How does migration change the way we age? AKKARE searches for answers among Kerala Americans – South first

Researchers in the United States and Kerala have joined forces for the Americans in Kerala Aging Research (AKKARE), which will examine how migration, cultural experiences, and social relationships may shape cognitive aging and dementia risk among first-generation Kerala Americans.

Published on August 16, 2026 | 1:48 pm ⚊ Updated on August 16, 2026 | 1:48 pm

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summary: A new research study conducted in the United States and Kerala tracks how immigration, culture, and social relationships may shape memory, brain health, and aging among first-generation Americans in Kerala. The AKKARE study will follow 400 older adults for up to five years, and compare 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 aging process is now the subject of major scientific study in the USA.

Researchers in the United States and Kerala have joined forces to Aging in Kerala American Research (Akari) The study will examine how immigration, cultural experiences, and social relationships may shape cognitive aging and dementia risk among first-generation Americans in Kerala.

The study plans to enroll 400 first-generation Kerala American seniors from the New York, New Jersey and Connecticut regions 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 biological and vascular markers of aging to understand the challenges and potential protective factors associated with migration and aging.

The study, funded by the US National Institutes of Health (NIH), the medical research agency of the US Department of Health and Human Services, comes at a time when basic epidemiological data on diseases of aging among American Indian immigrants remains limited.

The researchers hope that AKKARE will help identify factors that put older Americans in Kerala at greater risk for cognitive impairment, as well as those that may help them remain resilient as they age.

Read also: The “aging” state is preparing to support the elderly

Why “Akkari”?

The name AKKARE comes from Malayalam. It means “on the other side” or “on the other shore” and is commonly used in Kerala to refer to places abroad.

Akari logo

For the researchers, the word embodies the central idea behind the study, which is what happens to health and aging after crossing to another country.

AKKARE specifically looks at this question, with a particular focus on cognitive aging and dementia among first-generation Americans in Kerala.

A total of 15 researchers are collaborating on this study, which seeks to understand how immigrant experiences and cultural and social factors influence health later in life.

The principal investigator is Dr. Joe Verghese from the Department of Neurology, Renaissance School of Medicine, Stony Brook University (SUNY), USA.

The study emerged from observations that Americans in Kerala are not one unified immigrant group. The researchers identified two broad groups through interviews and their experiences with the community.

The first category includes people who moved to the United States during middle adulthood, primarily for education or work, and subsequently built their lives and grew old there. The second group consists of people who immigrated at an older age, often after retirement in India, to live with or be near their children in the United States.

The difference may be important.

Those who arrived early generally had more time to make friends, participate in community life, and learn about American culture. On the other hand, older immigrants, after retirement, may have had much less time to develop social networks and adapt to their new surroundings.

“These two immigrant groups from Kerala likely differ in their immigrant experiences and social determinants of health,” the researchers noted.

Read also: The search for an elderly care model collides with financial and social reality

Migration, culture, and cognitive aging

This question has broader significance because studies have shown that mild cognitive impairment and Alzheimer’s disease are particularly prevalent among some racial and ethnic minorities, including first-generation immigrants.

Recruitment poster for AKKARE study.

Research also suggests that immigrants can spend a greater portion of their later years living with cognitive impairment and dementia than native-born Americans.

However, migration in itself has little positive or negative impact on health.

Psychological stress, depression, age at immigration, acculturation, and strength of social relationships may influence cognitive aging.

At the same time, immigrants sometimes show better-than-expected health outcomes – a phenomenon often described as the “health migrant effect.”

Such benefits could reduce how long immigrants live in the United States, the researchers said.

There remains a significant knowledge gap about these processes among Asian Americans.

The 2021 National Institutes of Health Workshop on Asian American Populations highlighted the lack of basic epidemiological data and information on risk and resilience factors associated with diseases of aging in this rapidly growing population.

The AKKARE study aims to help address this gap among Americans in Kerala.

According to Dr. Sanesh Satyan from the Department of Molecular Biology at Kannur University, the research will examine how migratory and cultural factors, along with social relationships, influence cognitive aging. He is one of the researchers.

The study will address this issue from epidemiological, biological and vascular perspectives, looking beyond dementia itself to broader factors that may shape brain health later in life.

Read also: Aging faster, working slower

The answers AKKARE is looking for

AKKARE has three broad goals.

It seeks to identify immigrant and cultural factors—including age at immigration, length of residence in the United States, reasons for immigration, education, gender, and acculturation—that may influence the cognition, mood, and quality of life of older Americans in Kerala.

Researchers will also examine social networks, social support, coping, and resilience, including factors that may help protect cognitive health.

The second focus is biological aging. The researchers will examine whether experiences related to migration and social relationships are linked to biological aging, using biological clocks to measure how the body ages beyond a chronological age.

The third goal is to study vascular aging, including cardiovascular and cerebrovascular indicators, and compare outcomes among US participants with data from older adults in Kerala.

“Various migration-related and social factors can lead to physical and psychosocial stressors over months to years. Along with depression, apathy, anxiety and loneliness, these can lead to negative health and cognitive consequences, including Alzheimer’s disease and associated dementia,” Dr Satyan said.

The study could also shed light on the so-called “healthy migrant” effect – the possibility that some migrants may arrive healthier than the population in their country of origin but may face changing health risks as they spend more years in the host country.

The researchers will study coping and resilience mechanisms that can help maintain cognition despite these stresses.

Dr Satyan said one of the major strengths of AKKARE is that it can be compared to the Kerala Einstein Study (KES), a cohort of elderly people living in Kerala.

The comparison can help researchers understand how differences in migration, environment, culture, and social conditions reflect cognitive and biological aging.

“The proposed study has several strengths. Most notably, ours is the first study of its kind on cognition in first-generation American immigrants from Kerala, and the previous Kerala Einstein Study (KES), a cohort study of older adults residing in Kerala, will allow us to make cross-national comparisons,” said Dr. Satyan.

Recruitment for AKKARE has already begun, with around 110 participants registered so far.

“Recruitment has begun. Now we have 110 participants. The study is progressing well. Now the sample size is smaller, and preliminary conclusions have already been made. Perhaps we can come up with a preliminary report in a year or two,” Dr. Satyan added.

Participants will undergo follow-up assessments every 12 months for up to five years.

Read also: Education and marriage protect older people from cognitive decline

Kerala Study to help track the cognitive health of Americans in Kerala

The researchers said AKKARE will build on the results of a previous community-based study in Kerala to compare cognitive health between two population groups separated by migration and geography.

the from The combination will now provide a basis for comparison with the AKKARE study, which examines cognition, mood, quality of life, biological and vascular aging among first-generation American immigrants from Kerala in the United States.

The KES test, which was launched in 2008 in Kozhikode, was designed to identify risk factors and brain changes associated with motor perceptual compromise (MCR) syndrome – a condition characterized by slow gait and subjective cognitive complaints in people who do not yet have dementia or disability.

The study is particularly important because Kerala has one of the largest shares of elderly people in the country (16.5 per cent of the total population in 2021), raising concerns about the increasing burden of age-related conditions, including dementia.

Detecting cognitive decline before dementia develops could create an opportunity for early prevention and better care planning, the researchers note.

Previous KES work has also highlighted the relationship between cardiovascular health and cognitive aging.

Among the cognitively normal older adults in the group, 31% had hypertension, while ECG abnormalities ranged from 4% to 16%. Such abnormalities were more common among participants with dementia.

The researchers plan to combine MRI data from the US KES and Kerala cohorts to examine cerebrovascular disease and evaluate whether patterns of brain and vascular aging differ between populations.

AKKARE also aims to create a biorepository that can support future biological research.

Although the current goals are largely cross-sectional, the researchers propose to follow participants over time, creating a platform for future studies into the causes and progression of Alzheimer’s disease and other types of dementia.

The work could eventually extend beyond Kerala-Americans, providing a foundation for broader longitudinal studies on the health of Asian immigrants in the United States, the researchers said.

(Editing by Majnu Babu)