Cognitive impairment poses a major health challenge in China's aging society, profoundly affecting patients' quality of life and increasing the care burden. Currently, home-based rehabilitation for cognitive impairment in China faces several issues, including low detection rates, fragmented intervention measures, and an inadequate family support system. To establish a home-based rehabilitation framework suited to China's context, the Community Rehabilitation Working Committee of Chinese Rehabilitation Medicine Association organized a multidisciplinary expert panel to develop the Chinese Expert Consensus on the Management of Home-based Rehabilitation for Cognitive Impairment (2026 Edition), based on a systematic review of domestic and international evidence. This consensus retrieved relevant guidelines and high-quality studies from both Chinese and international databases and developed recommendations following evidence-based medicine principles. It focused on key issues such as early screening, non-pharmacological interventions, home environment adaptation, and caregiver support and training. The document aimed to provide scientific and practical guidance for community healthcare workers and caregivers, enhance family rehabilitation capacity, delay disease progression, and improve the quality of life for both patients and caregivers.

With the further aging of the population, the incidence of cognitive impairment is increasing, and there is a lack of effective treatments. The construction of an accurate risk prediction model can be used to help community healthcare workers to identify, warn and intervene with potential patients at an early stage, and to reduce the pressure on social healthcare.

This study aims to construct a prediction model for the risk of cognitive impairment in older adults in the community, analyse the influencing factors of cognitive impairment in older adults, and provide empirical references for the development of targeted interventions.

In April 2024, elderly people aged ≥60 years were selected from the China Health and Retirement Longitudinal Survey (CHARLS) 2020 database (n=7 334) , and their socio-demographic characteristics and data on their health status and behaviours, activities of daily living (ADL) , depression, and cognitive abilities were collected. They were randomly divided into a training set (n=5 133) and a validation set (n=2 201) in a ratio of 7∶3. The best predictor variables were screened using LASSO regression ten-fold cross-validation, the factors influencing cognitive impairment in older adults were analysed using Logistic regression, and nomagram were constructed, and the performance of the predicion model was assessed using the area under the curve of the subject work characteristics (ROC) curves and the analysis of the calibration curves.

The detection rate of cognitive impairment in older adults was 14.48% (1 062/7 334) . LASSO regression screened nine potential predictor variables, which were age, type of residence, marital status, gender, education, exercise, society, activity of daily living, and depression. The results of multifactorial Logistic regression analysis showed that age [OR (95%CI) =1.238 (1.109-1.504) for 70-79 years old and OR (95%CI) =2.231 (1.546-3.222) for ≥80 years old using 60-69 years old as a reference] , type of residence [OR (95%CI) =2.144 (1.617-2.842) for rural using urban as a reference] , marital status [OR (95%CI) =0.691 (0.562-0.851) for no spouse, using spousal as a reference] , education [OR (95%CI) =0.209 (0.173-0.254) for primary school and below, using illiteracy as a reference, and for junior high school OR (95%CI) =0.059 (0.038-0.090) , OR (95%CI) for high school/vocational high school=0.043 (0.021-0.089) , and OR (95%CI) for college and above=0.038 (0.005-0.280) ] , and society [with no society as a reference, and OR (95%CI) with society=0.746 (0.624-0.892) ] , ability to perform ADL [OR (95%CI) =1.529 (1.171-1.997) with no impairment as a reference and OR (95%CI) =1.580 (1.319-1.891) with impairment] , and depression [OR (95%CI) =1.580 (1.319-1.891) with no depression as a reference and OR (95%CI) =1.580 (1.319-1.891) with depression] were the influencing factors of cognitive impairment (P<0.05) . Based on the seven predictor variables screened by multifactor Logistic regression analysis, a prediction model was established. The areas under the ROC curves of the prediction model in the training and validation sets were 0.821 (95%CI=0.805-0.836) and 0.839 (95%CI=0.817-0.861) , respectively; the Hosmer-Lemeshow test χ²=5.022 (P=0.755) and χ²=3.963 (P=0.860) ; calibration curves showed significant agreement between predicted and actual values.

In this study, a prediction model for the risk of cognitive impairment in community-dwelling older adults containing a total of seven indicators, including age, residence, and so on, was established, and the prediction model had good accuracy and differentiation, which can be used to identify the risk of developing cognitive impairment in older adults.

With the rapid population aging in China, cognitive impairment in older adults has become a growing public health concern.

To examine the association between nighttime sleep duration and cognitive impairment among community-dwelling older adults.

Data were derived from the cohort of Older Adult Health and Modifiable Environmental Factors established in Fuyang City from July to September 2018, among whom a total of 4 837 older adults with complete data on cognitive function and sleep time were included in this study. General demographic characteristics〔gender, age, living area (urban or rural), education level, occupation, marital status〕, living habits, the history of chronic diseases, sleep duration, and overall cognitive function were extracted. Binary Logistic regression models were used to analyze the association between nighttime sleep duration and cognitive impairment. Restrictive cubic splines were used to further determine potential dose-response relationships between them.

The participants had a mean nighttime sleep duration of (6.95±1.75) hours, among whom 1 773 (36.65%) slept ≤6 hours per day, 2 088 (43.17%) slept >6-8 hours per day, and 976 (20.18%) slept >8 hours per day. The detection rate of cognitive impairment was 37.44% (1 811/4 837). After adjusting for gender, age, living area, education level and other confounding factors, the detection rate of cognitive impairment was 1.26〔95%CI (1.09, 1.46) 〕 times higher in older adults with nighttime sleep duration of ≤6 hours, and was 1.22〔95%CI (1.03, 1.46) 〕 times higher in older adults with nighttime sleep duration of >8 hours than in those with nighttime sleep duration of >6-8 hours (P<0.05). The detection rate of cognitive impairment in male older adults with nighttime sleep duration of >8 hours was 1.35〔 (95%CI (1.06, 1.72) 〕 times higher than in those with nighttime sleep duration of >6-8 hours (P<0.05). The detection rate of cognitive impairment in female older adults with nighttime sleep duration of≤6 hours was 1.29〔95%CI (1.06, 1.58) 〕 times higher than in those with nighttime sleep duration of >6-8 hours (P<0.05). The restriction cube spline curve showed an approximate U-shaped relationship between nighttime sleep duration and the risk for cognitive impairment, with the lowest risk at 7 hours.

Both shorter and longer nighttime sleep duration may be independent and dose-dependent risk factors for cognitive impairment in older adults. The optimal sleep time is about 7 hours. The association between longer sleep duration and cognitive impairment is pronounced in males, while the association between shorter sleep duration and cognitive impairment is pronounced in females.

Lifestyle factors are important modifiable influencing factors for cognitive decline and dementia. Understanding the status and influencing factors of community-dwelling middle-aged and elderly adults adhering to the lifestyles conducive to dementia risk reduction will be a basis for medical workers to formulate individualized interventions for primary prevention of dementia, yet there are still few related studies.

To understand the status and influencing factors of dementia risk reduction lifestyle in community-dwelling middle-aged and elderly adults.

Five hundred and six middle-aged and elderly adults (aged 45 years and older) who had received free health check-ups in a community health center were selected from five communities in Chongqing's Shapingba District by convenience sampling from January to October 2021. The self-designed general information questionnaire and the Dementia Risk Reduction Lifestyle Scale (DRRLS) were used to investigate. The level of DRRLS score in the participants was compare by sociodemographic characteristics. Ordinal and multinomial Logistic regression analysis was performed to identify the influencing factors of the levels of DRRLS scores.

The average score of DRRLS was (88.00±13.27). The median scores of items in mental activity and brain-benefiting exercise were at a low level (≤2.00). The level of DRRLS score in the participants varied significantly by gender, age, personal monthly income and experience of receiving dementia-related health education (P<0.05). Ordinal and multinomial Logistic regression revealed that gender, educational level, personal monthly income and experience of receiving dementia-related health education were important influencing factors of the level of DRRLS score (P<0.05) .

In general, the lifestyles for dementia risk reduction were assessed at a moderate level in the community-dwelling middle-aged and elderly adults. In the primary prevention of dementia, the effects of mental activity and brain-benefiting exercise should be emphasized. Moreover, priority in community health management should be given to men, those with a low educational level or no previous experience of receiving dementia-related health education, and relevant health education and preventive interventions should be strengthened for them. All these efforts will urge these adults to adopt a lifestyle for dementia risk reduction and brain health promotion.

Both frailty and potentially inappropriate medication (PIM) are relatively highly prevalent in adults with mild cognitive impairment (MCI) in the community, but the association of PIM with frailty in MCI population remains to be further explored.

To examine the association between PIM and frailty in older adults with MCI in the community.

This study was conducted between March to July 2021. By use of multistage sampling, older adults with MCI (n=230) were recruited from Baohe District, Hefei City. Sociodemographics, lifestyle indicators and physical functions of the subjects were collected by using the General Information Questionnaire developed by our research team. Frailty was assessed by the Comprehensive Frailty Assessment Instrument. PIM was assessed by the 2017 Criteria of Potentially Inappropriate Medications for Older Adults in China. Logistic regression analysis was applied to analyze the association of the number and types of PIM with frailty.

The prevalence of frailty and PIM in these older adults with MCI was 59.1% (136/230) and 59.1% (136/230) , respectively. The prevalence of PIM in the frailty group was much higher than that of non-frailty group〔80.9% (110/136) vs 27.7% (26/94) 〕 (P<0.05) . Multivariate Logistic regression analysis demonstrated that compared with MCI older adults without PIM, the risk of frailty was 4.591 times higher in those with only one PIM〔95%CI (1.903, 11.076) 〕, and 8.859 times higher in those with two or more PIMs〔95%CI (2.589, 30.321) 〕. Compared with MCI older adults with neurological disease but without PIM, the risk of frailty was 5.310 times higher in those with PIM〔95%CI (1.011, 27.877) 〕. The risk of frailty was 3.108 times higher in those with cardiovascular disease and PIM than that in those without PIM〔95%CI (1.173, 8.241) 〕.

The prevalence of frailty and PIM was higher in older adults with MCI in the community, and PIM was significantly associated with frailty. To decrease the prevalence of frailty and delay the progression of dementia in this population via reducing the prevalence of PIM, community-based health efforts should be made to strengthen the screening for frailty, enhance the identification of frailty related to medication use, and promote medication review and management.

China is seeing an increasing number of people suffering from dementia as aging advances and life expectancy prolongs. Early diagnosis is extremely important for dementia.

To understand the attitudes and views of community general practitioners (GPs) regarding dementia screening, providing suggestions for the development of dementia screening in the community.

In July 2021, by use of purposive sampling, GPs were recruited from community health centers (stations) in Lanzhou, Gansu, and invited to attend a semi-structured, in-depth, face-to-face individual interview for understanding their attitudes and views toward dementia screening. The interview results were analyzed using phenomenological analysis and thematic analysis.

Ten GPs from five community health centers and five community health stations were finally enrolled, including five males and five females, with an average age of (46.6±6.5) years〔range (35, 57) 〕, an average years of (14.90±8.46) working as a GP〔range (5, 26) 〕; seven with a bachelor degree; four with a title of attending physician. Three themes were extracted: insufficient basic conditions for carrying out community-based dementia screening, difficulties in carrying out community-based dementia screening, and improvement of community GPs' abilities to participate in dementia screening. Nine subthemes were also extracted.

Community GPs supported community-based dementia screening, but had insufficient capacities to carry out the screening. The following may be effective measures for promoting early screening and intervening dementia: improving the ability of community GPs to screen dementia, strengthening the publicity and popularization of dementia-related knowledge to reduce social discrimination against dementia, and deepening the development of contracted family doctor services.

As the primary place of treatment for mild cognitive impairment (MCI), community primary medical institutions need to carry out cognitive function health management for the MCI population. At present, the community still lacks the specific process and program of MCI cognitive function health management. Based on the "Structure-Process-Results" three-dimensional quality structure theoretical model, this study reviewed the community MCI cognitive function health management strategies from three dimensions of functional departments and organizational structure (Structure), health management program (Process) and effect evaluation system and methods (Results), aiming to provide support and reference for the standardized and process-oriented MCI cognitive function health management practice in Chinese communities.

The accelerated aging process, combined with the increase in widowhood and social isolation, has led to a rise in chronic diseases, further increasing the social burden.

To explore the association between the marital status of older adults and the prevalence of cognitive impairment, as well as the impact of social support and lifestyle on this association.

A total of 9 466 older adults aged 65 years and above from Wuhan and Xiaogan, Hubei Province, were included in this study from 2018 to 2023. Participants were categorized into a married group (n=7 055) and an unmarried group (n=2 411) based on their marital status. Baseline information was collected through structured questionnaires, and cognitive function was assessed using the Mini-mental State Examnation and the Montreal Cognitive Assessment-basic China (MoCA-BC). A multivariable Logistic regression model was employed to analyze the association between marital status and cognitive impairment in the overall population as well as in subgroups stratified by age and sex. Further analyses explored the independent and combined effects of marital status, social support, and lifestyle habits on cognitive impairment risk.

Compared with the elderly with spouses, no spouse was an independent risk factor for cognitive impairment (OR=1.299, 95%CI=1.227-1.376, P<0.001). Further subgroup analysis showed that never married (OR=1.679, 95%CI=1.448-1.947, P<0.001) and widowed (OR=1.282, 95%CI=1.206-1.362, P<0.001) were independent risk factors for cognitive impairment in the elderly. Gender and age stratified analysis showed that never married (OR=2.316, 95%CI=1.680-3.193, P<0.001) and widowed (OR=1.731, 95%CI=1.405-2.131, P<0.001) were independent risk factors for cognitive impairment in elderly men. Widowed was an independent risk factor for cognitive impairment in elderly women (OR=1.163, 95%CI=1.002-1.351, P=0.047). In the 65-74 years old group, never married (OR=1.953, 95%CI=1.390-2.746, P<0.001) and widowed (OR=1.315, 95%CI=1.120-1.545, P=0.001) were independent risk factors for cognitive impairment. In the ≥75 years old group, widowed was an independent risk factor for cognitive impairment (OR=1.470, 95%CI=1.238-1.747, P<0.001). Multivariate Logistic regression analysis on marital status, social support and living habits associated with cognitive impairment showed that compared with the elderly with spouse and social support and healthy living habits, the elderly with spouse and social support but unhealthy living habits (OR=1.262, 95%CI=1.169-1.363, P=0.002), spouse and no social support but healthy lifestyle (OR=1.650, 95%CI=1.479-1.841, P<0.001), spouse and no social support but unhealthy lifestyle (OR=1.777, 95%CI=1.575-2.005, P<0.001), no spouse and social support with healthy lifestyle (OR=1.284, 95%CI=1.189-1.397, P<0.001), no spouse and social support with unhealthy lifestyle (OR=1.999, 95%CI=1.768-2.260, P<0.001), no spouse and social support with unhealthy lifestyle (OR=1.999, 95%CI=1.768-2.260, P<0.001), no spouse and no social support but healthy lifestyle (OR=1.680, 95%CI=1.500-1.882, P<0.001), no spouse and no social support but unhealthy lifestyle (OR=2.422, 95%CI=2.141-2.740, P<0.001), no spouse and no social support but healthy lifestyle (OR=2.422, 95%CI=2.141-2.740, P<0.001) were at increased risk for cognitive impairment.

The prevalence of cognitive impairment, especially among older adults without spouses, notably increases, particularly for those who have never married or are widowed. Regardless of marital status, the lack of social support and unhealthy lifestyle are risk factors for cognitive impairment. This study highlights the importance of paying attention to marital status, social support, and lifestyle in the health management of older adults.

China has now launched the Alzheimer's disease prevention and treatment promotion action, and local communities are actively carrying out cognitive function screening around the community elderly population. However, there is no suitable evaluation standard to be used as the basis for the screening of cognitive impairment in the community.

To construct an evaluation system for cognitive impairment screening services applicable to the community, and to provide a reference for the appraisal and quality control of large-scale community-based cognitive function screening programs among older adults in various regions of China.

By literature research and policy analysis, the first draft of the indicator system was proposed around the five elements of the RE-AIM framework, and 15 experts were selected to carry out a Delphi expert consultation to construct an evaluation indicator system for community-based cognitive impairment screening services from October 2023 to January 2024. The weights of the indicators were determined using the multiplier method.

The positive coefficients of experts in the two rounds of Delphi were 100.0% and 93.3%, the experts' authority coefficients were 0.83 and 0.86, and the coordination coefficients of experts' opinions were 0.242 and 0.265 (P<0.001), and the final evaluation system consisted of 5 first-level indicators, 15 second-level indicators, and 20 third-level indicators. The first-level indicators and their weights were screening reachability (0.203 5), screening efficacy (0.203 5), program adoption by the organization (0.194 8), program implementation (0.203 5), and program maintenance (0.194 8).

The evaluation index system of the community cognitive impairment screening service initially constructed in this study, which contains 5 first-level indicators, 15 second-level indicators, and 20 third-level indicators, is of good scientific validity and reliability, and has certain reference value for improving the assessment system of cognitive impairment screening.

Management of mild cognitive impairment (MCI) can reduce the burden of disease on society, families and individuals. The performance of family doctor team is the key to the quality of service, which acts as the main force of chronic disease management in China.

To explore the factors influencing the performance of family doctor teams in providing chronic disease management service for patients with MCI.

In July 2021, a total of 28 medical workers from 8 community health service centers in 4 districts of Shanghai were selected by purposive sampling method to conduct semi-structured interviews, the interview data were coded and analyzed after the interviews.

After three levels of coding, 114 concepts, 49 categories and 8 main categories were sorted out, 4 core categories of factors influencing performance were concluded of service organizer (government), service provider (doctor), service demander (patient) and task implementation. The theoretical framework was organized into five main processes, including organizers driving both provider and demander, provider taking the initiative to implement, demander cooperating with implementation, interaction between provider and demander, task execution cycle improvement.

Although performance of family doctor teams in providing chronic disease management service for patients with MCI is affected by many factors, the process and results are the key to test performance. The driving role of the organizer, execution function of the provider and cooperation of demander are the premise for execution process and result. However, the feedback effect of task execution can improve the quality of service, and eventually form a circular optimization mechanism from organizer drive, to provider execution and demander cooperation, to task execution feedback.

The aging process in China is accelerating, and the number of older adults with chronic diseases is increasing. The association between hypertension, along with its comorbidities, and dementia in older adults requires further investigation.

To investigate the association between hypertension, its comorbidities, and dementia in community-dwelling older adults, and to provide evidence for dementia prevention.

This study utilized cross-sectional data from 14 732 individuals aged ≥65 years from the China Multicenter Dementia Survey (CMDS, 2018-2023). Data on sociodemographic characteristics, chronic diseases, and cognitive function were collected. We employed a multivariate Logistic regression model to analyze the association between hypertension and its comorbidities and dementia in the total population and different age and sex groups.

Among the 14 732 older adults (≥65 years), 8 293 (56.3%) had two or more comorbidities, and 7 786 (52.9%) had hypertension along with other comorbidities. Of these hypertensive individuals, the numbers with 1, 2, 3, and 4 comorbidities were 2 569 (17.4%), 2 064 (14.0%), 1 018 (6.9%), and 443 (3.0%), respectively. Dementia was identified in 1 111 participants (7.5%). After adjusting for covariates, multivariate Logistic regression results showed that the risk of dementia in the hypertension-only group was 1.516 times (95%CI=1.014-2.267, P=0.042), and the risk of dementia among those with hypertension and 1 to 4 comorbidities was 1.879 times (95%CI=1.312-2.692, P=0.001), 2.071 times (95%CI=1.428-3.004, P<0.001), 2.338 times (95%CI=1.612-3.392, P<0.001), 2.591 times (95%CI=1.634-4.108, P<0.001). The highest risk of dementia was observed in individuals with hypertension coexisting with cerebrovascular disease (OR=2.550, 95%CI=1.384-4.700, P=0.003). In analyses stratified by sex and age, the risk of dementia increased significantly with the number of hypertension comorbidities (P<0.05). The strongest association was observed for hypertension coexisting with cerebrovascular disease, with adjusted odds ratios of 2.842 (95%CI=1.095-7.375, P=0.032) in men and 2.348 (95%CI=1.060-5.203, P=0.036) in women. In the group aged <75 years, the highest risk was observed for hypertension coexisting with diabetes (OR=2.833, 95%CI=1.046-7.675, P=0.041), while in the group aged≥75 years, the highest risk was observed for hypertension coexisting with cerebrovascular disease (OR=2.707, 95%CI=1.168-6.273, P=0.020). Among participants with hypertension and two comorbidities, the highest dementia risk was observed in those with coexisting heart disease and cerebrovascular disease (OR=3.559, 95%CI=1.338-9.468, P=0.011). Similarly, among those with hypertension and three comorbidities, the highest prevalence of dementia was observed in individuals with coexisting heart disease, cerebrovascular disease, and autonomic dysfunction (OR=3.881, 95%CI=1.736-8.677, P=0.001).

The prevalence of hypertension and its comorbidities is high among Chinese older adults. Patients with hypertension and its comorbidities have a significantly elevated risk of dementia, which varies by age and sex. These findings underscore the importance of optimized management of chronic diseases in this population. Implementing tailored prevention and treatment strategies based on individual characteristics could contribute to reducing the risk of dementia.

Type 2 diabetes mellitus (T2DM) and mild cognitive impairment (MCI) are common health problems in the elderly in the community. Research on the status and influencing factors of MCI in the elderly with T2DM who participate in community management is needed.

To explore the cognitive characteristics and related factors of elderly patients with T2DM complicated with MCI under community management.

From July to October 2022, a total of 399 patients with type 2 diabetes over 60 years of age in a community health service center in Shanghai were selected by systematic sampling method. General demographic data and health problems, physical examination and laboratory test results, including fasting blood glucose (FBG), total triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin (HbA_1c) were collected. They were divided into MCI group (n=157) and non-MCI group (n=242) according to the presence or absence of MCI. Binary Logistic regression analysis was used to explore the influencing factors of MCI in elderly patients with type 2 diabetes under community management.

The prevalence of MCI was 39.3% (157/399) in community-managed elderly patients with type 2 diabetes. The comparison of cognitive characteristics between MCI group and non-MCI group showed that the MCI group had higher abnormality rates in executive function, orientation, calculation, abstraction, delayed memory, visual perception, naming and attention than the non-MCI group, and the differences were statistically significant (P<0.05), and delayed memory impairment (92.4%) was the most common. There were significant differences in age, marriage, years of education, drinking, FBG, HbA_1c, TC, LDL-C between the two groups (P<0.05) ; Binary Logistic regression analysis showed that age≥80 years old (OR=3.002, 95%CI=1.379-6.534), FBG≥7.0 mmol/L (OR=2.432, 95%CI=1.436-4.119), HbA_1c 7%-9% (OR=2.349, 95%CI=1.380-3.997), HbA_1c>9% (OR=5.106, 95%CI=2.150-12.130), LDL-C (OR=2.451, 95%CI=1.266-4.743), 7-12 years of education (OR=0.419, 95%CI=0.183-0.960) and >12 years (OR=0.243, 95%CI=0.086-0.692) was the influencing factor for MCI in elderly patients with type 2 diabetes (P<0.05) .

The prevalence of MCI in community-managed elderly patients with type 2 diabetes is high, and there are multiple cognitive impairment, age≥80 years old, FBG≥7.0 mmol/L, HbA_1c 7%-9%, HbA_1c>9% and high level of LDC. High level of education is a protective factor for MCI in community-managed elderly patients with type 2 diabetes. Early cognitive impairment screening, long-term blood glucose control, and lowering LDL-C levels are helpful to improve the cognitive function of community-managed elderly patients with type 2 diabetes.

Lifestyle is an important modifiable risk factor for dementia. Knowledge and beliefs are important factors affecting lifestyle. However, there is a lack of research on the types of knowledge, beliefs, behaviors of reducing dementia risk, and it remains unclear whether there are differences in dementia risk and cognitive function among residents with different types of knowledge, belief, and behavior.

To understand the current situation of knowledge, beliefs, behaviors of reducing dementia risk in the middle-aged and elderly adults in the community, explore and analyze the types of knowledge, beliefs and behaviors and the differences of cognitive function, and provide a basis for the development of targeted dementia prevention measures in the community.

From March 2021 to February 2022, middle-aged and elderly adults who participated in free health checkups at community health centers and established health management files in five communities in Shapingba District of Chongqing were selected as the survey objects by convenience sampling method. The general information questionnaire, Dementia Knowledge Assessment Scale (DKAS), Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction (MCLHB-DRR), Dementia Risk Reduction Lifestyle Scale (DRRLS), Beijing version of Montreal Cognitive Assessment (MoCA) and Cardiovascular Risk Factors, Aging and Dementia (CAIDE) scores were used for the investigation. K-means cluster analysis was used to classify the knowledge, beliefs, behaviors of reducing dementia risk of residents, and the differences in demographic characteristics, cognitive function and dementia risk among different types were compared and analyzed.

A total of 232 questionnaires distributed and 211 valid questionnaires were recovered, with an effective recovery rate of 90.9%. The cluster analysis results showed that the knowledge, beliefs and behaviors of reducing dementia risk of the middle-aged and elderly adults in the community could be divided into three types of good knowledge, beliefs and behaviors type, low knowledge-poor behaviors type, low beliefs-poor behaviors type, which accounted for 39.8% (84/211), 37.4% (79/211), and 22.8% (48/211), respectively. The average years of education of middle-aged and elderly residents in good knowledge, beliefs and behaviors type were significantly higher than those in low knowledge-poor behaviors type (t=2.703, P<0.001), and low beliefs-poor behaviors type (t=1.524, P=0.022). The CAIDE scores of residents in low knowledge-poor behaviors type (t=1.431, P<0.001) and low beliefs-poor behaviors type (t=1.080, P=0.002) were significantly higher than those in good knowledge, beliefs and behaviors type. The MoCA scores of residents in low knowledge-poor behaviors type were lower than those in good knowledge, beliefs and behaviors type (t=-2.529, P<0.001) and low beliefs-poor behaviors type (t=-1.869, P=0.018) .

The knowledge, beliefs, behaviors of reducing dementia risk of the middle-aged and elderly adults in the community could be divided into three types of good knowledge, beliefs and behaviors type, low knowledge-poor behaviors type, low beliefs-poor behaviors type, and there are significant differences in years of education, dementia risk and cognitive function scores among the different types. Developing targeted dementia prevention measures based on the characteristics of different types of knowledge, beliefs, behaviors of reducing dementia risk, may be effective in reducing the risk of dementia and maintaining or slowing cognitive decline.

Under the background of an aging population, maintaining brain health has become an inevitable requirement of building a healthy China, and it is of great significance to carry out research on community populations' perceptions of cognitive impairment diseases. However, there is no suitable tools for investigating community populations' perceptions level of Mild Cognitive Impairment (MCI) .

To develop a questionnaire on perceptions toward MCI and test its reliability and validity, so as to provide a basis for promoting the management of cognitive disorders.

On the basis of literature review and special group discussion, the theoretical framework of questionnaire was put forward and the items of the questionnaire were preliminarily worked out. Then the items were evaluated according to the results of two rounds of mail-based Delphi surveys conducted by 13 experts in related fields in April-May 2021. The description of the items was revised through pre-survey, and the items were analyzed through questionnaire survey by difficulty index analysis, discrimination analysis, correlation coefficient analysis, reliability and validity evaluation in October-December 2021, so as to further improve the questionnaire.

(1) Delphi survey: The positive degree of experts in the two rounds of Delphi survey was 100.0% and 84.6%, and the expert authority coefficient were 0.858 and 0.845, respectively. The range of "importance" average score of each item in the two rounds of letter inquiry was 3.77-4.92 and 3.91-4.91, and the coefficient of variation of the two rounds was 0.056-0.246 and 0.061-0.213, respectively. The harmony coefficients of Kendall in the two rounds of consultation were 0.197 and 0.252, respectively (P<0.001). 29 and 12 expert opinions and suggestions were received in the two rounds of consultation. (2) Questionnaire survey: A total of 809 questionnaires were sent out and 797 valid questionnaires were recovered, with an effective recovery rate of 98.52%. The difficulty index of each item was concentrated in 10%-90%. The discrimination index of each item is mostly above 20%. The scores of each item and each dimension were positively correlated with the total score of the questionnaire (P<0.05). The Cronbach'sα coefficient of the questionnaire was 0.712, and the split-half reliability was 0.764. The KMO value of model test was 0.800, and the Chi-square value of Bartlett spherical test was 3 049.278 (P<0.05), which suggested that it was suitable for factor analysis. The results of exploratory factor analysis showed that the cumulative variance contribution rate was 54.930%. The final questionnaire included 20 items, including "understanding of basic knowledge of MCI" "personal experience" "expectation of treatment"and "decision and behavior of seeking medical treatment" four dimensions.

The questionnaire on perceptions toward MCI based on Delphi method has good reliability and validity, and can be used as a tool to investigate the perceptions toward MCI among residents.

Proactive health is an important measure to implement the Healthy China strategy. Mild cognitive impairment (MCI) is an important breakthrough point for early detection and intervention of cognitive impairment disorders and it is also a key link in the realization of brain health.

To activate the initial health intervention among community population and fully realize the construction of a healthy China by understanding the perceptions and medical willingness among community populations aged over 55 years in Shanghai.

From October to December 2021, one district of Shanghai's urban and suburban areas was randomly selected (Yangpu District for the urban area and Jiading District for the suburban area), and 1-2 community health service centers were randomly selected from each district (Daqiao Community Health Service Center and Dinghai Community Health Service Center for Yangpu District, and Jiading Town Community Health Service Center for Jiading District). An on-site face-to-face questionnaire survey was conducted among the residents waiting for outpatient consultation at the community health service centers in accordance with the inclusion criteria. The content of community populations' perceptions questionnaire included: (1) general demographic characteristics; (2) the level of MCI disease awareness among the community population; (3) the medical willingness of the community population. Logistic regression analysis was used to explore the factors influencing the medical willingness of the community population.

A total of 970 questionnaires were distributed and 951 valid questionnaires were recovered, with a valid recovery rate of 98.04%. (1) The total score of the community populations' perceptions questionnaire for MCI was (14.55±5.24), 51.3% (488/951) of the community populations were aware of "mild cognitive impairment", mainly through the media (61.7%, 301/488) ; 59.9% (570/951) of the populations believede that "mild cognitive impairment occurs in old age"; 14.1% (134/951) of the population had participated in relevant screening activities; 6.2% (59/951) had consulted a doctor for memory impairment or suspected cognitive impairment. (2) Univariate and multivariate analysis showed that family history of cognitive impairment, knowledge and understanding of MCI as well as personal experience were all influencing factors of community populations' medical willingness for MCI.

Community population aged over 55 years have poor MCI disease perceptions and poor medical willingness. The community populations with poor knowledge, biased understanding of MCI and lack of relevant practical experience had poor medical willingness. It is suggested that multi-angle publicity should be carried out to improve the perceptions of MCI disease in the community and provide comprehensive support, to improve the accessibility of proactive health, and explore effective ways to promote proactive health.

Community screening and diagnosis of mild cognitive impairment (MCI) in the community are of great value in the prevention of dementia. Currently, there is still no consensus on the management of community screening and diagnosis in the MCI population. This study conducted a detailed review of the current management of community screening and diagnosis, specific items for screening and diagnosis, and peri-diagnostic support for the MCI population, and found that community screening and diagnosis of MCI need to be comprehensively assessed in terms of population definition, history taking, cognitive assessment and auxiliary testing; peri-diagnostic support should include post-diagnostic disclosure, development of post-diagnostic support program and guidance on post-diagnostic support. Thus, it is suggested that community healthcare workers should carry out comprehensive assessment and diagnosis of the MCI population, and actively carry out rapid post-diagnostic support actions to promote the dementia prevention to be really moved forward.

The number of persons living with Alzheimer's disease (AD) will increase dramatically in China. Community physicians play an increasingly critical role in its early screening and management. However, the structure and applicability of the Alzheimer's Disease Knowledge Scale (ADKS) within this population remain unclear.

To explore the factor structure of ADKS in Chinese community physicians.

A cross-sectional online survey was conducted from December 1, 2021, to January 7, 2022, using convenience sampling. Demographic information and ADKS scores were collected from participating community physicians. Exploratory factor analysis (EFA) using principal component analysis with varimax rotation was performed to identify the underlying factor structure. Confirmatory factor analysis (CFA) was subsequently carried out in R 4.3.0 with the Lavaan package to evaluate model fit, and the final model was visualized using semPlot.

A total of 5 313 persons viewed at the online survey, with 1 288 community physicians completing the questionnaire. Among the 1 288 participants, 389 (30.2%) were male and 899 (69.8%) were female, with an average age of (38.5±9.2) years. A total of 419 (32.5%) participants held below-bachelor qualifications, while 869 (67.5%) had a bachelor's degree or higher. EFA extracted eight factors with eigenvalues of 2.58, 1.73, 3.22, 1.11, 1.43, 1.37, 1.64, and 1.35, collectively explaining 48.13% of the total variance. These factors were labeled as knowledge about disease causes, symptoms, patient experience, comorbidity, differential diagnosis, treatment and rehabilitation, care needs, and life impact. CFA indicated acceptable model fit (GFI=0.929, χ²/df=3.71, RMSEA =0.046). All items showed factor loadings above 0.3, and moderate correlations were observed among the eight factors.

The ADKS demonstrated a clear and clinically interpretable 8-factor structure when applied to community physicians. This model comprehensively covers key domains of AD knowledge from a clinical practice perspective, supporting the use of the scale as a reliable instrument for systematically assessing AD-related knowledge in community physicians.

Alzheimer's disease and related cognitive disorders are characterized by an insidious onset and long disease course, making early identification a critical strategy for reducing disease burden. The 10th edition of the Guidelines for Preventive Activities in General Practice issued by the Royal Australian College of General Practitioners (RACGP) adopts a strong primary care orientation and emphasizes opportunistic case-finding among high-risk populations, integrating evidence-based principles on screening, selection of cognitive assessment tools, and multidimensional management of modifiable risk factors. Drawing on the 2024 Lancet Commission on Dementia Prevention, Intervention and Care, World Health Organization evidence, and the life-course management framework, this paper systematically interprets the key recommendations of the RACGP guideline from a general practice perspective, with a focus on risk identification, exclusion of reversible causes, stratified use of screening instruments, and longitudinal management. The analysis suggests that commonly used tools such as the MoCA, GPCOG, RUDAS and AD8 demonstrate complementary strengths across different community populations and clinical contexts, supporting their integration into opportunistic screening pathways in primary care. In addition, interventions targeting physical activity, metabolic control, hearing impairment, sleep disorders and medication optimization constitute a feasible life-course prevention package. In the Chinese primary care context, early identification of cognitive impairment remains constrained by insufficient linkage between screening and referral, limited workforce training and resource integration, and low public awareness. This paper proposes embedding cognitive screening into family doctor contract services and chronic disease management programmes, and leveraging integrated care networks to establish a closed-loop pathway encompassing screening, assessment, referral, intervention and follow-up, thereby advancing earlier prevention and strengthening the role of primary care in dementia risk reduction.