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Introduction: We examined the efficacy of a multidomain intervention in preventing cognitive decline among Japanese older adults with mild cognitive impairment (MCI)., Methods: Participants aged 65-85 years with MCI were randomized into intervention (management of vascular risk factors, exercise, nutritional counseling, and cognitive training) and control groups. The primary outcome was changes in the cognitive composite score over a period of 18 months., Results: Of 531 participants, 406 completed the trial. The between-group difference in composite score changes was 0.047 (95% CI: -0.029 to 0.124). Secondary analyses indicated positive impacts of interventions on several secondary health outcomes. The interventions appeared to be particularly effective for individuals with high attendance during exercise sessions and those with the apolipoprotein E ε4 allele and elevated plasma glial fibrillary acidic protein levels., Discussion: The multidomain intervention showed no efficacy in preventing cognitive decline. Further research on more efficient strategies and suitable target populations is required., Highlights: This trial evaluated the efficacy of multidomain intervention in individuals with MCI. The trial did not show a significant difference in preplanned cognitive outcomes. Interventions had positive effects on a wide range of secondary health outcomes. Those with adequate adherence or high risk of dementia benefited from interventions., (© 2024 The Authors. Alzheimer's & Dementia published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Background: Young-onset dementia (YOD) community care requires personalised approaches. Yet, the specific details of YOD consultations are unclear. This study explored how initial consultations correlate with client profiles., Methods: Data from regional YOD helplines were used to analyze the main characteristics of people living with YOD or who had concerns about the possibility of YOD (n = 132). Among several categorical variables, the following were used for analysis: age group, sex, type of living arrangement, employment status, presence of dementia, and content of the consultation. To identify groups of items that frequently occur together, strongly connected rules were identified using association rule analysis with the a priori algorithm. To focus on the characteristics of clients, rules related to client characteristics were extracted based on the type of consultation., Results: A total of 51 rules were identified for the consultations. These rules fell into two categories: (1) consultations for medical matters, which mainly involved employed individuals with undiagnosed dementia, and (2) other consultations on daily life or work, which mainly involved individuals diagnosed with dementia and were characterised by the influence of sex. These rules indicate the importance of medical involvement in confirming the diagnosis and specific individualised care following diagnosis for people living with YOD., Conclusion: Clients with or without a dementia diagnosis were consulted differently in the YOD helplines. Before receiving a diagnosis, medical matters were the main theme of consultations, whereas after receiving a diagnosis, adjustments to daily life or work were the main themes. The results of this study suggest that the needs of people living with YOD and the services they require may vary depending on their backgrounds., (© 2024 Japanese Psychogeriatric Society.)

Objectives: Regular physical activity throughout life is generally recommended to prevent dementia; however, there is little evidence regarding the association between lifetime physical activity and mild cognitive impairment (MCI), which often precedes dementia. This study aimed to examine the association of lifetime physical activity and their transitions with late-life MCI., Design: A population-based case-control study., Setting and Participants: A total of 2968 Japanese community-dwelling older adults aged ≥70 years without dementia., Methods: We evaluated the participants' early-, mid-, and late-life physical activity habits and categorized their transitions across life stages. Cognitive functions in late life were assessed for memory, attention, executive function, and processing speed; functional impairment in one or more cognitive domains was defined as MCI., Results: Regular physical activity in early life was not significantly associated with late-life MCI [odds ratio (OR), 0.80; 95% CI, 0.63-1.02], although those in mid-life (OR, 0.64; 95% CI, 0.51-0.81) and late-life (OR, 0.74; 95% CI, 0.59-0.91) were associated with lower odds of late-life MCI. Compared with nonexercisers, participants who acquired new habits of physical activity during mid- or late-life (OR, 0.71; 95% CI, 0.55-0.91) and those who maintained physical activity throughout their life span (OR, 0.61; 95% CI, 0.42-0.87) had lower odds of late-life MCI; those who stopped regular activity during mid- or late-life did not (OR, 0.79; 95% CI, 0.58-1.06)., Conclusions and Implications: While physical activity throughout the life span is associated with the lowest odds of MCI, starting regular physical activity, even later in life, confers a benefit and should be encouraged as a "lifelong approach" to MCI risk reduction., Competing Interests: Disclosure The authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: We developed a predictive model for all-cause mortality and examined the risk factors for cause-specific mortality among people with cognitive impairment in a Japanese memory clinic-based cohort (2010-2018)., Methods: This retrospective cohort study included people aged ≥65 years with mild cognitive impairment or dementia. The survival status was assessed based on the response of participants or their close relatives via a postal survey. Potential predictors including demographic and lifestyle-related factors, functional status, and behavioral and psychological status were assessed at the first visit at the memory clinic. A backward stepwise Cox regression model was used to select predictors, and a predictive model was developed using a regression coefficient-based scoring approach. The discrimination and calibration were assessed via Harrell's C-statistic and a calibration plot, respectively., Results: A total of 2610 patients aged ≥65 years (men, 38.3%) were analyzed. Over a mean follow-up of 4.1 years, 544 patients (20.8%) died. Nine predictors were selected from the sociodemographic and clinical variables: age, sex, body mass index, gait performance, physical activity, and ability for instrumental activities of daily living, cognitive function, and self-reported comorbidities (pulmonary disease and diabetes). The model showed good discrimination and calibration for 1-5-year mortality (Harrell's C-statistic, 0.739-0.779). Some predictors were specifically associated with cause-specific mortality., Conclusions: This predictive model has good discriminative ability for 1- to 5-year mortality and can be easily implemented for people with mild cognitive impairment and all stages of dementia referred to a memory clinic., (© 2023 John Wiley & Sons Ltd.)

Background: Established clinical assessments for detecting dementia risk often require time, cost, and face-to-face meetings. We aimed to develop a Simplified Telephone Assessment for Dementia risk (STAD) (a new screening tool utilizing telephonic interviews to predict dementia risk) and examine the predictive validity of the STAD for the incidence of dementia., Methods: We developed STAD based on a combination of literature review, statistical analysis, and expert opinion. We selected 12 binary questions on subjective cognitive complaints, depressive symptoms, and lifestyle activities. In the validation study, we used STAD for 4298 community-dwelling older adults and observed the incidence of dementia during the 24-month follow-up period. The total score of STAD ranging from 0 to 12 was calculated, and the cut-off point for dementia incidence was determined using the Youden index. The survival rate of dementia incidence according to the cut-off points was determined. Furthermore, we used a decision-tree model (classification and regression tree, CART) to enhance the predictive ability of STAD for dementia risk screening., Results: The cut-off point of STAD was set at 4/5. Participants scoring ≥ 5 points showed a significantly higher risk of dementia than those scoring ≤ 4 points, even after adjusting for covariates (hazard ratio [95% confidence interval], 2.67 [1.40-5.08]). A decision tree model using the CART algorithm was constructed using 12 nodes with three STAD items. It showed better performance for dementia prediction in terms of accuracy and specificity as compared to the logistic regression model, although its sensitivity was worse than the logistic regression model., Conclusions: We developed a 12-item questionnaire, STAD, as a screening tool to predict dementia risk utilizing telephonic interviews and confirmed its predictive validity. Our findings might provide useful information for early screening of dementia risk and enable bridging between community and clinical settings. Additionally, STAD could be employed without face-to-face meetings in a short time; therefore, it may be a suitable screening tool for community-dwelling older adults who have negative attitudes toward clinical examination or are non-adherent to follow-up assessments in clinical trials., (© 2021. The Author(s).)

Background: Both pain interference and depressive symptoms have certain effects on dementia, and these are reciprocally related. However, comorbid effects of pain interference and depressive symptoms on dementia have not been examined in detail., Objective: This longitudinal study aimed to examine the combined effects of pain interference and depressive symptoms on the incidence of dementia in community-dwelling elderly individuals., Methods: This prospective cohort study with a 36-month follow-up period included 4,326 community-dwelling elderly individuals without dementia at baseline. Pain interference and depressive symptoms were assessed for every participant at baseline. We collected medical records in the Japanese public health insurance system to identify the incidence of dementia for 36 months., Results: The incidence rates of dementia during the follow-up period in the control, pain-interference, depressive-symptoms, and comorbid group were 3.2%, 6.2%, 7.9%, and 11.3%, respectively. A Cox regression analysis showed that the hazard ratios for the incidence of dementia were 1.85 (95% CI: 1.13-3.03) in the pain interference group, 1.87 (95% CI: 1.27-2.76) in the depressive symptoms group, and 2.20 (95% CI: 1.26-3.84) in the comorbid group, after adjusting for covariates., Conclusion: The coexistence of pain interference and depressive symptoms had a greater effect on the incidence of dementia than either condition alone in community-dwelling elderly individuals. Pain interference and depressive symptoms are known as common comorbid conditions and often form a negative cycle that accelerates the worsening of the individual symptoms of both. Thus, the comorbidity of these conditions may require monitoring for the prevention of dementia.

Aim: The prevalence of dementia is rising due to increases in the aging population and chronic health conditions. The present study examined whether lifestyle activities, including instrumental activities of daily living and social roles, were associated with dementia incidence in Japanese community-dwelling older adults., Methods: This longitudinal study involved 4564 participants (age ≥65 years) who were classified by age and sex. Lifestyle activities, risk factors for dementia and incidence of new dementia were recorded., Results: After an average of 42.6 months, 219 participants (4.8%) experienced a new onset of dementia. Survival analyses using the Cox proportional hazards regression model showed that the probability of dementia was significantly lower in participants who engaged in daily conversation (hazard ratio [HR] 0.56, 95% confidence interval [CI] 0.35-0.89, P = 0.015), driving a car (HR 0.63, 95% CI 0.45-0.88, P = 0.007), shopping (HR 0.57, 95% CI 0.34-0.96, P = 0.033) and field work or gardening (HR 0.71, 95% CI 0.54-0.94, P = 0.016)., Conclusions: We concluded that specific lifestyle activities might play an important role in preventing dementia in older adults. The activities that prevent dementia might differ depending on sex and age. Geriatr Gerontol Int 2018; 18: 1491-1496., (© 2018 Japan Geriatrics Society.)

This study aimed to examine whether the expectation for physical activity to minimize dementia risk was associated with physical activity level and whether this association was moderated by perceived high value of dementia prevention among older adults. Participants (n = 2,824) completed questionnaires and wore accelerometers to measure their average daily steps and levels of physical activity. The expectation for physical activity to minimize dementia risk, perceived value of dementia prevention, and potential covariates (expectation of other desirable outcomes, demographics, and health-related factors) were also measured. The main effects of the expectation and perceived value and their interaction were not significant for physical activity variables in generalized linear models. These findings indicate that expecting physical activity in minimizing dementia risk might not be sufficient to influence physical activity behavior regardless of perceived high value of dementia prevention among older adults.

Aim: Numerous neuropsychological tests are implemented in the clinical setting. However, a readily available cognitive test is required to detect the risk of dementia in the community setting., Methods: A total of 4151 persons aged ≥65 years participated in the present prospective cohort study. We assessed cognitive performance using the Mini-Mental State Examination and the National Center for Geriatrics and Gerontology-Functional Assessment Tool. The National Center for Geriatrics and Gerontology-Functional Assessment Tool includes tests of story and word list memory, attention and executive function, processing speed, and visuospatial skill to screen for cognitive impairment. All measurements were transformed to Z-scores to compare among the cognitive tests. The incidence of dementia was determined using data collected by the Japanese Health Insurance System over 36 months., Results: After an average of 43 months, 180 (4.3%) participants were diagnosed with dementia. Survival analyses showed that the probability of dementia was significantly associated with all cognitive tests, except for visuospatial skill. The processing speed test showed the highest hazard ratios for the incidence of dementia (Z-score: hazard ratio 0.61, 95% confidence interval 0.50-0.75, P < 0.01). In subgroup analysis, there were no significant relationships between cognitive tests and the incidence of dementia in participants without global cognitive impairment., Conclusions: We conclude that the National Center for Geriatrics and Gerontology-Functional Assessment Tool, as well as the Mini-Mental State Examination, play an important role in detecting the risk of dementia in the community setting. Further analysis is required to identify the risk of dementia in older people without global cognitive impairment. Geriatr Gerontol Int 2017; 17: 2383-2388., (© 2017 Japan Geriatrics Society.)

INTRODUCTION: We examined the efficacy of a multidomain intervention in preventing cognitive decline among Japanese older adults with mild cognitive impairment (MCI). METHODS: Participants aged 65‐85 years with MCI were randomized into intervention (management of vascular risk factors, exercise, nutritional counseling, and cognitive training) and control groups. The primary outcome was changes in the cognitive composite score over a period of 18 months. RESULTS: Of 531 participants, 406 completed the trial. The between‐group difference in composite score changes was 0.047 (95% CI: −0.029 to 0.124). Secondary analyses indicated positive impacts of interventions on several secondary health outcomes. The interventions appeared to be particularly effective for individuals with high attendance during exercise sessions and those with the apolipoprotein E ε4 allele and elevated plasma glial fibrillary acidic protein levels. DISCUSSION: The multidomain intervention showed no efficacy in preventing cognitive decline. Further research on more efficient strategies and suitable target populations is required. Highlights: This trial evaluated the efficacy of multidomain intervention in individuals with MCI.The trial did not show a significant difference in preplanned cognitive outcomes.Interventions had positive effects on a wide range of secondary health outcomes.Those with adequate adherence or high risk of dementia benefited from interventions. [ABSTRACT FROM AUTHOR]

Background: The estimated absolute cardiovascular disease (CVD) risk level is known to be a useful surrogate marker for future cognitive impairment; however, evidence regarding its predictive validity in terms of cognitive subtypes is limited. We aimed to examine subtype-dependent differences in the associations between absolute CVD risk and the incidence of cognitive impairment in a community-dwelling older Japanese cohort. Methods and Results: This study comprised 1,641 cognitively intact older Japanese participants without CVDs at baseline. We estimated absolute CVD risk using WHO region-specific risk estimation charts and included age, sex, diabetes mellitus, smoking, systolic blood pressure, and total cholesterol at baseline, and the CVD risk level was stratified into the three following risk categories: low (<10%), moderate (10 to <20%), and high (≥20%). Objective cognitive screening was performed using a multicomponent neurocognitive test at baseline and follow-up, and the incidence of cognitive impairment over 48 ± 2 months was determined. The incidence of cognitive impairment in low-, moderate-, and high-CVD risk participants was 1.2, 3.0, and 5.4%, respectively, for amnestic subtypes and 5.8, 10.1, and 14.0%, respectively, for non-amnestic subtypes. After adjusting for potential confounding factors, the absolute CVD risk level was significantly associated with non-amnestic impairment but not with amnestic impairment. Conclusions: The absolute CVD risk estimated using region-specific risk estimation charts in old age is useful to predict incidence of cognitive impairment. Strategies to screen populations at risk of cognitive impairment and to prevent progression to dementia should be cognitive subtype-specific. [ABSTRACT FROM AUTHOR]

The prevalence of disability is increasing due to an expanding aging population and an increasing incidence of chronic health problems. Cognitive impairment may predict the development of disability in older adults. Therefore, we examined the association of mild cognitive impairment (MCI) and/or general cognitive impairment (GCI, defined as a Mini Mental State Examination [MMSE] score of 20–23) with the development of disability in a cohort of Japanese community-dwelling older adults. A total of 4290 participants (aged ≥65 years) enrolled in the Obu Study of Health Promotion for the Elderly were classified according to the presence and degree of cognitive impairment as follows: cognitively healthy, GCI, MCI single domain (MCIs), MCIs with GCI, MCI multiple domain (MCIm), and MCIm with GCI. MMSE scores, risk factors for dementia, and incidences of new disability were recorded. After an average of 29.5 months, 205 participants (4.8%) experienced a new onset of disability. All subtypes of cognitive impairment showed significant relationships with disability except for GCI alone. The following hazard ratios (HRs) were determined: MCIs (HR, 2.04; 95% CI, 1.39–3.00), MCIs with GCI (HR, 2.10; 95% CI, 1.21–3.62), MCIm (HR, 2.32; 95% CI, 1.39–3.85), and MCIm with GCI (HR, 4.23; 95% CI, 2.73–6.57). These results indicate that cognitive impairment may be related to an increased risk for the development of disability. Healthcare providers should implement global cognitive assessments to identify MCI and GCI and consider preventive interventions for disability, especially in older persons. [ABSTRACT FROM AUTHOR]

Aim Cognitive impairment can negatively affect driving performance and increase the risk of driving errors, leading to vehicle crashes. We used a population-based survey to identify the prevalence of cognitive impairments in older drivers. Methods A total of 10 073 older adults were enrolled in the National Center for Geriatrics and Gerontology - Study of Geriatric Syndromes. We characterized general cognitive impairment using the Mini-Mental State Examination ( MMSE). We also used the National Center for Geriatrics and Gerontology- Functional Assessment Tool, which includes six tasks to assess word list memory, logical memory, attention and executive function, processing speed, and visuospatial skill. Results Just 15% of older women with moderate cognitive decline ( MMSE ≤20) drove, whereas 61% of older men with moderate cognitive decline drove. Cognitively normal participants ( MMSE score 27 and over) scored significantly better on six cognitive tests compared with those with mild ( MMSE score 21-26) or moderate cognitive decline, and those in the mild cognitive decline group scored significantly better on six cognitive tests than those in the moderate cognitive decline group. Conclusion A total of 61% of older men with moderate cognitive decline did not cease driving. These older drivers showed poor cognitive performance in multiple domains compared with those with normal and mild cognitive decline. Further studies are required to clarify the relationships between cognitive decline and car crashes in these high-risk populations. Geriatr Gerontol Int 2016; 16: 508-514. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to research on how cognitive impairment and how it impacts daily living in a community-dwelling of older adults in Japan.

This study clarified the patterns of possessing modifiable risk factors of dementia that can be corrected by the elderly who were primarily determined to have mild cognitive impairment (MCI), and then determined the relationship between retention patterns and outcomes from MCI through a 4-year follow-up study. The participants were 789 community-dwelling elders who were ≥65 years old with MCI at baseline. After 4 years, participants were classified into reverters and nonreverters, according to their cognitive function. Repeated measures analysis was performed after imputing missing values due to dropout. Nine modifiable risk factors at baseline were classified by latent class analysis. Subsequently, we performed binomial logistic regression analysis. The reversion rate of 789 participants was 30.9%. The possession patterns of modifiable risk factors among the elderly with MCI were classified into five patterns: low risk, psychosocial, health behavior, educational, and smoking factors. According to logistic regression analysis, the low risk factors class was more likely to recover from MCI to normal cognitive than the other classes (p < 0.05). These results may provide useful information for designing interventions to prevent cognitive decline and dementia in individuals with MCI. [ABSTRACT FROM AUTHOR]

Cognitive frailty, defined as the presence of both frailty and cognitive impairment, is a risk factor for adverse events in older adults. However, prevalence rates of cognitive frailty are low (1.1–2.5%), so primary screening is unsuitable in community settings. The aim of the study was to examine whether a new definition of cognitive frailty, which was developed for primary screening, is useful to predict incident dementia in community-dwelling older adults. A total of 4570 older adults participated in the study (2326 women; average age, 71.9 ± 5.5 years). We defined physical frailty as the presence of ≥1 of the following symptoms: slow walking speed and muscle weakness. Cognitive impairment was defined as ≥1 symptom of cognitive impairment, indicated by an age- and education-adjusted score that was ≥1.5 standard deviations below the reference threshold in word list memory, attention, executive function, and processing speed tests. Cognitive frailty was defined as comorbid physical frailty and cognitive impairment. The incidence of dementia was determined using data collected by the Japanese Health Insurance System over 36 months. The prevalence rates of physical frailty, cognitive impairment, and cognitive frailty were 17.5%, 15.3%, and 9.8%, respectively. Cognitive impairment (hazard ratio [HR]: 2.06, 95% confidence interval [95% CI]: 1.41–3.02) and cognitive frailty (HR: 3.43, 95% CI: 2.37–4.97) were found to be significant risk factors for dementia. However, the association between dementia and physical frailty was not significant (HR: 1.13, 95% CI: 0.76–1.69). Individuals with comorbid physical frailty and cognitive impairment could have a higher risk of dementia than healthy older adults or older adults with either physical frailty or cognitive impairment alone. [ABSTRACT FROM AUTHOR]

Driving cessation is a major negative life event that has been associated with a decline in health conditions including dementia. The increase in activity owing to the expansion of life space is a possible explanation for the positive relationship between driving and brain health. The present study examined the association between driving, life space, and structural brain volume in older individuals. High-resolution magnetic resonance imaging was employed to examine the brain volume in 1063 older adults. Participants were classified as non-drivers, those who drove <7 days a week, and everyday drivers. They were further classified into a non-driving group, an active group (drove 10 km at least once a week), and a less-active group (drove 10 km less than once a week). The hippocampal volume was greater in drivers than in non-drivers. Occipital cortex volume was greater in low-frequency drivers than in non-drivers and high-frequency drivers. Active drivers exhibited larger temporal cortex volumes than less-active drivers, larger cingulate cortex volumes than non-drivers and less-active drivers, and larger hippocampal volumes than non-drivers. Driving was associated with hippocampal brain atrophy attenuation, with active drivers exhibiting decreased brain atrophy in the temporal and cingulate cortices. • Driving, life space, and structural brain volume association was evaluated. • High-resolution MRI was employed to examine the brain volume in 1063 older adults. • Hippocampal volume was greater in drivers than in non-drivers. • Driving was associated with hippocampal brain atrophy attenuation. • Active drivers exhibited decreased brain atrophy in temporal and cingulate cortices. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Preventive strategies for frailty and mild cognitive impairment (MCI) are important for avoiding future functional decline and dementia in older adults. The purpose of this study was to use a population-based survey to ascertain the single and combined prevalence of frailty and MCI and to identify the relationships between frailty and MCI in older Japanese adults. Design: Cross-sectional study. Setting: General community. Participants: A total of 5104 older adults (aged 65 years or older, mean age 71 years) who were enrolled in the Obu Study of Health Promotion for the Elderly (OSHPE). Measurements: Each participant underwent detailed physical and cognitive testing to assess frailty and MCI. We considered the frailty phenotype to be characterized by limitations in 3 or more of the following 5 domains: mobility, strength, endurance, physical activity, and nutrition. Screening for MCI included a standardized personal interview, the Mini-Mental State Examination, and the National Center for Geriatrics and Gerontology-Functional Assessment Tool (NCGG-FAT), which included 8 tasks used to assess logical memory (immediate and delayed recognition), word list memory (immediate and delayed recall), attention and executive function (tablet version of Trail Making Test-part A and B), processing speed (tablet version of digit symbol substitution test), and visuospatial skill (figure selection). Results: The overall prevalence of frailty, MCI, and frailty and MCI combined was 11.3%, 18.8%, and 2.7%, respectively. We found significant relationships between frailty and MCI (the odds ratio adjusted for age, sex, and education was 2.0 (95% confidence interval 1.5–2.5). Conclusions: Using the OSHPE criteria, we found more participants with MCI than with frailty. The prevalence of frailty and MCI combined was 2.7% in our population. Future investigation is necessary to determine whether this population is at increased risk for disability or mortality. [Copyright &y& Elsevier]

Objectives Approximately 25% of individuals who are diagnosed with amnestic mild cognitive impairment (aMCI) revert to normal cognition (NC) rather than progressing to Alzheimer disease (AD). However, the prevalence of progression and reversion among older people in Asia remains unclear. Design A prospective cohort study. Setting A community in Japan. Participants A total of 4153 individuals without dementia aged ≥65 years were classified as having NC, aMCI single domain (aMCIs), non-aMCI single domain (naMCIs), aMCI multiple domain (aMCIm), non-aMCI multiple domain (naMCIm), or global cognitive impairment (GCI). Measurements The National Center for Geriatrics and Gerontology-Functional Assessment Tool and the Mini-Mental State Examination were used to conduct cognitive screening. The participants completed baseline (August 2011 to June 2012) and follow-up (August 2015 to June 2016) assessments. We followed up monthly for newly incident AD, as recorded by the Japanese National Health Insurance and Later-Stage Medical Care systems. Multiple imputation was used to adjust for selection bias and loss of information. Results At 4-year follow-up, the reversion rates to NC in aMCIs, naMCIs, aMCIm, naMCIm, and GCI were 38.7%, 57.0%, 25.7%, 20.9%, and 43.7%, respectively. Of the participants with NC, aMCIs, naMCIs, aMCIm, naMCIm, and GCI at baseline, 4.7%, 4.5%, 13.1%, 20.6%, 21.6%, and 14.3%, respectively, were subsequently diagnosed with AD. We found significant associations between incident AD and naMCIs [hazard ratio (HR) compared to NC: 2.18, 95% confidence interval (CI): 1.45-3.26], and between AD and aMCIm (HR: 4.39, 95% CI: 2.06-9.39) and between AD and naMCIm (HR: 3.60, 95% CI: 2.13-6.08). However, the association between incident AD and aMCIs and between AD and GCI did not reach significance. Conclusion Reversion to NC from MCI and GCI was frequent, and individuals with aMCIs and GCI did not show higher risk of incident AD than those with NC. Older adults with multiple cognitive impairments may be potential targets for preventing dementia. [ABSTRACT FROM AUTHOR]