Rapid naming tests are widely used to detect early cognitive impairment, yet naming performance reflects not only brain health but also lifelong language and sociocultural experience. One important but understudied question is whether rural living experience influences rapid naming performance.

To address this question, we developed the Chinese Rapid Naming Test (RNT-C) through a collaboration between Shandong University and the University of California, San Francisco. We evaluated 93 cognitively healthy Chinese adults aged 50 years and older and quantified rural living experience as the proportion of lifetime spent in rural environments.

We found that greater rural living experience was independently associated with poorer rapid naming performance, including slower naming speed, fewer correctly named items within the first minute, and lower naming accuracy. These associations remained significant after adjustment for demographic, socioeconomic, and cognitive factors. In contrast, no independent association was observed with Design Fluency, and the association with MMSE was attenuated after adjustment. Education neither mediated nor moderated these relationships.

These findings remind us that language-based cognitive tests are influenced not only by neurocognitive function but also by lifelong environmental experiences. Future normative studies should better represent populations with diverse sociocultural backgrounds to improve the interpretation of cognitive assessment.