Social prescribing interventions in response to older adults' needs in community settings - nurses' perspectives: a qualitative study.

Dementia denotes cognitive impairment arising from diverse brain diseases and injuries (). According to WHO reports in 2021, 57 million people worldwide were living with dementia, more than 60% of whom resided in low- and middle-income countries, and nearly 10 million new cases occurred annually; dementia ranked as the seventh leading cause of death (). By the end of 2024, China’s population aged 60 years and older reached 310 million, representing 22.0% of the total population. As a large developing country, China therefore faces a growing dementia burden that parallels the peak of population aging (). One report showed that in 2021 China’s age-standardized dementia prevalence reached 900.8 per 100,000—the highest among 204 countries—underscoring the escalating public health challenge (). Because most dementia begin insidiously, progress irreversibly, and currently lack effective cures, research has shifted toward delaying progression at the preclinical stage, especially among people with cognitive impairment (CI) (). CI signifies reduced cognitive performance without implying a cognitive disorder or clinical diagnosis, yet the potential for Mild cognitive impairment(MCI) and dementia remains. MCI denotes a progressive decline in memory or other cognitive domains that does not substantially impair activities of daily living and does not meet diagnostic criteria for dementia; it therefore represents a transitional stage between normal cognitive aging and dementia (). In China, MCI prevalence among older adults is high: epidemiological surveys estimate that approximately 38.77 million people aged 60 and above have MCI, corresponding to an overall prevalence of 15.5% (). Within 3 to 5 years: roughly one-third of MCI patients remain stable, one-third revert to normal cognition, and one-third progress to dementia (). Thus, MCI is considered a “golden window” for interventions aimed at delaying dementia onset and progression, making large-scale community screening and the identification of high-risk factors in older adults essential for preventing conversion (). Previous studies indicate that the incidence of recovery from mild cognitive impairment (MCI) to normal cognition is 31% (). Consequently, identifying the controllable factors associated with CI in Chongqing can offer a theoretical foundation for clinicians in the management and treatment of this condition. Neuropsychological assessment is essential for diagnosing and studying cognitive impairment (CI) because it evaluates cognitive function and can detect CI with brief tests (). The Mini-Mental State Examination (MMSE) is heavily affected by educational level and lacks sensitivity for differentiating CI from Alzheimer’s disease (AD) or from cognitively normal individuals; thus, it has limited value for CI detection and is unsuitable for community screening (, ). The Montreal Cognitive Assessment (MoCA) assesses a wider range of cognitive domains than the MMSE but shows a relatively high false-positive rate, and the evidence that it reliably separates normal older adults from those with CI is only level II (); therefore, it is not recommended for community screening. Prior work has focused mainly on these two instruments and has insufficiently examined alternative scales; consequently, this study does not recompare the MMSE and MoCA. This study targets practical community screening and therefore includes seven neuropsychological instruments commonly used for CI detection in Chinese communities: the Clinical Dementia Rating (CDR) Scale (), Ascertain Dementia 8 (AD8) (), Mini-Cog, Verbal Fluency Test (VFT) (), Community Screening Instrument for Dementia (CSI-D) (), Rey Auditory Verbal Learning Test (RAVLT) (), and the Activity of Daily Living Scale (ADL) (). Their combined use balances comprehensiveness with simplicity and field practicality. Prior work has been limited by single-center or region-specific designs, small samples, and comparisons restricted to two or three measures; these limitations reduce representativeness, reliability, and the scope of clinical conclusions (, ). To address these gaps, we conducted a multicenter study to assess concordance among these seven instruments in identifying CI, Because this study has a larger and more representative sample, it may yield different or novel findings.