A cross-sectional study to assess the prevalence of mild cognitive impairment among older adults

 Corresponding author: Marjorie Miraclin k Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. A cross-sectional study to assess the prevalence of mild cognitive impairment among older adults Marjorie Miraclin k *, Swath R, Varghese George, Thangapriya and Sathish V Faculty of Allied Health Sciences, Dr. MGR Educational and Research Institute., Chennai, India. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 465-476 Publication history: Received on 25 February 2025; revised on 03 April 2025; accepted on 05 April 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.22.1.0358 Abstract Aim: The Aim of the study is to determine the prevalence of Mild Cognitive Impairment (MCI) among older adults. Objectives: The main objective of this study is 1.To evaluate the prevalence of Mild cognitive impairment using ADDENBROOKE’S COGNITIVE EXAMINATIONIII.2. To evaluate the prevalence of Mild Cognitive Impairment using Everyday Ability Scale of India.3.To collect and analyze the significant data on Mild Cognitive Impairment of older adults in order to their sociodemographic data. Results: Our study on Mild Cognitive Impairment (MCI) in 600 older adults revealed key demographic patterns, including higher prevalence among those aged 60–69, females, and individuals with lower education and socioeconomic status. Using the ACE-III tool ensured reliable cognitive. N terms of socio-economic status, our study revealed that 71.8% of the participants belonged to the Below Poverty Line (BPL) category, while 28.2% were Above Poverty Line (APL). Discussions: In our study contributes to the existing body of knowledge on MCI by providing insights into the prevalence and demographic characteristics of older adults with MCI. By comparing our findings with other prevalence studies, we can observe commonalities and differences, helping to identify potential risk factors and inform future research and interventions. Conclusion: In conclusion, most participants were aged 60–69, with a slight female majority and low educational attainment. Over half were married, and a significant number were widowed or separated. A large portion lived below the poverty line and with family other than their spouse. Alcohol and tobacco use were notable, but regular physical activity was low at 12.7%. Keywords: MCI; DEMENTIA; COGNITIVE Decline; Activities of daily living 1 Introduction Mild cognitive impairment (MCI) represents an intermediate stage between the typical age-related decline in memory and thinking and the more severe deterioration associated with dementia. Individuals with MCI may experience difficulties with memory, language, or judgment. They might notice a decline in their cognitive abilities, and those close to them may also observe these changes. However, these impairments are not severe enough to significantly impact daily life or disrupt routine activities. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 465-476 466 MCI can increase the risk of developing dementia due to Alzheimer’s disease or other neurological disorders. However, not all individuals with MCI will experience further decline—some may remain stable, and others may even show improvement over time. Studies measuring the progression of MCI to dementia indicate that approximately 10-15% of individuals with amnestic MCI develop Alzheimer’s disease (AD) each year. Some research has reported a lower progression rate of around 6% annually, likely due to differences in study populations and assessment methods, such as the Clinical Dementia Rating (CDR) scale. A reasonable estimate suggests that 10-12% of individuals with MCI progress to AD each year, which is significantly higher than the 1-2% annual conversion rate in the general population. Researchers have identified several potential predictors of MCI progression. Studies indicate that individuals carrying the Apolipoprotein E-ε4 (ApoE4) variant, a well-established genetic risk factor for AD, are more likely to develop the disease. Additionally, ApoE4 has been associated with accelerated hippocampal atrophy in cognitively normal adults, as observed in MRI studies. Various diagnostic tools have been developed to predict and monitor MCI progression. Noninvasive neuroimaging techniques, such as Pittsburgh Compound B (PIB) and FDDNP labeling of amyloid plaques and neurofibrillary tangles, have proven useful. Furthermore, individuals with MCI who exhibit low levels of amyloid-beta (Aβ) and high levels of tau protein in cerebrospinal fluid (CSF) are at increased risk of progressing to AD. Combining genetic susceptibility data (ApoE4), neuroimaging findings, and CSF biomarkers enhances the reliability of predictions regarding the transition from MCI to AD. 2 Methodology The study was carried out at ACS Medical College and Hospital in Chennai, which has 50 beds and 80 outpatient visits to the psychiatry OPD each day. ACS Medical College and Hospital adapted it to include both urban and rural areas. 2.1 Population 2.1.1 Target population Participants who are susceptible to the inclusion criteria 2.1.2 Accessible population Older adults (of age 60 above) visited Psychiatry opd and ACS medical college and hospital 2.1.3 Sample size The sample size of the study comprises of 600 patients who fulfill inclusion criteria 2.1.4 Sampling techniques Simple random sampling techniques 2.1.5 Inclusion criteria • Participants who are age group (>60 years) • Who have agreed to participate in this study 2.1.6 Exclusion criteria • Participants who are less than the age of 59 and below • Participants who have severe visual and hearing impairment • Participate those who are not willing to participate in the study Aim: -The Aim of the study is to determine the prevalence of Mild Cognitive Impairment (MCI) among older adults. Objectives: The main objective of this study is • To evaluate the prevalence of Mild cognitive impairment using ADDENBROOKE’S COGNITIVE EXAMINATIONIII • To evaluate the prevalence of Mild Cognitive Impairment using Everyday Ability Scale of India • To collect and analyze the significant data on Mild Cognitive Impairment of older adults in order to their sociodemographic data World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 465-476 467 3 Results 3.1 Demographic variables Table 1 Description of variables Baseline characteristics of the study participants(n=600) Socio-demographic variables S.no Characteristics Categories n percentage 1 AGE 60 to 69 368 61.3% 70 & above 232 38.7% 2 GENDER Male 281 46.8% Female 319 53.2% 3 YEAR OF EDUCATION less than 8 378 63% greater than 8 222 37% 4 MARITAL STATUS Married 330 55% Widowed 188 31.3% Separated 63 10.5% Unmarried 19 3.2% 5 OCCUPATION Pensioner 137 22.8% Employed 161 26.8% Unemployed 146 24.3% Home maker 156 26% 6 Socioeconomic status APL 169 28.2% BPL 431 71.8% 7 LIVING ARRANGEMENTS With spouse 169 28.2% With family other than spouse 431 71.8% LIFE STYLE FACTORS 8 ALCOHOL Ever user 249 41.5% Never user 351 58.5% 9 TOBACCO USER Ever user 147 24.7% Never user 447 75% 10 HAD PHYSICAL ACTIVITY Yes 76 12.7% No 524 87.3% 3.2 Assessment of addenbrooke’s cognitive impairment iii scale (ACE III) 3.2.1 Age distribution of ACE III Table 2 In group of 600 individuals, the prevalence of Mild Cognitive Impairment (MCI) and normal cognitive functioning was investigated across different age categories. In the age range of 60 to 69, out of 222 individuals, 25 were categorized as MCI (6.1% of the total) and 197 were considered to have normal cognitive functioning. The statistical analysis yielded a p-value of 0.586, indicating that there was no significant difference in the prevalence of MCI between the age group 60 to 69 and the normal cognitive group. The odds ratio (OR) for MCI in this age group was calculated as World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 465-476 468 1.233, with a 95% confidence interval ranging from 0.580 to 2.619. This suggests that there was a slightly higher likelihood of having MCI in the age range of 60 to 69, although the result was not statistically significant. Table 2 MCI & Normal age distribution Determine of MCI (factor) Categories MCI (Pattern N=368) Normal cognitive (Pattern A, n=39) P value OR (95%CL) AGE 60 to 69 222(54.5%) 25(6.1%) 0.586 1.233(.580 to 2.619) 70 and above 146(35.9% 14(3.4%) 3.2.2 Gender distribution of ACE Table 3 MCI and Normal group gender distribution Determine of MCI (factor) Categories MCI (Pattern N=368) Normal cognitive (Pattern A, n=39 P value OR (95%CL) Gender Male 167(41%) 20(4.9%) 0.286 1.554(.692 to 3.488) Female 201(49.4%) 19(4.7%) In Table 3 In a group of 600 participants, the gender distribution and cognitive status based on ACE III assessment were analyzed. Among the participants, 41% (167 individuals) were male, while 49.4% (201 individuals) were female. In terms of cognitive status, 368 individuals were classified as having Mild Cognitive Impairment (MCI) based on Pattern N, and 39 individuals exhibited normal cognitive function under Pattern A. The statistical analysis revealed a p-value of 0.286, indicating no significant association between gender and cognitive status. However, the odds ratio (OR) was calculated as 1.554, suggesting a slightly higher odds of having MCI for males compared to females. The 95% confidence interval for the OR ranged from 0.692 to 3.488. Overall, these findings provide insights into the gender distribution and cognitive status of the participants based on the ACE III assessment. 3.2.3 Years of education status distribution of ACE III Table 4 MCI and Normal group educational status distribution Determine of MCI (factor) Categories MCI (Pattern N=368) Normal cognitive (Pattern A, n=39 P value OR (95%CL) Years of eduation Less than 8th std 240(59%) 20(4.9%) 0.395 .732(.356 to 1.503) Greater than 8th std 128(31.4%) 19(4.7%) In Table 4 In a group of 600 participants, the distribution of years of education and cognitive status based on ACE III assessment was examined. Among the participants, 59% (240 individuals) had less than an 8th standard education, while 31.4% (128 individuals) had education greater than the 8th standard. Regarding cognitive status, 368 individuals were classified as having Mild Cognitive Impairment (MCI) based on Pattern N, while 39 individuals showed normal cognitive function under Pattern A. Statistical analysis revealed a p-value of 0.395, indicating no significant association between years of education and cognitive status. The odds ratio (OR) was calculated as 0.732, suggesting a slightly lower odds of having MCI for individuals with less than 8th standard education compared to those with greater than 8th standard education World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 465-476 469 3.2.4 Socio-economic status distribution of ACE III Table 5 MCI & Normal distribution of socio-economic status distribution Determine of MCI (factor) Categories MCI (Pattern N=368) Normal cognitive (Pattern A, n=39 P value OR (95%CL) Socio-economic status APL 100(24.6%) 19(4.7%) 0.009 2.573(1.270 to 5.216) BPL 268(65.8%) 20(4.9%) Table 5 In a group of 600 participants, the socio-economic status and cognitive status based on ACE III assessment were analyzed. The participants were divided into two categories: APL (Above Poverty Line) and BPL (Below Poverty Line). Among the participants, 24.6% (100 individuals) belonged to the APL category, while 65.8% (268 individuals) fell under the BPL category. Regarding cognitive status, 368 individuals were classified as having Mild Cognitive Impairment (MCI) based on Pattern N, while 39 individuals exhibited normal cognitive function under Pattern A. The statistical analysis revealed a significant association between socio-economic status and cognitive status, with a p-value of 0.009. The odds ratio (OR) was calculated as 2.573, indicating a higher odd of having MCI for individuals in the APL category compared to those in the BPL category. The 95% confidence interval for the OR ranged from 1.270 to 5.216. Overall, these findings highlight the impact of socio-economic status on cognitive function in the study group. 3.2.5 Marital status Gender distribution of ACE III Table 6 MCI & Normal distribution of Marital status distribution Determine of MCI (factor) Categories MCI (Pattern N=368) Normal cognitive (Pattern A, n=39 P value OR (95%CL) Marital status Married 199(48.9%) 25(6.1%) 0.219 1.688(0.738 to 3.771) Widowed 169(41.5%) 14(3.4%) Table 6 In a group of 600 participants, the marital status and cognitive status based on ACE III assessment were examined. The participants were categorized into two groups: married and widowed. Among the participants, 48.9% (199 individuals) were married, while 41.5% (169 individuals) were widowed. In terms of cognitive status, 368 individuals were classified as having Mild Cognitive Impairment (MCI) based on Pattern N, while 39 individuals exhibited normal cognitive function under Pattern A. The statistical analysis showed a p-value of 0.219, suggesting no significant association between marital status and cognitive status. The odds ratio (OR) was calculated as 1.688, indicating a slightly higher odds of having MCI for married individuals compared to widowed individuals. However, the 95% confidence interval for the OR ranged from 0.738 to 3.771, indicating a wide range of uncertainty. In summary, these findings suggest that marital status may not have a strong impact on cognitive function in the study group, but further research is needed to draw conclusive results. 3.2.6 Occupation distribution of ACE III Table 7 MCI & Normal distribution of occupation status distribution Determine of MCI (factor) Categories MCI (Pattern N=368) Normal cognitive (Pattern A, n=39 P value OR (95%CL) Occupation Employed 276(67.8%) 30(7.4%) 0.762 1.136(0.436 to 2.594) unemployed 92(41.5%) 9(2.2%) The occupation distribution of individuals with Mild Cognitive Impairment (MCI) and normal cognitive function is shown in Table 7. Among the employed individuals, 67.8% have MCI and 7.4% have normal cognitive function. The P value for this distribution is 0.762, indicating no significant difference in MCI prevalence compared to normal cognitive function. The Odds Ratio (OR) is 1.136, with a 95% confidence interval (CL) ranging from 0.436 to 2.594. Among the unemployed individuals, 41.5% have MCI and 2.2% have normal cognitive function World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 465-476 470 3.2.7 Alcohol user distribution of ACE III Table 8 MCI & Normal distribution of Alcohol status distribution Determine 4of MCI (factor) Categories MCI (Pattern N=368) Normal cognitive (Pattern A, n=39 P value OR (95%CL) Alcohol Ever user 94(23.1%) 10(2.5%) 0.371 0.681(.294 to 1.579) Never user 274(67.7%) 29(7.1%) From table 8 The distribution of alcohol users among individuals with Mild Cognitive Impairment (MCI) and normal cognitive function was examined. Out of 368 individuals with MCI, 23.1% were classified as ever users of alcohol. In the group of individuals with normal cognitive function (n=39), only 2.5% were classified as ever users of alcohol. Statistical analysis showed that there was no significant association between alcohol use and the presence of MCI, with a p-value of 0.371. The odds ratio indicated that the odds of having MCI among alcohol users compared to non-users were not significantly different from 1 (OR=0.681, 95% CI: 0.294 to 1.579). 3.2.8 Tobacco user distribution of ACE III Table 9 MCI & Normal distribution of tobacco status distribution Determine 4of MCI (factor) Categories MCI (Pattern N=368) Normal cognitive (Pattern A, n=39 P value OR (95%CL) Tobacco Ever user 92(22.9%) 7(1.7%) 0.191 .521(.196 to 1.386) Never user 271(67.4%) 32(8%) Table 9 describes the distribution of tobacco users among individuals with Mild Cognitive Impairment (MCI) and normal cognitive function was examined. Out of 368 individuals with MCI, 22.9% were classified as ever users of tobacco. In the group of individuals with normal cognitive function (n=39), only 1.7% were classified as ever users of tobacco. The statistical analysis showed no significant association between tobacco use and the presence of MCI, with a p-value of 0.191. The odds ratio indicated that the odds of having MCI among tobacco users compared to non-users were not significantly different from 1 (OR=0.521, 95% CI: 0.196 to 1.386). 3.2.9 Had adequate physical activity distribution of ACE III Table 10 MCI & Normal distribution of physical activity status distribution Determine of MCI (factor) Categories MCI (Pattern N=368) Normal cognitive (Pattern A, n=39 P value OR (95%CL) Had adequate physical activity Yes 46(11.3%) 5(1.2%) 0.875 .915(.304 to 2.760) No 322(79.1%) 34(8.4%) 3.10 Logistic regression Table 11 logistic Regression Determinants of MCI P value Adjusted OR 95%CI of adjusted OR Alcohol use (ever users or never users) 0.371 0.681 0.294 to 1.579 Had physical activity 0.875 0.915 0.304 to 2.760 Food remembering 0.019 2.388 1.153 to 4.948 Message delivery 0.361 0.690 0.311 to 1.529 The logistic regression analysis in Table 11 examined factors associated with Mild Cognitive Impairment (MCI) in a prevalence study. The results showed that food remembering was significantly associated with MCI, indicating that World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 465-476 471 individuals with difficulty remembering food had higher odds of having MCI. However, there were no significant associations observed for alcohol use, physical activity, or message delivery in relation to MCI. 3.11 Prevalence of Mild Cognitive Impairment The Aim is to examine the prevalence of MCI in different population by evaluating available literature and examining pertinent studies. We can acquire insights into the extent and magnitude of the cognitive problem by analyzing existing data. As well as detect any variation or pattern that may present Table 12 Prevalence Rates of Cognitive function Categories Prevalence Mild Cognitive impairment 61.3% Inconclusive 32.16% Normal 6.5% 3.12 Assesment of EASI (Everyday ability scale of India) 3.12.1 Does he/she ever forget that he/she has just eaten and asks for food again after he/she has just eaten? Table 13 Food remembering distribution of EASI Factor MCI Inconclusive Normal p value Food Could 88 58 16 0.037 Could not 280 135 23 The distribution related to food remembering among individuals with Mild Cognitive Impairment (MCI), inconclusive results, and normal cognitive function, as shown in Table 13, reveals that among those with MCI, 88 individuals could not remember that they have just eaten, while 280 individuals could remember. Among those with inconclusive results, 58 individuals could not remember, while 135 individuals could remember. Among those with normal cognitive function, 16 individuals could not remember, while 23 individuals could remember. The P value of 0.037 indicates a statistically significant difference, suggesting that individuals with MCI are more likely to forget that they have just eaten compared to those with normal cognitive function. 3.12.2 Does he/she urinate in an appropriate place? Table 14 Urination distribution of EASI Factor MCI Inconclusive Normal p value Urinate Could 7 8 2 .211 Could not 361 185 37 The distribution of urination behavior among individuals with Mild Cognitive Impairment (MCI), inconclusive results, and normal cognitive function, as shown in Table 14, indicates that a small number of individuals across all groups could urinate in an appropriate place. Specifically, among those with MCI, 7 individuals could urinate appropriately, while 361 individuals could not. Among those with inconclusive results, 8 individuals could urinate appropriately, while 185 individuals could not. Among those with normal cognitive function, only 2 individuals could urinate appropriately, while 37 individuals could not. The observed P value of 0.211 suggests that there is no statistically significant difference in urination behavior between individuals with MCI and those with normal cognitive function. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 465-476 472 3.12.3 Does him /her clothes ever get dirty from urine or stools? Table 15 Dirty clothes distribution of EASE Factor MCI Inconclusive Normal p value Dirty Clothes Could 18 7 2 0.775 Could not 350 186 37 The distribution of dirty clothes from urine or stools among individuals with Mild Cognitive Impairment (MCI), inconclusive results, and normal cognitive function, as presented in Table 15, indicates that a small number of individuals across all groups experienced their clothes getting dirty. Specifically, among those with MCI, 18 individuals had dirty clothes, while 350 individuals did not. Among those with inconclusive results, 7 individuals had dirty clothes, while 186 individuals did not. Among those with normal cognitive function, only 2 individuals had dirty clothes, while 37 individuals did not. The calculated P value of 0.775 suggests that there is no statistically significant difference in the occurrence of dirty clothes from urine or stools between individuals with MCI and those with normal cognitive function. Tell me the following about his/her clothes (4 & 5) 3.12.4 I his/her shirt buttoned properly? Table 16 Button distribution of EASI Factor MCI Inconclusive Normal p value Buttons Could 364 191 39 .809 Could not 4 2 0 3.12.5 Is his/her dhoti/petticoat tied properly? Table 17 Petticoat distribution of EASI Factor MCI Inconclusive Normal p value Petticoat Could 299 145 29 .145 Could not 67 48 10 3.12.6 Is he/she able to work as a member of a team i.e. in a group activity, which requires different roles from People, will he/she be able to participate? Table 18 Team work involvement distribution of EASI Factor MCI Inconclusive Normal p value Team work Could 305 149 26 .028 Could not 63 44 13 Table 18 displays the distribution of team work capabilities in a group activity, based on three factors: MCI (Mild Cognitive Impairment), Inconclusive, and Normal. The data reveals that individuals with MCI faced greater difficulties participating in team work, with 63 individuals unable to contribute, while 305 individuals could. For those with Inconclusive classifications, 44 individuals were unable to work in a team, while 149 individuals could. Among those classified as Normal, 13 individuals could not partake, while 26 individuals could. These results indicate that individuals with MCI may encounter challenges when engaging in group activities that demand diverse roles from team members. Appropriate support and accommodations should be provided to ensure their effective participation. World Journal of Biology Pharmacy and Health Sciences, 2025, 22(01), 465-476 473 3.12.7 Does he/she express his/her opinion appropriately on important family matters, e.g. marriage? Table 19 Family Function participation distribution of EASI Factor MCI Inconclusive Normal p value Family Function Could 302 157 26 0.066 Could not 66 36 13 Table 19 shows the distribution of individuals' ability to express their opinions appropriately on important family matters, specifically regarding marriage. The findings indicate that individuals with MCI (Mild Cognitive Impairment) had a higher proportion who struggled to express their opinions effectively compared to those with Inconclusive or Normal classifications. Among those with MCI, 66 individuals could not participate, while 302 individuals could. In the Inconclusive group, 36 individuals were unable to express their opinions, while 157 individuals could. For the Normal group, 13 individuals faced challenges in participation, while 26 individuals could actively contribute. Although the pvalue of 0.066 suggests a trend towards significance, further examination and consideration of individual needs are necessary to ensure inclusive and meaningful participation of individuals with MCI in important family matters, such as marriage. 3.12.8 If he/she is assigned or himself/herself decides to undertake an important task, can he/she follow it Through completion? Table 20 Undertake Task distribution of EASI Factor MCI Inconclusive Normal p value Task Could 296 145 29 .288 Could not 72 48 10 Table 20 presents the distribution of individuals' ability to undertake tasks based on three factors: MCI (Mild Cognitive Impairment), Inconclusive, and Normal. The data suggests that there is no statistically significant association (p-value of 0.288) between the factors and the ability to undertake tasks. Among those with MCI, 72 individuals faced challenges, while 296 individuals could undertake tasks. In the Inconclusive group, 48 individuals struggled, while 145 individuals were capable. For the Normal group, 10 individuals encountered difficulties, while 29 individuals were able to undertake tasks. These findings indicate that, overall, there is no significant difference in the ability to undertake tasks among individuals with different classifications, highlighting the importance of providing support as needed for individuals facing task-related challenges. 3.12.9 Is he/she able to remember important festivals such as Holi, Diwali? Table 21 festival remembering distribution of EASI Factor MCI Inconclusive Normal p value Festival Could 303 151 24 .008 Could not 65 42 15 Table 21 shows the distribution of individuals' ability to remember festivals, categorized into three factors: MCI (Mild Cognitive Impairment), Inconclusive, and Normal. The data reveals a statistically significant association (p-value of 0.008) between the factors and the ability to remember festivals. Individuals with MCI had a higher proportion unable to remember festivals (65 individuals) compared to those with Inconclusive (42 individuals) or Normal classifications (15 individuals). Conversely, a larger number of individuals with MCI (303 individuals) could remember festivals compared to those with Inconclusive (151 individuals) or Normal classifications (24 individuals). These findings highlight the impact of cognitive impairment on festival remembering and emphasize the need for tailored support and interventions to enhance individuals' participation and enjoyment of festive events.