Alzheimer's Disease and related dementias (ADRD) resulting in cognitive epigenetic changes have been shown to be especially prevalent in populations whose environmental and epigenetic biomarkers place them at higher risk of ADRD development. Understanding the risks and trajectories of cognitive decline requires tools that can accurately capture cognitive function across diverse cultural and literacy contexts. In Malawi, where many older adults have limited formal schooling, standard cognitive assessments may reflect educational exposure, gendered social roles, or cultural familiarity with test content rather than true cognitive ability. This can introduce bias and complicate both within country and cross national comparisons. My research focuses on how cognitive assessments can be adapted to low literacy settings to distinguish between genuine cognitive ability and confounding influences. Using data from the Malawi Longitudinal Study of Families and Health (MLSFH), I examine contextual, cultural, and statistical adaptations, including adjustments for literacy, gendered social roles, and locally relevant measures of wealth and daily activities. By analyzing how these adaptations affect the measurement of cognition, I aim to contribute to ongoing efforts to harmonize cross cultural cognitive data and to improve our understanding of risk factors for cognitive adversities in Malawi’s aging population.