The Policy Environment domain explores how government policies influence key determinants of brain health across the life course. This work focuses on several key policy areas, including education policies that affect early cognitive development and lifelong learning; public health measures that affect health behaviors; physical environment policies that shape exposure to risk factors; income and benefit programs for older adults; mental health policies that address depression and access to mental health care across the life-course; and health system policies that govern how healthcare is delivered and financed. Although the focus is on US policies, there are cases in which policies from other countries can be used to understand the impact of policies on cognitive function and dementia. Studying variations in policies across jurisdictions (e.g., US states, countries, regions) and over time enable researchers to assess their impact on AD/ADRD risk factors and outcomes.
To advance this work, the Policy Environment domain focuses on identifying understudied policies, developing standardized and cutting-edge methods for policy data collection and harmonization, and creating robust analytical approaches to evaluate policy effects on dementia outcomes. The Policy Environment domain engages with policy across six main areas:
Education Policies
Education policies—such as those governing compulsory schooling, early childhood education, and access to adult learning—play a critical role in shaping cognitive development and resilience across the life course. Higher levels of educational attainment are consistently linked to better cognitive function in later life and a lower risk of dementia. Policies that extend years of schooling, select students into different educational tacks, or promote adult literacy and lifelong learning opportunities may impact cognitive function and brain health outcomes later in life.
Health Behavior and Public Health Policies
Public health policies are essential tools in dementia prevention, as they influence key behavioral risk factors. Measures such as pricing strategies to reduce consumption of tobacco, alcohol, and unhealthy foods, along with initiatives that promote physical activity, can support healthier lifestyles. Likewise, policy initiatives that encourage physical activity can support healthier lifestyles. By shaping these behaviors, public policies can help reduce the risk of cognitive decline and promote long-term brain health.
Physical Environment Policy
Policies can shape physical exposures — such as air quality, pollution levels, and access to transportation — that are increasingly recognized as important for cognitive health. These exposures can affect brain development, cognitive function, and the progression of cognitive decline over time. By addressing these factors, policies may strengthen cognitive resilience and help reduce dementia risk over the life course.
Old-Age Income and Retirement Policies
Policies that govern access to income support based on age and/or income thresholds -such as retirement or non-contributory pension programmes- can influence work decisions, income security and, indirectly, social participation, all potential risk factors for cognitive decline and AD/ADRD. By influencing income security and participation in cognitively stimulating activities, these policies can influence cognitive health and dementia risk across the life course.
Mental Health Policies
Mental health policies—such as laws that mandate insurance coverage for mental health services—can enhance access to care and ensure continuity of treatment. These policies are particularly relevant given that depression is a well-established modifiable risk factor for dementia. By supporting mental health throughout the life course, mental health policies may contribute to prevent cognitive decline and reduce overall dementia risk.
Health Systems Policies
Health system policies encompass all of the decisions, plans, and actions taken by governments to shape the organization, financing, and delivery of healthcare services. These policies can play a key role in preventing or delaying the onset of dementia and influencing dementia outcomes. For example, structured entry points in healthcare systems may facilitate early diagnosis and care coordination, while insurance coverage policies may enhance access to treatment and support services. Health system policies also offer a valuable context for studying dementia prevention, enabling researchers to assess how specific features—such as scheduled preventive visits— contribute to prevent AD/ADRD.
In the fall of 2024, the GECC hosted a series of town hall meetings with hundreds of unique participants. These meetings yielded critical insights for the Policy Environment domain, including highlighting key themes and gaps in research.
Key Themes
Gaps in Research
To address these priorities and facilitate a better understanding of the relationship between the exposome and AD/ADRD outcomes, the Policy Environment domain will use existing measures as well as develop novel measures.
Our aim is to develop common standards and guidance for the collection, harmonization, documentation, archiving, and linking of data on policies for studying the causes of AD/ADRD, using rigorous scientific tools and methods for legal mapping and policy surveillance. Based on this guidance, measures of specific policies within each priority domain will be developed.
Mauricio Avendano
University of Lausanne
Domain Lead
Clémence Kieny
University of Lausanne
Postdoctoral Fellow
McKayla Wenner
University of Southern California
Domain Coordinator
Mathéo Bourgeois
University of Lausanne
Intern
Géraldine Marks Sultan
University of Lausanne
Domain Contributor
Kelly Luo
University of Southern California
Cross-Domain Initiatives Coordinator
The GECC is funded by the National Institute on Aging (NIA) U24AG088894.
