To provide a comprehensive overview of the relation between risk of dementia, prevention, and migrant background, the main research question we followed for this scoping review was:

The overall aim was to identify and present research carried out to date on this research objective. To ensure a clear concept and a comprehensible implementation of the scoping review, we further formulated three more in-depth research objectives:

A scoping review was deemed appropriate to capture existing evidence and the possible breadth of research on dementia risk and prevention in individuals with a migrant background. This approach allows for the inclusion of diverse study types, which is particularly relevant given the anticipated heterogeneity in this field (Munn et al., 2018). We further aim to both synthesize existing knowledge and identify gaps in the literature.

Three databases were searched for articles and studies published until October 2025: PubMed, PsycInfo, and Web of Science. Previously, a preliminary search of PubMed, the Cochrane Database of Systematic Reviews, and JBI Evidence Synthesis was conducted. While one relevant protocol was identified on OSF in 2022, no associated publication could be found. Furthermore, we identified one published review focusing exclusively on the prevalence of dementia in the migration population (Selten et al., 2021), and another that examined selected dementia-related factors in the Australian context (Hamrah et al., 2023). To our knowledge, no comprehensive review to date has addressed both the risk and prevention of dementia in the context of migration. In the next step, a preliminary search for respective research questions was undertaken to identify potentially relevant keywords and terms for developing a final search strategy across all databases. An overview of the final search strings is listed in Supplementary Table S1. The strings for each research objective were used across all databases and were adjusted to the interface, respectively. Furthermore, gray literature was screened (OpenGrey, Bielefeld Academic Search Engine (BASE), Google Scholar, and Google) as well as reference lists of all included sources of evidence (World Health Organization, 2017).

Following a pilot screening to identify duplicates, two independent reviewers (FW, JK) screened for assessment against the inclusion criteria for the Review. Potentially relevant sources were retrieved in full for eligibility. Any uncertainties and disagreements that arose between the reviewers at each stage of the selection process were resolved through discussion with a third reviewer (ML). The results of the systematic search are presented in a PRISMA flow diagram (see Figure 1), included studies are extracted regarding key data and findings, while the content and results of included studies are synthesized and discussed.

Since risk and prevention in relation to migration background encompass a broader spectrum of possible factors, the socio-ecological model (SEM) was used to better structure the results. The SEM is widely used, among others for prevention and health promotion and classifies factors according to respective socio-ecological levels at individual, interpersonal, community, and policy levels (Kilanowski, 2017).

In order to achieve a clear structure, methodological fineness, and completeness, the PRISMA Guidelines were used (Tricco et al., 2018). The PRISMA ScR Checklist is available in Appendix. Moreover, the scoping review has been preregistered at Open Science Framework (OSF; Wittmann, 2025).

For the selection of studies, we followed the Population, Concept, and Context (PCC) framework according to Peters et al. (2022). The PCC framework enables the determination of goals and specific research questions as well as the specification of study characteristics regarding inclusion and exclusion (see Table 1).

A flow diagram of screened, retrieved, and included studies was developed (see Figure 1).

After removing duplicates, 1,027 studies were screened across all three research questions. Of the screened studies, 53 studies were then included, the majority of which related to the first research question on risk and risk factors. A detailed list including stratification for research questions, including reasons for exclusion, can be found in the flowchart in Figure 1. All included studies are listed in detail in Table 2.

In total, 39 studies were included to evaluate research question one about what is currently known about dementia risk and associated risk factors among individuals with a migration background. Of those, 15 studies were cross-sectional (Nguyen et al., 2022; Jang et al., 2021; Casanova and Aguila, 2020; Guo et al., 2022; Kindratt et al., 2024; Franco and Choi, 2020; Luo et al., 2023; Saadi et al., 2021; Fuller-Thomson et al., 2020; Moon et al., 2019; Hamrah et al., 2025a,b; Lindhout et al., 2025; Oaxaca Carrasco et al., 2025; Kim et al., 2024), 15 studies were longitudinal (Garcia et al., 2017; Wong and Soong, 2024; Kezios et al., 2023; Weden et al., 2017; Downer et al., 2018b; Zahodne et al., 2014; Vásquez et al., 2022; Tang et al., 2023; Haan et al., 2011; Kim et al., 2023; Singh et al., 2023; Tang et al., 2019; Downer et al., 2018a; Torres et al., 2020; Chen et al., 2025) with one short Pre-Post study (Daniel et al., 2024) and one study protocol (Meyer et al., 2024). Two studies used qualitative approaches (Kaki et al., 2025; Bridi et al., 2023a). Two comments on research were included (Holwerda and Hoogendijk, 2020; Prakash, 2011), one literature update (Kovaleva et al., 2021), a systematic and a perspective review (Hamrah et al., 2023; Simon et al., 2023). While 30 studies were from America, two longitudinal studies were from Canada (Fuller-Thomson et al., 2020; Singh et al., 2023), one comment was from India (Prakash, 2011), and one comment and one study were from the Netherlands (Holwerda and Hoogendijk, 2020; Lindhout et al., 2025) and one review from Australia was included (Hamrah et al., 2023). One study came from Mexico (Oaxaca Carrasco et al., 2025) and two others from Australia (Hamrah et al., 2025a,b). Study samples were more heterogeneous, but mainly focused on Individuals with a Hispanic background, mostly Mexico-related. Some studies included Asian origins, mostly people from China and just a few included other origins or foreign-born in general. Half of the studies were published in the last 3 years and only a quarter are older than 7 years with the oldest study from 2011.

On an individual level, 17 studies reported risk factors for dementia in relation to migration background. A recent study by Lindhout et al. used three different risk scores [Cardiovascular Risk Factors, Aging and Incidence of Dementia (CAIDE), Lifestyle for BRAin Health (LIBRA), and Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI)] to find that the risk scores were higher for various migrant populations than for the non-migrant population, in this case, the native Dutch population (Lindhout et al., 2025). Four studies reported age at migration as a risk factor. Respectively, among older people with a migration background, the higher the risk of developing cognitive decline. In this regard, different ages were reported: higher risk was found with migration at 50 years or older (Luo et al., 2023; Vásquez et al., 2022), also in reference to 18–34 year old immigrants and even higher compared to people who immigrated at 18 years or younger (Luo et al., 2023). One study found this effect only for women, assuming a bias due to health selectivity (Garcia et al., 2017). Education was found to mediate the association between age of migration and risk of cognitive impairment (Downer et al., 2018a). All four studies reported results of individuals with a Hispanic background. Gender as a factor of risk was taken up by three studies: One study reported higher risk for immigrated women but not for men. This was partly explained by the selection hypothesis, which indicates less positive selection of female immigrants than their male counterparts (Casanova and Aguila, 2020). A higher risk for women was also found in other studies, not linked to immigration experience (Tang et al., 2019) but mediated by education, which was not found for men (Downer et al., 2018a). Socioeconomic factors as such were reported by two studies only: it was found to be lower in migrant subgroups linked to risk of cognitive impairment (Singh et al., 2023). This makes health care access more difficult as well as health-promoting lifestyle as direct consequences (Kindratt et al., 2024).

A more frequently discussed risk factor associated with cognition was language and language proficiency (Daniel et al., 2024). Increased depression due to poorer language skills, a higher tendency to live in insular settings, or the difficulty of diagnosis due to poorer understanding are among the possible causes (Kovaleva et al., 2021). One study explicitly found that limited language proficiency mediated the association between immigration status and (undiagnosed) dementia (Franco and Choi, 2020). However, bilingualism does not appear to protect against cognitive decline, even over a period of 23 years (Zahodne et al., 2014).

Few studies were found regarding physical health. One study reported lower odds for hypertension, obesity, and hearing loss for people with a Middle Eastern or Northern African background (Kindratt et al., 2024), which was mainly supported by findings from a systematic review focused on Australia (Hamrah et al., 2023). A more frequently surveyed factor was diabetes, well-known as a risk factor for dementia, and in most studies found with a higher prevalence among people of a migration background (Vásquez et al., 2022; Hamrah et al., 2023; Kindratt et al., 2024). An association between significant tooth loss and MCI was also reported. According to the study, significant tooth loss in people with a Hispanic migration background was considered a risk factor for MCI, with a modifying effect of age at migration (Luo et al., 2023).

Mental health was addressed in several studies. The most surveyed risk factor was depression, which was found to be more prevalent in people with a migration background in general (Kindratt et al., 2024; Hamrah et al., 2023). Therefore, possible explanations are immigration as a major stressor, changes in culture, and few social interactions (Kovaleva et al., 2021). A study examining behavioral and sociocultural constructs found that stress internalization is a significant risk factor for age-associated cognitive decline, including greater perceived stress, greater hopelessness, and lower conscientiousness (Chen et al., 2025). Besides depression, anxiety was also found to be more prevalent in individuals with a Middle Eastern or North African migration background compared to white US-born people (Kindratt et al., 2024). A further risk factor for dementia that is relevant in relation to migration is social isolation. A study with Korean immigrants in America found that social isolation is associated with cognitive impairment, with loneliness as a mediator of this association (Jang et al., 2021). Furthermore, traumata and post-traumatic stress disorder (PTSD) were surveyed. Saadi et al. found both to be associated with decreased cognitive functioning in people with an Asian migration background, but not in people with a Hispanic background (Saadi et al., 2021). This is supported by a qualitative study reporting that participants with Arab, African, and Afghan migration backgrounds are convinced that stress, traumatic experiences, and mental ill-health related to their migration history are associated with dementia. Furthermore, war and experienced violence are also mentioned as affecting cognitive decline (Kaki et al., 2025).

Lifestyle factors related to migration background and dementia risk have only been studied to a limited extent. Lower odds for both smoking and alcohol consumption were found for people with a Middle Eastern or North African migration background (Kovaleva et al., 2021), whereby only lower odds of reporting alcohol consumption were found for South Asian migrants in Australia (Hamrah et al., 2025b). This was largely confirmed by the included studies in the Review of Hamrah et al. for Australia, who found obesity and alcohol consumption were a little bit lower, with smoking nearly the same or unclear across the studies, but physical inactivity was significantly higher (Hamrah et al., 2023). Overall, however, it must be noted that the factors differ greatly, much more than the regional origin (Hamrah et al., 2025a).

Migration status was also investigated, with results indicating that it is particularly relevant in relation to lifetime trajectories of SES. Among others, the number of generations since immigration is associated with the effects of cumulative deprivation on cognitive function (Haan et al., 2011). Furthermore, Moon et al. report results of immigration status as a significant moderator for the relationship between ethnicity and dementia (Moon et al., 2019).

Social aspects are an important aspect of migration and have been found in several studies. Low social cohesion was found to be a dementia risk factor by Wong et al. regarding knowing people, but more in relation to aspects of help and trust (Wong and Soong, 2024). Social isolation and loneliness were further reported as significant risk factors regarding cognitive health, whereby loneliness was found to be a potential mediator between social isolation and subjective impairment (Jang et al., 2021). Kim et al. also found a link between social isolation and cognitive health in studies of older Korean Americans, interestingly, with dietary risk as a mediator. The underlying factors named are eating alone, fewer than two meals, cooking or consumption, or not having enough money to buy food, physical difficulties obtaining food, or mouth problems (Kim et al., 2024). The importance of social participation as a key factor in dementia risk has been mentioned in other studies (Holwerda and Hoogendijk, 2020; Hamrah et al., 2023), not least confirmed by a machine learning regression with data from the Canadian Longitudinal Study, supporting the evidence of social support as a protective factor for cognitive functioning among older Chinese immigrants (Singh et al., 2023).

At the interpersonal level, there are two studies that examine the topic of dementia risk in relation to migration regarding non-migrants, the parents (Holwerda and Hoogendijk, 2020). In a first study with data from the Mexican Health and Aging study, having one or more adult children who emigrated to the US was associated with lower SES, higher depression, and greater social engagement, but no differences in odds for developing CI (Downer et al., 2018b). In a follow-up study, Torres et al. found this effect for women, but not for men, in total highlighting the migration status of family members as a highly relevant societal determinant of cognitive aging, especially in low- and middle-income countries (LMICs) (Torres et al., 2020).

At a community level, the experience of discrimination and neighborhood factors have been considered. Looking at life-course immigration, reasons for migration, acculturation, and perceived discrimination. Low levels of acculturation and perceived discrimination in particular were found to be potential risk factors for cognitive decline (Tang et al., 2023). One aspect examined several times was the neighborhood and its influence on cognition. Results suggest that while neighborhood physical disorder was significantly higher among foreign-born individuals, together with low social cohesion, neither neighborhood physical disorder nor social cohesion moderated the association between migration status and increased dementia risk (Wong and Soong, 2024). In fact, another study found that neighborhood SES was associated with poorer cognitive aging among people with migration or minority backgrounds (Weden et al., 2017). While the two studies refer to the US, a study from Denmark found that neighborhood disadvantage among refugees was not associated with dementia risk, but was associated with lower mortality (Kim et al., 2023). Finally, Goo et al. examined another aspect—living in an ethnic enclave (i.e., Chinatown). The study found that living in an ethnic enclave was a risk factor for poorer cognition, with education serving as a moderator of this effect (Guo et al., 2022).

Two studies addressed the so-called Hispanic paradox in relation to dementia and cognition. The phenomenon states that despite poorer socioeconomic factors—particularly, in this case, risk factors for dementia, such as lower education and socioeconomic disadvantage—the outcomes are not poorer. Keizos et al. find increased risk factors, but no difference in dementia risk with partwise slower decline (Kezios et al., 2023). A second study on the paradox found living in an immigrant enclave to be protective against prevalent CI among foreign-born Mexican Americans, while individual and neighborhood SES largely explained the disparities between minorities compared to US-born non-Hispanic whites (Weden et al., 2017).

Two studies examine important aspects of faith and attitudes. Faith and spirituality are particularly important for illness perception and coping strategies. Spiritual fatalism can act as a barrier, as it may hinder the understanding of illness and thus make care-seeking and preventive behavior more difficult to understand (Bridi et al., 2023a). In a subsequent study, Kaki et al. examined attitudes toward dementia among people with a migrant background. According to the qualitative study, faith and spirituality, but also trauma and anxiety, loss of self-efficacy and community support, isolation, and language barriers are relevant. At an institutional and policy level, lack of necessities, engagement with mental healthcare, and immigration policy, such as family separation and travel bans, were identified as risk factors (Kaki et al., 2025).

The second research question addresses the prevention of dementia in relation to a migration background. The content of included studies can be broken down into three major topics: attitudes and beliefs, preventive behavior, and diagnosis.

Five studies examined the role of attitudes, faith, and knowledge regarding dementia and cognitive decline (Bridi et al., 2023a,b; Daniel et al., 2024; Neter and Chachashvili-Bolotin, 2022; Tran et al., 2025). The two studies by Bridi et al. analyzed attitudes and faith using two approaches at the socioecological levels and using the Leventhal Self-Regulation Model. Attitudes toward dementia on socioecological levels included the individual level, whereas individuals were convinced that mental aspects, such as stress, traumatic history from refugee experience, but also low SES and poor health, are associated with dementia risk. Also of relevance is the community level, on which shared language, religion, and culture are of importance. In this very study, those factors were mentioned as protective, since the host country was a neighboring country. Conversely, it can be assumed that those factors may be challenging and hindering preventive behavior for host countries with different backgrounds (Bridi et al., 2023b). At the community level, two other studies can be placed: Neter et al. found differences in the attitude toward Alzheimer's disease between former Soviet Union immigrants and Palestinian Citizens in Israel based on deep-rooted differences in cultural background, mainly regarding the perception of cognitive health, but also regarding the aspect of mental illness and older people. Furthermore, they report differences between the groups in preventive behavior, attributing them to socioeconomic status and human resources. The second study by Bridi et al. examined faith and its role in both illness representation and coping procedures. An important aspect of a resume is that faith is both a hindrance and a benefit, depending on its role. It can be used wisely to build coping to prevent cognitive impairment. A study interviewing 216 Latino migrants in New York about knowledge and beliefs found an overall knowledge gap, highlighting the potential for educational intervention, including cultural competency in healthcare (Tran et al., 2025). Finally, regarding attitudes and knowledge, the language scores for the host language and education were associated with knowledge of Alzheimer's disease. This was significantly improved by a single educational intervention with a faith-based health educator (Daniel et al., 2024). Another intervention was based on community engagement and dissemination with Korean American migrants. Here, effects were achieved in terms of knowledge, attitudes, and behavior. One difference here was whether people participated in person or only online, with the culturally tailored program ultimately being highlighted (van Ta Park et al., 2025).

Taken together, these studies suggest differences in attitudes and faith regarding cognitive health and preventive behavior across different cultural backgrounds. However, while it partially hinders examination and perception of cognitive health, spiritual practices can be used to build resilience and target prevention strategies related to this background.

Regarding preventive behavior, four of the included studies contribute: Neter et al. found a strong correlation between Internet use and knowledge toward Alzheimer's disease and preventive behavior. Building knowledge about AD, including risk factors, needs to take into account cultural attitudes, but by doing so, the promotion of dementia risk reduction is possible (Neter and Chachashvili-Bolotin, 2022). This was done in a study with Afro-Caribbeans living in a rural area in the USA. The pre-post study showed a significant increase in knowledge about AD and prevention after a single intervention, which consisted of a review and discussion of the participants' basic knowledge about AD with a faith-based health educator, including health-promoting factors such as social engagement, exercises, managing diabetes, and hypertension (Daniel et al., 2024). Two study protocols with similar ideas were found. The first protocol by Teixeira-Santos et al. describes a planned two-armed intervention with one a health-promoting program and a mindfulness-based stress reduction program over 8 weeks with migrant individuals (Teixeira-Santos et al., 2023). A second protocol describes the MIND-PRO (The Mobile Health (mHealth) Intervention for Dementia Prevention through lifestyle Optimization), a self-managing lifestyle modification intervention including remote coaching for participants with lower socio-economic status and/or migration background (van der Endt et al., 2025). No results were found yet. Completing a review of Adult Day Service Centers (ADS) is to name, which mentions cognitive health and dementia only in passing. Nevertheless, ADS were effective in supporting individual's health most effectively by culturally based components. The use and efficiency differed by functional impairment, gender, and degree of loneliness. ADS are therefore relevant for primary prevention of dementia, as they address the psychosocial needs of individuals. ADS enable social participation, integrating individuals into social structures, and ensure healthy nutrition and physical activity. Important for participation were transportation, bilingual nurses, peer support, and cultural activities (Sadarangani and Murali, 2018).

What stands out is a theoretical review about the design and implementation of culturally safe dementia risk reduction strategies for immigrant and ethno-culturally diverse women. None of the included 17 studies focused on women only, a group at enhanced risk due to multiple interacting factors, compared to men. However, based on the evidence, the authors recommend focusing on in-person meetings, including didactic lectures and interactive discussions, using videos and follow-up materials, and participants' first language. Furthermore, involving representatives from a community and using community organizations can be beneficial to improve dementia knowledge (Iziduh et al., 2025).

Additionally, one study examined diagnosis from the perspective of General Practitioners, which is crucial for secondary prevention. Almost all participants who answered the questionnaire reported barriers at least once in diagnosing dementia for individuals with a migrant background (96%). Most common reasons were uncertainties, language barriers, and information deficits in patients, as well as a lack of acceptance and shameful interactions (Tillmann et al., 2019).

There was hardly any evidence about risk, risk factors, or prevention of dementia for more marginalized individuals with a migrant background, such as asylum seekers, undocumented and irregular migrants, and refugees. Two studies were initially included (Simon et al., 2023; Hamrah et al., 2023). Both studies are reviews, and neither reports results for the group of interest. In the review by Hamrah et al., the terms refugees, asylum seekers, and migrants were used interchangeably without further stratification. Only two of the included studies of the review report results regarding asylum seekers, indicating a higher prevalence of depression (Lies et al., 2019; Silove et al., 2007). The perspective review by Simon et al. raises ambiguity about the inclusion of undocumented individuals in the term migrants, making it harder to analyze the diverse life situations of individuals with a migrant background. One study certainly focuses on undocumented migrants in the U.S., but after returning to Mexico as their country of origin. Undocumented migrants were classified as not being reported as permanent residents or citizens, and not being reported as contributing to the U.S. Social Security system or having a Social Security number. This was found to be a risk factor due to migration experience, especially when working in the informal sector after return (Oaxaca Carrasco et al., 2025). According to a situation, implementation is seen differently as well. The authors stressed that there is an urgent need to include and focus on undocumented people, in this case, undocumented Brazilians living in the US (Simon et al., 2023).

Conducting this scoping review, we provide a double-screened synthesis of peer-reviewed literature on the risk and prevention of dementia in migrant populations, in the hopes of supporting future research targeting risk factors that may be higher in migrant populations and of implementing targeted and effective prevention. To our knowledge, this is the first scoping review to combine risk and prevention for dementia in relation to migration background. In doing so, however, there are some limitations, some of which are content-related. First, we did not assess the methodological quality of the risk-of-bias assessment of the included studies. However, this is typical for a scoping review and is based on the wide range of study types (Peters et al., 2022). Second, following this argument, there was significant heterogeneity of study designs, populations, and definitions of “migrant background,” which limits the comparability of findings, as already discussed. Third, our search was restricted to English- and German-language publications, excluding relevant studies in other languages, which is particularly relevant given the topic. Furthermore, a majority of the included studies were conducted in the US, with a strong focus on individuals of Hispanic background. This limits the universality of findings to other migrant populations, particularly in Europe. Finally, some studies highlighted challenges in ensuring the cultural and linguistic appropriateness of research instruments or procedures. These challenges may affect the validity of both risk and outcome measurements in migrant populations or might lead to selection biases.