Implementation and Evaluation of the Harmonized Cognitive Assessment Protocol in an Arabic-Speaking Population: The Lebanon Study on Aging and Health (LSAHA)

The Middle East and North Africa (MENA) region is projected to experience the fastest growth in dementia burden globally, yet population-based data on cognitive aging remain scarce. We present the implementation and psychometric evaluation of a comprehensive cognitive assessment in the Lebanon Study on Aging and Health (LSAHA), the first large-scale, population-based study of cognitive aging and dementia in an Arab country. We implemented a construct-centered adaptation of the Harmonized Cognitive Assessment Protocol (HCAP), integrating culturally-relevant and field-informed adaptation and implementation procedures. The battery was administered in a large, socioeconomically and educationally diverse sample of older adults in Lebanon (n=3,027). Confirmatory factor analyses (CFA) were used to evaluate psychometric performance. CFA results demonstrated good to excellent model fit across general and domain-specific cognition. Cognitive scores showed expected trajectories across age, education, and subjective health and memory indicators. Findings were consistent with HCAP studies across multiple countries, supporting cross-national comparability. This study establishes a foundational infrastructure for cognitive aging research in Lebanon and the broader Middle-East and North Africa (MENA) region and demonstrates the feasibility and value of adapting HCAP for underrepresented populations.