INTRODUCTION
In South Korea, due to rapid population aging, the number of older adults with dementia is expected to reach 3.15 million in 2050, an increase of 15.9% compared to the present. As of 2021, out of 8.58 million older adults aged 65 and above, about 890,000 (10.4%) have dementia, and about 2.04 million (22.7%) have mild cognitive impairment (MCI) [1]. In 2021, the national cost of dementia care was KRW 18.7 trillion, accounting for about 0.9% of the gross domestic product (GDP), and this number has gradually increased over the past 6 years, with the cost of dementia care per person increasing by about 5% and the national cost of dementia care increasing by 31.9% [1]. This not only increases the social and economic burden of care but also weakens the caregiving function of families, increasing the demand for organized services according to the disease stage and care needs [2].
Because dementia is an irreversible disease characterized by degenerative changes in the brain, it is important to identify the stage of cognitive change in older adults with MCI and maintain cognitive function to prevent in progressing to dementia. MCI is an intermediate stage between normal cognition and dementia, where there is no functional impairment in daily life; however, objective cognitive decline has been reported [3]. The transition rate from normal cognition to dementia in older adults is 1% to 2%, the likelihood of transitioning from MCI to dementia is as high as 10% to 15%, and the transition rate from MCI to Alzheimer’s disease in older adults is 12% within 1 year and 80% within 6 years, indicating rapid progression with age [4]. Recent studies have shown that only 18% to 24% of older adults with MCI return to normal cognition, indicating that early prevention of MCI is crucial [5]. Therefore, early detection of cognitive changes in older adults, identification of risk factors, and ongoing management are important to prevent dementia [5]. Previous international studies have shown that the factors associated with MCI and dementia are similar, including sex, age, education, marital status, and smoking [6], and that managing risk factors such as alcohol consumption, obesity, and physical inactivity can prevent or delay the progression to dementia by up to 40% [7]. A study analyzing data from the Korean Longitudinal Study of Aging (KLoSA) found that demographic characteristics, such as age and subjective socioeconomic status, as well as the number of social activities, such as participation in volunteer activities and activities of daily living (ADLs), were the main predictors of dementia among older adults with MCI [8].
Recently, active social engagement and cognition have been shown to prevent dementia and improve cognitive function in older adults with MCI. The importance of non-pharmacological programs has also been observed [9]. A Korean study on the effects of a community-based non-pharmacological program on cognitive function and subjective memory in older adults with MCI reported a 2.13 point increase in cognitive function and a 3.53 point decrease in subjective memory decline in the participants of a cognitive stimulation program (36 sessions, three times a week for 3 months) [10]. Participation in a non-pharmacological program for older adults with MCI has also been shown to improve cognitive and daily life functioning, reduce behavioral problems, and improve quality of life [11].
As early diagnosis and management of risk factors are recognized as important for preventing the progression of dementia in older adults with MCI, longitudinal studies are needed to examine the risk factors for cognitive changes. However, most previous studies on factors related to dementia progression in older adults with MCI were cross-sectional correlational studies or studies conducted at a later time point after diagnosis rather than immediately after diagnosis, limiting the ability to identify cognitive changes and changes in related factors from the time of diagnosis [12].
To reduce the burden on individuals and society by offering support for dementia treatment and management at the national level, the government introduced the Dementia Management Act in 2012 and built a nationwide dementia care centers to establish the foundation for early dementia screening and management system [1]. These care centers provide prevention and management services according to the cognitive status of older adults residing in a community. The services include regular check-ups, non-pharmacological programs, and ADL-related education for dementia prevention after MCI diagnosis. Therefore, it is important to secure basic data on post-diagnosis cognitive changes and use of dementia management services of older adults with MCI using a longitudinal study design.
Therefore, based on population-level data from the Seoul Dementia Management Project over a 3-year period, this current study analyzed the utilization of dementia management services by older adults with MCI and dementia, and factors related to the development of dementia, such as demographic characteristics, health habits, and participation in non-pharmacological programs. The findings of these analyses would help develop national and local dementia management policies, nursing interventions for older adults with MCI, and dementia prevention strategies.
This study analyzed data from the Seoul Dementia Management Project to examine the cognitive changes and factors related to dementia progression among older adults with MCI in a local community. The study objectives are as follows.
• To compare the changes in cognitive function between groups of MCI maintenance and progression to dementia in older adults with MCI over 3 years.
• To compare demographic characteristics, health status, health behavior characteristics, and utilization of dementia-preventive care services between groups of MCI maintenance and progression to dementia in older adults with MCI over 3 years.
• To examine factors associated with progression to dementia in older adults with MCI.
METHODS
Ethic statement: This study was conducted after the Institutional Review Board (IRB) of Hanyang University approved an exemption from review (IRB no. HYUIRB-202204-020). Obtaining informed consent was exempted by the IRB because this study was secondary data analysis of the existing data.
1. Study Design
This retrospective longitudinal study analyzed data registered in the Dementia Management Project database, specifically data from a dementia care center in the northeastern region of Seoul for the period January 2016 to December 2018. This study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines (http://www.strobe-statement.org/).
2. Study Participants
The study participants who registered in the online database of the Dementia Management Project in Seoul from January 1, 2016 to December 31, 2018, were selected. They had provided consent for the use of their personal information. Those registered older adults were directly contacted through the national dementia early screening project and health center visiting project. If the participants were unable to visit the dementia care centers in person, the screeners visited the participants’ homes, welfare centers, senior centers, and so on. The screeners conducted the dementia screening including basic tests and provided diagnoses of MCI or of progression from MCI to dementia. As of January 1, 2016, a total of 1,421 people were diagnosed with MCI. Of those people, 46 had recovered and went back to normal as of December 31, 2018. Among the remaining 1,375 individuals, 1,141 continued to have MCI and 234 transitioned to dementia.
3. Measurements
In this study, the variables were defined based on the items of the basic information and enrollment survey for the dementia management project.
1) Demographics
Demographic characteristics were based on information from the 2016 baseline and enrollment surveys, including age, sex, years of education, type of medical coverage, and living arrangements. Age was defined as 60 years old or older in 2016. Sex was categorized into male and female; years of education were measured by the number of years of actual education; medical coverage was categorized into general and medical care I and II; and living arrangements were categorized as living alone or living with family members.
2) Health Status and Health Behavior
The variables of health status and health behavior were based on responses from the 2016 baseline and enrollment surveys, including body mass index (BMI), history of alcohol consumption, smoking, and exercise. BMI was calculated by weight and height. Weight and height were measured using weight scales and stadiometers provided at the dementia care center, and portable scales and stadiometers were used during home visits. BMI of 18.4 kg/m2 or less is categorized as “underweight,” 18.5~22.0 kg/m2 is “normal weight,” 23.0~24.9 kg/m2 is “overweight,” and 25.0 kg/m2 or more is considered “obese” based on the standards of the Asia-Pacific region and the Korean Society of Obesity. History of alcohol consumption was categorized as “never drinking,” “current drink,” or “stop drinking.” Smoking was categorized as “never smoking,” “current smoking,” or “stop smoking.” Exercise was collected by interviewing subjects who answered “yes” or “no” to the question, “Do you usually engage in regular exercise or activity at least once a week?”
3) Utilization of Dementia-Preventive Care Service
Utilization of the dementia preventive care services were assessed by the numbers of regular check-ups and participation in non-pharmacological programs, and participation in education for improving ADLs. Those services were available at dementia care center during the 3-year period ending December 31, 2018, for those diagnosed with MCI as of January 1, 2016. Regular check-ups were counted as one visit only if the detailed examination for dementia were completed. The non-pharmacological program conducted by an occupational therapist at the dementia care center was a multimodal program consisting of gardening, occupational, music, and art therapy. In data analysis, participants were divided into those who participated in eight or more sessions and those who participated in less than eight sessions during 3 years after MCI diagnosis. The cutoff of the eight sessions was determined based on the operational criteria for cognitive enhancement programs in the guidelines for dementia management of the Ministry of Health and Welfare in Korea [13]. The ADL-related education was a 120-minute program (four sessions) with weekly sessions conducted by a nurse at the dementia care center. The program focused on ADL such as eating, personal hygiene, and using the community. Only those who participated in all four sessions were classified as having attended the ADL-related education.
4) Changes in Cognitive Function
For changes in cognitive function, the study sample was divided into two groups: those who were diagnosed with MCI as of January 1, 2016, and maintained to have MCI for 3 years and those who transitioned to dementia during the same period. The dementia screening process consisted of screening and a detailed examination. The screening was performed using the Mini-Mental State Examination-Dementia Screening (MMSE-DS). Screening was conducted by nurses who specialized training in dementia and had been systematically trained for performing the screening. After screening, participants were categorized as cognitively impaired if their sex-, age-, and education-adjusted z-scores were less than -1.5 standard deviations from the mean; those categorized as cognitively impaired were referred to the next step process called detailed examination for dementia. First, detailed examination was administered by a nurse or clinical psychologist who trained to administer the neuropsychological test using the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease-Korean [13]. The second stage of detailed examination was performed by a physician at the dementia care center according to the criteria of the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer’s Disease and Related Disorders Association [14].
4. Data Collection
Data on the MCI group entered in the online database of the Seoul Dementia Management Project from January 1, 2016, to December 31, 2018, was obtained from the jurisdictional public health center by requesting.
5. Data Analysis
Frequency and descriptive statistics were conducted to identify the characteristics of the study participants. The chi-squared tests and independent t-tests were conducted to determine whether there was a difference in the characteristics of the study subjects between MCI-maintained and dementia transition groups. Logistic regression analysis was conducted to identify the factors relating to progression to dementia. SPSS ver. 26.0 (IBM Corp.) was used for the statistical analysis.
6. Ethical Considerations
This study was conducted after the Institutional Review Board (IRB) of Hanyang University approved an exemption from review (IRB no. HYUIRB-202204-020). This study analyzed data from online databases of dementia management projects in Seoul as a secondary source. The data were downloaded in anonymized form after obtaining approval from the jurisdictional public health center to use the data. The data used in this study were not used for any purpose other than research for meeting the study objectives. In addition, the data were not altered or manipulated to achieve the expected results during the data analysis process and were kept in a designated office and computer to ensure confidentiality and anonymity to protect personal information, and only the first author accessed the data.
RESULTS
1. General Characteristics
The general characteristics of the participants at baseline in January 2016 are presented in Table 1. The mean age was 76.78±7.25 years, with 446 males (32.4%) and 929 females (67.6%). Regarding number of years of education, 257 (18.7%) had 0 years, 491 (35.7%) had 1 to 6 years, 523 (38.0%) had 7 to 12 years, and 104 (7.6%) had 13 or more years. In terms of medical coverage, 1,121 (81.5%) were general, 251 (18.3%) had medical care I and II, and for the remaining 3 (0.2%), the information was missing. In terms of living arrangement, 419 (30.5%) were living alone, 952 (69.2%) were living with family members, and for the remaining 4 (0.3%), the information was missing. According to BMI, 84 (6.1%) were in the underweight group, 574 (41.7%) in the normal weight group, 324 (23.6%) in the overweight group, and 317 (23.1%) in the obese group; 76 (5.5%) showed no information. Regarding the history of alcohol consumption, 980 (71.3%) had never drunk in their lifetime, 221 (16.1%) were current drinker, 169 (12.3%) drank in the past but had stopped now, and 5 (0.4%) showed no information (missing). Regarding smoking, 1,087 (79.1%) had never smoked, 79 (5.7%) were current smokers, 205 (14.9%) smoked in the past but had stopped now, and 4 (0.3%) gave no information. Regarding exercise, 732 participants (53.2%) did not exercise, 628 (45.7%) had engaged in regular exercise at least once a week, and for 15 (1.1%) the data was missing.
2. Changes in Cognitive Function and Utilization of Dementia-Preventive Care Service After 3 Years
Changes in cognitive function and characteristics of the participants’ use of dementia preventive services over 3 years are shown in Table 2. In terms of changes in cognitive function, 1,141 participants (83.0%) maintained to have MCI, and 234 (17.0%) developed dementia. The mean number of regular check-ups using neuropsychological tests was 1.20±0.43. Regarding participation in non-pharmacological programs during 3 years, 1,201 (87.3%) participated in fewer than eight times and 174 (12.7%) in more than eight times. Furthermore, only 173 (12.6%) individuals attended the total four sessions of ADL-related education programs while 1,202 (87.4%) participated in less than 4 sessions categorized as no attendance.
3. Differences in Characteristics Between the MCI Maintenance Group and Dementia Transition Group
Differences in baseline characteristics between the MCI maintenance and dementia transition group are shown (Table 3). Age was significantly different: the mean age in the MCI maintenance group was 76.31±7.40 years and that in the dementia transition group was 79.09±5.98 years (t=-6.19, p<.001). Physical exercise was significantly different in the MCI maintenance group, with 52.6% “no” exercising and 47.4% engaging in regular exercise compared to 59.7% “no” exercising and 40.3% engaging in regular exercise in the dementia transition group (χ2=3.92, p=.048), indicating that the MCI maintenance group was more likely to exercise. The mean number of regular checkups was 1.16±0.40 for the MCI maintenance group and 1.34±0.51 for the dementia transition group indicating statistically significant difference (t=-5.93, p<.001). Participation in non-pharmacological programs was also significantly different. In the MCI maintenance group, 13.1% participated eight or more times, and in the dementia transition group, 10.7% participated eight or more times (χ2=60.65, p<.001). Participation in ADL-related education was significantly different between the MCI maintenance group (87.3% no, 12.7% yes) and the dementia transition group (88.0% no, 12.0% yes) (t=2.93, p=.030).
4. Factors Influencing Transition From MCI to Dementia
Logistic regression analysis was conducted to identify the factors influencing dementia transition. The Hosmer and Lemeshow test showed that the regression model was a good fit (χ2=12,183, p>.05), with an explanatory power of 6.1% (Cox & Snell’s R2=.061).
The significance of the regression coefficients showed that each additional year of age was associated with approximately 1.06 times the odds of developing dementia (95% CI=1.04~1.09, p<.001), while not exercising was associated with 1.42 times the odds of developing dementia compared to those who did (95% CI=1.04~1.93, p=.026). Participation in non-pharmacological programs was also found to have a statistically significant effect on the likelihood of developing dementia, with those who participated in fewer than eight times being 4.17 times (95% CI=2.05~8.49, p<.001) more likely to develop dementia compared to those who participated in eight or more times. Furthermore, those who did not attend ADL-related education were 1.05 times (95% CI=1.02~1.26, p<.001) more likely to develop dementia compared to those who attended all four ADL education sessions (Table 4).
DISCUSSION
This study focused on community-dwelling older adults diagnosed with MCI, and compared those who maintained MCI for 3 years with those who transitioned to dementia to determine the rate of dementia transition and factors associated with dementia transition. First, the transition rate to dementia is as follows: among 1,375 older adults diagnosed with MCI through an early dementia screening in the community, 83.0% (1,141 people) remained with MCI for 3 years, and 17.0% (234 people) transitioned to dementia. A longitudinal study of cognitive changes over 8 years in older adults with MCI aged 55 years or older enrolled in a dementia clinic in Switzerland [15] reported that 22.2% (n=21) of 95 individuals transitioned to dementia, which is approximately 5.0% higher than this current study. In South Korea, a study analyzing cognitive changes and influencing factors over a 2-year period in older adults with MCI aged 65 years and older using data from the 6th and 7th KLoSA [8] reported that 21.0% (n=162) of the 773 subjects transitioned to dementia, which was 4.0% higher than this current study. In another Korean study, the transition rate to dementia was 17.0% (n=52) after 1 year among 306 community-dwelling older adults with MCI aged 60 years or older [16], which is consistent with our results.
The overall rate of dementia progression from MCI in previous studies ranged from 17.0% to 22.2%, despite different follow-up periods. The differences or similarities with our results may be due to the following reasons. First, the time of change in cognitive function in previous studies varied from 1 year [16] to 8 years [15], whereas in this study, dementia transition was tracked for 3 years, which may have affected the transition rate. Second, the diagnostic process of MCI in this study was based on the MMSE-DS; if the sex-, age-, and education-adjusted z-score was less than -1.5 standard deviations from the mean score, the patient was classified as cognitively impaired and was referred to the detailed examination. Therefore, due to the ceiling effect of screening, many older adults with early MCI who did not show obvious cognitive decline were classified as normal, which may explain the difference in dementia transition rates compared to the studies [8] using the MMSE. Third, the mean number of having neuropsychological tests to complete the detailed examination in the 3 years after diagnosis of MCI in this study was 1.20±0.43, which was lower than the mean of 1.32 in a previous study [17] on transition to dementia in older adults with MCI. These results excluded older adults who were diagnosed with MCI at the dementia care center and subsequently diagnosed with dementia outside a medical institution, which may have affected the rate of dementia transition. Therefore, future studies should be conducted on the timing of transition to dementia in community-dwelling older adults with MCI to observe cognitive changes and explore ways to participate in ongoing screening.
Next, this study found the number of participation in non-pharmacological program, exercise, age, and participation in ADL-related education as statistically significant factors in transition to dementia among older adults with MCI. First, we found that older adults with MCI who participated in non-pharmacological programs less than eight times over a 3-year period were 4.17 times more likely to transition to dementia than those who participated in more than eight times. To date, the literature on non-pharmacological programs for older adults with MCI is dominated by short-term interventions using art, gardening, play, music, animals, occupational therapy, and reality therapy [18]. In light of these previous studies, the results of this current study regarding the effect of participating in non-pharmacological programs more than eight times over 3 years on cognitive function in older adults with MCI are highly significant. Similar to this study, a 3-year longitudinal study of a 50-session cognitive intervention for 552 community-dwelling older adults with MCI aged 60 years and older in Korea found that MMSE-DS scores assessed once a year after the cognitive intervention program, increased significantly over time [19]. Several studies using non-pharmacological intervention in Korea have found the improved subjective memory and cognitive function using Subject Memory Complaint Questionnaire (SMCQ) and Korean-MMSE (K-MMSE), respectively in older adults with MCI [10,20]. However, there are limitations in determining the lasting effect on memory and cognition over time. In the United States, 39 older adults with MCI enrolled in a dementia clinic who received 20 hours of memory training over 12 weeks showed increases in self-efficacy and recall 2 years later [21]. Future studies should include a follow-up period after participation in the program to assess the persistence of the intervention’s effects to determine cognitive changes over time and consider additional intervention strategies. The importance of active participation in non-pharmacological programs and ongoing education has been suggested to prevent the transition to dementia in older adults with MCI [22]. In this study, providing eight or more sessions of non-pharmacological programs to older adults with MCI was effective in maintaining cognitive function for over 3 years, which is consistent with the goals of the National Dementia Care Project. However, of the 1,375 individuals analyzed in this study, only 12.7% (n=174) participated in eight or more sessions. This may be because the main tasks of dementia care centers in community focus on early screening, dementia diagnosis, customized case management, dementia support services, and shelter operations [23]. In other words, there is a lack of manpower and infrastructure for prevention efforts. Thus, when establishing the business direction of the dementia care center in the future, it is believed that the national level systems and support would be needed to strengthen the prevention of older adults with MCI. Additionally, the older adults diagnosed with MCI and their family must be informed about the importance of non-pharmacological programs to encourage active participation. Just as this study identified the effect of frequency of participation in non-pharmacological programs conducted by occupational therapists on dementia transition, participation in non-pharmacological programs by older adults with MCI has been shown to be highly correlated with other factors such as cognitive function, depression, physical function, ability to perform ADL, and self-efficacy [18,24]. Thus, further studies are needed to develop various types of non-pharmacological programs that include physical, cognitive, and emotional domains and analyze their effectiveness on dementia transition.
Exercise was found to have a significant effect on transition to dementia: those who did not exercise were found to be 1.42 times more likely to develop dementia than those who exercised at least once a week. In a comparison between the two groups of maintained MCI and transition to dementia, 52.6% (n=594) and 59.7% (n=138) of older adults answered ‘no,’ confirming the relationship between cognitive status and exercise. Exercise contributes to maintaining quality of life and independence in older adults and is known to improve cerebral blood flow, which reduces with aging. Several studies have shown that exercise is an important factor in improving cognitive function in older adults with MCI [25]. A study [26] examined the relationship between cerebrovascular responses and cognitive function after performing aerobic exercise for more than 30 minutes three times a week for 2 years in 70 community-dwelling older adults with MCI, aged 55 to 80 years in the United States. They concluded that exercise boosted and reduced cerebral arterial stiffness, which affected cognitive function by improving vasodilatation. In addition, a study analyzing factors affecting cognitive function in retired older adults by examining data from the 1st to 7th waves of the KLoSA found that exercise increased K-MMSE scores by about 0.47 points, and for every 1 kg increase in muscle strength, K-MMSE scores increased by 0.07 points [27]. This supports the findings of the present study that exercise affects cognitive changes in older adults with MCI.
A meta-analysis study on the effectiveness of exercise interventions on improving cognition in older adults with MCI in Korea reported that the effectiveness of exercise interventions varied by participation time and type of exercise, with the highest effectiveness of cognitive improvement occurring when the participation time was 20 hours during exercise interventions, the duration of participation reached 8 weeks, and the type of exercise was a combination of aerobic and resistance exercises [28]. However, since this study investigated the habit of exercise at the time of diagnosis of MCI, further studies must consider whether older adults with MCI maintain exercise habits after diagnosis, how long they exercise (duration), and type of exercise to examine the relationship between exercise and cognitive function. Understanding this relationship is key to providing guidelines for exercises that help prevent dementia in older adults with MCI and crucial exercises to be performed daily.
Age was found to increase the likelihood of transitioning to dementia by 1.06 times for every 1 year increase in age. A study analyzing cognitive changes and influencing factors in older adults with MCI aged 65 and older over 2 years using data from the 6th and 7th KLoSA found that the rate of dementia transition increased by 1.09 times for every 1-year increase in age. In addition, a Korean study [16] analyzing cognitive changes after 1 year in 306 community-dwelling older adults with MCI aged 60 years and older found that the rate of dementia transition increased by 0.94 times for every 1-year increase in age, which is similar to the findings of this current study. These results show similar dementia transition rates, suggesting that age is a highly predictive factor for cognitive changes in MCI; most previous studies have also reported a significant correlation between age and dementia, and MCI [6]. The average age of the older adults with MCI in this current study was 76.78±7.25 years, and although we did not analyze the results by age group, we tried to reflect the characteristics of factors affecting cognitive changes, such as daily activities. Therefore, in the future, it is necessary to identify the rate of dementia transition according to the age classification of older adults with MCI [29] by reflecting the characteristics of factors that affect cognitive change, and to actively participate in regular checkups and seek ways to expand dementia prevention activities.
Regarding the impact of participation in ADL-related education on transition to dementia, those who did not participate in the education session were 1.05 times more likely to develop dementia than those who participated. For older adults, ADLs and instrumental ADLs (IADLs) are the most fundamental activities for maintaining home-based living and are significantly correlated with cognitive function, making maintenance of ADLs and IADLs a critical factor for community-dwelling older adults. However, most previous studies conducted so far have been studies regarding factors that affect the maintenance of ADL and IADL or studies that have focused on the impact of the declining daily living function in older adults. There is an urgent need to develop programs to improve ADL and IADL function in older adults with MCI [30]. In this current study, the impact on dementia transition was determined by the participation in the existing education operated in dementia care center, rather than directly providing an intervention to improve daily living activities; in fact, only 12.6% (n=173) of the total subjects participated in the education. In the future, we propose to develop an intervention to improve ADLs for older adult with MCI, preventing early loss of ADL function. The intervention must be provided to a large number of older adults with MCI and must be periodically evaluated for its effectiveness.
The dementia prevention, intervention, and care study [7] lists 12 risk factors for the active prevention and management of dementia because dementia has complex causes and symptoms, and suggests providing comprehensive management policies for physical, social, and cognitive improvement. Therefore, for the implementation factors found to be significant in this current study, we propose follow-up research through the establishment of dementia preventive management guidelines and program development for older adults with MCI, considering not only the specific management of single factors but also the relationships among factors.
This study was conducted to analyze the characteristics of older adults with MCI registered in one district of the Dementia Management Project database in Seoul, Korea and to identify factors that contribute to the progression to dementia, which can be used as a basis for finding effective management plan to actively prevent dementia transition in older adults with MCI. However, the results should be generalized cautiously considering the limitations in the selection of various variables, such as the severity of dementia, age at diagnosis, presence of comorbidities, and classification of non-pharmacological programs. In addition, the study was limited to a 3-year period (2016~2018) due to data limitations and restrictions on the primary role of dementia care centers due to the COVID-19 outbreak. In the future, we recommend that further longitudinal studies be conducted to investigate the factors that contribute to progression to dementia in older adults with MCI including various regions. Such studies would contribute to designing dementia preventive nursing plans and strategies that take into account the characteristics of older adults with MCI in the community.
CONCLUSION
This study identified factors associated with progression to dementia by comparing groups of older adults with MCI who maintained their MCI condition for 3 years after diagnosis and those who developed dementia. The results showed that as age increased, older adults with MCI who did not exercise were more likely to develop dementia than those who exercised. For non-pharmacological programs, those who participated in fewer than eight times during 3 years were more likely to develop dementia than those who participated in eight or more sessions, and older adults with MCI who did not participate in ADL-related education were more likely to develop dementia than those who did.
Based on these findings, in order to effectively prevent dementia in community-dwelling older adults with MCI, it is necessary to increase subjective awareness of the need for regular cognitive screening and delay the transition to dementia through monitoring and management of changes in cognition. Especially after COVID-19, it is necessary to provide information to promote physical activity, link community sports facilities, and encourage regular exercise to strengthen physical function and prevent changes in cognitive function. In addition, multifaceted non-pharmacological programs that consider the cognitive status of older adults with MCI should be developed, and active participation in the diagnosis of MCI should be explored to prevent the transition to dementia. Finally, interventions should be provided to improve self-care habits by developing educational content to promote the maintenance of ADL and IADL in older adults with MCI. The results of this study are expected to serve as a basis for developing nursing interventions and establishing individualized nursing strategies to actively prevent dementia in older adults with MCI in community-based dementia care centers.
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