a cohort of 1200 middle-aged adults to begin novel investigations of less-studied, modifiable, midlife determinants of later-life cognitive impairment, specifically targeting psychosocial factors in midlife that might independently affect health status and cognitive function in middle age, or plausibly offset the consequences of limited health literacy and self-management skills.

 Participants will complete a 4-hour comprehensive biopsychosocial battery, comprised of two encounters with certified research coordinators involving a full cognitive battery, physical health assessments, and lifestyle, mental health, and social support questions. We will align our methods to an existing active study of older adults (Health Literacy and Cognitive Function among Older Adults (‘LitCog’); R01AG030611; NUIRB# STU00026255) to explore age-related associations of cognition, HL, SM skills, healthcare utilization and health outcomes among patients ages 35 to 90 years old.

Our specific aims and hypotheses (H) are to:

Aim 1 Characterize HL, SM skills, and cognitive function in detail among middle-aged adults.

Aim 2 Evaluate associations between HL, SM skills, health behaviors, healthcare use, health status, chronic disease outcomes, and cognitive function over time among middle-aged adults.
  • H1 Limited HL will be associated with inadequate SM skills; both will be associated with lower uptake of recommended health behaviors, infrequent healthcare use, worse health, and poorer cognitive function.
  • H2 Presence of uncontrolled chronic conditions, sensory impairments, physical inactivity, obesity, excess drug/ alcohol use, perimenopause, depression, stress & poor sleep will be associated with poorer cognition.
  • H3 Among middle-aged adults with ≥1 chronic condition, poor treatment adherence, infrequent healthcare use, and worse health outcomes will mediate associations between HL, SM skills, and cognitive function.
Aim 3 Investigate whether certain modifiable, psychosocial factors (health activation, treatment burden, social support) moderate associations between HL, SM skills, health status & cognitive function.

Aim 4 Using MidCog + LitCog data, explore associations between age, HL, SM skills, health status, presence & management of chronic disease, and cognitive function among adults ages 35 to 90. identifier:



Principal Investigators: Michael S. Wolf, PhD MPH
Project Lead: Pauline Zheng, MPH


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