Rural Context and Cognitive Health: A Scoping Review of Non-Modifiable and Modifiable Factors in Aging Populations

Background Cognitive health in rural aging populations is influenced by a complex interplay of nonmodifiable and modifiable risk factors. Objective This scoping review conducted using the Arksey & O’Malley framework and reported with PRISMA-ScR provides a structured synthesis of existing literature, offering a comprehensive examination of cognitive health determinants in rural environments worldwide. Eligibility Included studies were English-language, peer-reviewed articles on cognitive health in rural adults aged 50+ and relevant risk factors sourced from different databases. Results Systemic determinants, including educational attainment and living environment, significantly shape cognitive reserve, with lower education levels and rural residency linked to higher cognitive impairment risk. Socioeconomic disparities, such as income inequality and limited healthcare access, further exacerbate cognitive decline. Additionally, environmental exposures, including pesticides, alcohol consumption, and smoking, pose additional risks, particularly in rural populations with limited regulatory oversight and healthcare access. Health conditions such as vascular disease, brain injury, diabetes, obesity, and dementia contribute to cognitive decline. Lifestyle and daily habits, including sleep quality, nutrition, physical activity, and functional independence, play crucial roles in cognitive resilience. Psychological factors, particularly mental health conditions, depression, and social isolation, are strongly associated with cognitive decline, emphasizing the need to prioritize mental well-being in aging populations. Finally, cognitive and social engagement emerged as a protective factor, with intellectual stimulation, social participation, and volunteerism contributing to better cognitive outcomes. Conclusion These findings underscore the urgent need for targeted interventions aimed at reducing modifiable risk factors and promoting protective lifestyle behaviors, particularly in underserved rural communities. (246 words)