Published Aug 16, 2026 | 1:48 PM ⚊ Updated Aug 16, 2026 | 1:48 PM
Researchers will seek to understand both the challenges and potential protective factors associated with migration and ageing. (iStock)
Synopsis: A new US-Kerala research study is tracking how migration, culture and social ties may shape memory, brain health and ageing among first-generation Kerala Americans. The AKKARE study will follow 400 older adults for up to five years, comparing them with people in Kerala to understand what puts migrants at risk and what helps them age well.
For a community that has carried Kerala’s culture, memories and family ties across continents, the ageing process is now becoming the subject of a major scientific study in the United States of America.
Researchers in the US and Kerala have joined forces for the Ageing in Kerala Americans Research (AKKARE) study, which will examine how migration, cultural experiences and social relationships may shape cognitive ageing and dementia risk among first-generation Kerala Americans.
The study plans to enrol 400 older first-generation Kerala Americans from the New York, New Jersey and Connecticut tristate area and follow them at 12-month intervals for up to five years.
Researchers will look beyond memory and cognition, assessing mood, quality of life and markers of biological and vascular ageing to understand both the challenges and potential protective factors linked to migration and ageing.
Funded by the US National Institutes of Health (NIH), the medical research agency of the US Department of Health and Human Services, the study comes at a time when basic epidemiological data on diseases of ageing among Indian American immigrants remain limited.
Researchers hope AKKARE will help identify the factors that place older Kerala Americans at greater risk of cognitive impairment, as well as those that may help them remain resilient as they age.
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The name AKKARE comes from Malayalam. It means “on the other bank” or “on the other shore” and is commonly used in Kerala to refer to overseas places.
The logo of AKKARE
For the researchers, the word captures the central idea behind the study — what happens to health and ageing after crossing over to another country.
AKKARE is looking at precisely that question, with a particular focus on cognitive ageing and dementia among first-generation Kerala Americans.
A total of 15 researchers are collaborating for the study, which seeks to understand how immigrant experiences and cultural and social factors influence health in later life.
The principal investigator is Dr Joe Verghese of the Department of Neurology, Renaissance School of Medicine, Stony Brook University (State University of New York), US.
The study has emerged from observations that Kerala Americans are not a single, uniform immigrant population. Researchers identified two broad groups through interviews and their experiences with the community.
The first comprises people who moved to the United States during middle adulthood, mainly for education or employment, and subsequently built their lives and aged there. The second consists of people who migrated at an older age, often after retirement in India, to live with or be near their children in the US.
The difference may be important.
Those who arrived earlier generally had more time to establish friendships, participate in community life and become familiar with American culture. Older, post-retirement migrants, on the other hand, may have had considerably less time to develop social networks and adapt to their new surroundings.
“These two immigrant groups from Kerala likely vary in migrant experiences and social determinants of health,” the researchers noted.
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The question has wider significance because studies have shown that mild cognitive impairment and Alzheimer’s disease are particularly prevalent among some racial and ethnic minority populations, including first-generation immigrants.
A recruitment poster of AKKARE study.
Research has also suggested that immigrants can spend a greater share of their later years living with cognitive impairment and dementia than native-born Americans.
Migration itself, however, does not have a simple positive or negative effect on health.
Psychological stress, depression, age at migration, acculturation and the strength of social relationships may influence cognitive ageing.
At the same time, migrants sometimes show better health outcomes than expected — a phenomenon often described as the “healthy migrant effect.”
Such advantages, researchers said, can diminish the longer immigrants live in the US.
A major knowledge gap remains about these processes among Asian Americans.
A 2021 National Institutes of Health workshop on the Asian American population highlighted the lack of basic epidemiological data and information on risk and resilience factors associated with diseases of ageing in this rapidly growing population.
The AKKARE study aims to help address that gap among Kerala Americans.
According to Dr Sanish Sathyan of the Department of Molecular Biology, University of Kannur, the research will examine how immigrant and cultural factors, along with social relationships, affect cognitive ageing. He is one of the researchers.
The study will approach the issue from epidemiological, biological and vascular perspectives, looking beyond dementia itself to the broader factors that may shape brain health in later life.
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AKKARE has three broad objectives.
It seeks to identify immigrant and cultural factors — including age at migration, duration of residence in the US, reasons for migration, education, sex and acculturation — that may influence cognition, mood and quality of life in older Kerala Americans.
Researchers will also examine social networks, social support, coping, and resilience, including factors that may help protect cognitive health.
A second focus is biological ageing. The researchers will examine whether migration-related experiences and social relationships are associated with biological ageing, using biological clocks to measure how the body is ageing beyond chronological age.
The third objective is to study vascular ageing, including cardiovascular and cerebrovascular indicators, and compare findings among the US participants with data from older adults in Kerala.
“Various migration- and social-related factors can lead to physical as well as psychosocial stresses over months to years. Along with depression, apathy, anxiety and loneliness, these can result in adverse health and cognitive consequences, including Alzheimer’s disease and related dementias,” Dr Sathyan said.
The study could also shed light on the so-called “healthy migrant” effect — the possibility that some migrants arrive with better health than the population in their country of origin but may face changing health risks as they spend more years in the host country.
Researchers will examine coping and resilience mechanisms that could help preserve cognition despite these pressures.
Dr Sathyan said one major strength of AKKARE is that it can be compared with the Kerala Einstein Study (KES), a cohort of older adults living in Kerala.
The comparison could help researchers understand how differences in migration, environment, culture and social circumstances are reflected in cognitive and biological ageing.
“The proposed study has several strengths. Most notably, our study is a first-of-its-kind study of cognition in first-generation Kerala American immigrants, and our previous Kerala Einstein Study (KES), a cohort study of older adults residing in Kerala, will allow us to make cross-national comparisons,” Dr Sathyan said.
Recruitment for AKKARE has already begun, with about 110 participants enrolled so far.
“Recruitment started. Now we have 110 participants. The study is progressing well. Now the sample size is smaller, and initial inferences have already been made. Maybe in one or two years we could come out with an initial report,” Dr Sathyan added.
Participants will undergo follow-up assessments every 12 months for up to five years.
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The researchers said AKKARE will draw on findings from an earlier community-based study in Kerala to compare cognitive health across two populations separated by migration and geography.
The KES cohort will now provide a basis for comparison with the AKKARE study, which is examining cognition, mood, quality of life and biological and vascular ageing among first-generation Kerala American immigrants in the US.
The KES, launched in 2008 in Kozhikode, was designed to identify risk factors and brain changes linked to motoric cognitive risk syndrome (MCR) — a predementia condition marked by slow gait and subjective cognitive complaints in people who do not yet have dementia or disability.
The study is particularly relevant as Kerala has one of the country’s largest shares of older adults (16.5 per cent of the total population in 2021), raising concerns over a growing burden of age-related conditions, including dementia.
Researchers have noted that detecting cognitive decline before dementia develops could create an opportunity for early prevention and better care planning.
The earlier KES work has also highlighted the link between cardiovascular health and cognitive ageing.
Among cognitively normal older adults in the cohort, 31% had hypertension, while ECG abnormalities ranged from 4% to 16%. Such abnormalities were more common among participants with dementia.
Researchers plan to combine MRI data from the KES and Kerala American cohorts to examine cerebrovascular disease and assess whether patterns of brain and vascular ageing differ between the populations.
AKKARE is also intended to create a biorepository that can support future biological research.
Although the current objectives are largely cross-sectional, investigators propose following participants over time, creating a platform for future studies into the causes and progression of Alzheimer’s disease and other dementias.
The researchers said the work could eventually extend beyond Kerala Americans, providing a foundation for broader longitudinal studies of the health of Asian immigrants in the United States.
(Edited by Majnu Babu).
