Objective:

Our study assessed cognitive health among adults older than 50 years old in Shawi Indigenous communities of the Peruvian Amazon.

Background:

Indigenous populations in the Amazon have historically been excluded from health research, limiting available cognitive data. In the Peruvian Amazon, Shawi communities face major barriers to healthcare access due to language isolation, geographic remoteness, poverty, and the impacts of climate change.

Design/Methods:

We conducted a cross-sectional study in 40 Shawi villages in Loreto, Peru, enrolling 431 adults aged ≥50 years between November 2023 and February 2024. Our instruments were culturally adapted and translated into Shawi through forward-backward translation, expert review, and pilot testing. Cognitive performance was assessed using the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) and the Bolivian version of the Modified Mini-Mental State Examination (3MS). A subsample (n=196) of participants underwent a neurological examination by a specialist.

Results:

The median participant age was 59 years; 54.5% were female, 70% had no formal education, and about two-thirds were Shawi monolingual speakers. The prevalence of mild cognitive impairment and dementia was estimated in 11.8% and 1.9%, respectively. Lower cognitive scores were associated with depression and anxiety symptoms (p<0.05), lower functionality (p<0.001), lower BMI(p<0.001), and being monolingual (p<0.001). Our multilinear regression showed lower cognitive scores among females (β = –0.30, 95% CI: –0.45 to –0.16; p<.001) and those with less education (β = 0.13, 95% CI: 0.10 to 0.16; p<.001). Both sex and education explained 16% of cognitive scores’ variance.

Conclusions:

This is the first study to assess cognition in a predominantly monolingual Indigenous population in Peru. Findings highlight the role of social determinants of health in cognitive outcomes, and underscore the need for culturally tailored tools and interventions to address cognitive health and increase access to care in Indigenous Amazonian communities.