Uptake of dementia screening and associated factors among urban, community-dwelling older adults in Wuhan, China: a cross-sectional survey following the rollout of China’s National Action Plan to Address Dementia in the Elderly (2024–2030)

Introduction

Dementia represents one of the most formidable public health challenges of the 21st century, imposing a profound burden on healthcare systems, economies, and families worldwide (1-4). As the global population ages, the epicenter of this epidemic is shifting rapidly toward low- and middle-income countries, with China bearing the largest share of the burden (5,6). Recent epidemiological data indicate that the prevalence of Alzheimer’s disease and related dementias in China is rising, with an estimated 16.99 million prevalent cases in 2024 (5). Despite this escalating crisis, a significant “diagnosis gap” persists. National surveys reveal that only 28.6% of older adults with dementia in China have received a formal diagnosis, a figure that drops to nearly 7% in rural areas (7). Furthermore, for those who are diagnosed, there is typically a delay of approximately two years between symptom onset and medical confirmation (8). This delay deprives patients of the benefits of early intervention, such as modifiable risk factor management and care planning, while exacerbating the heavy load on family caregivers (9).

The causes of this diagnostic deficit are multifaceted, stemming from a complex interplay of supply-side and demand-side barriers. On the supply side, the primary care infrastructure in China has historically lacked the specialized resources and workforce competency to effectively identify cognitive impairment (10,11). On the demand side, low dementia literacy and deep-seated cultural stigma contribute to a reluctance to seek help; symptoms are often dismissed as a normal part of aging rather than recognized as a pathological condition requiring care (12,13). To bridge this gap, community-based screening has emerged as a pivotal strategy. By shifting detection from reactive hospital-based diagnosis to proactive community health services, screening aims to identify cognitive impairment in its prodromal stages (14). However, the success of such programs depends entirely on public uptake. Literature suggests that participation in screening is influenced by diverse sociodemographic and psychosocial factors, yet data specific to the Chinese context remains sparse (15).

In response to these challenges, the Chinese government has elevated dementia care to a national strategic priority. The recently released National Action Plan for Addressing Dementia in the Elderly [2024–2030] mandates the establishment of a comprehensive prevention and control system (16). A cornerstone of this policy is the ambitious target to achieve an 80% cognitive screening rate for community-dwelling adults aged 65 years and older by 2030. While this directive provides a robust framework for action, there is currently a paucity of empirical data on the actual uptake of screening services following the plan’s rollout. Understanding the factors associated with screening participation in this new policy era is critical for identifying implementation gaps and refining intervention strategies. This study aims to fill this knowledge void by evaluating the uptake of dementia screening and its associated factors among older adults in Wuhan, China, in the wake of the National Action Plan’s implementation.

Wuhan was selected as the study site for several strategic and demographic reasons. As the largest metropolis in central China, Wuhan had an estimated permanent population of approximately 14 million in 2024 (17). Notably, 17.2% of its population were aged ≥65 years, exceeding the national average of 15.6% in the same year, indicating that the city has already entered a stage of deep population ageing (6,17,18). As one of the early pilot cities implementing the National Action Plan to Address Dementia in the Elderly [2024–2030], Wuhan launched a large-scale community-based dementia prevention and screening campaign in May 2024 (19). The city’s advanced urban health infrastructure, relatively diverse educational attainment among older residents, and rapidly expanding digital service environment make it a valuable case for examining both the opportunities and structural barriers in scaling up dementia screening (20-23). Given Wuhan’s relevance as a major urban center undergoing accelerated demographic ageing, its experiences may provide valuable insights for other large Chinese cities facing similar population transitions. We present this article in accordance with the STROBE reporting checklist (available at https://jphe.amegroups.com/article/view/10.21037/jphe-2026-1-0005/rc).

Methods

Participants and sampling

In December 2025, we conducted a cross-sectional survey in six urban communities in Wuhan, China. The survey served as an early-stage outcome evaluation of an ongoing public dementia campaign in Wuhan, launched in 2024. The campaign was initiated in response to China’s National Initiative on Promoting Dementia Prevention and Treatment among Older Adults [2023–2025] (24), and continued following the release of China’s National Action Plan for Addressing Dementia in the Elderly [2024–2030] (16). It aims to improve older residents’ knowledge and awareness of dementia and to increase participation in dementia screening services offered at community health centers.

Participants were recruited using a two-step sampling approach. First, 250 households with at least one older adult were randomly selected from the household registration system in each community. Second, one older adult was randomly selected from each selected household. The six communities were selected because they were among the first pilot sites for the community-based dementia campaign in Wuhan.

The sample size was calculated to estimate the expected dementia screening uptake rate with adequate precision (25). Assuming a conservative uptake rate of 20%, a 95% confidence interval (CI) level, and a CI width of 6%, the minimum required sample size was approximately 894 participants (equivalent to about 150 households per community) (26). Considering the multistage community-based sampling design and the need to conduct subgroup and multivariable analyses, we increased the target sample size to 1,500 to enhance statistical power and representativeness. Accordingly, 250 households were randomly selected from each of the six communities.

Campaign activities included free dementia counseling and screening delivered through community health centers, as well as monthly specialist-led dementia education sessions held at senior activity centers. The health education covered common clinical manifestations and early warning signs of dementia; major risk and protective factors; prevention strategies; the benefits of early and regular dementia screening; and the importance of early diagnosis and timely intervention. These sessions also encouraged older adults to proactively seek routine cognitive screening at their local community health service centers (CHSCs). The local residential committee invited older residents to attend these sessions, which typically attracted 30–60 participants each. In addition, dementia education materials (e.g., brochures, posters, and leaflets) were distributed at common gathering places for older adults, including senior universities, recreation centers, open areas in front of stores, farmers’ markets, and public squares. These intervention measures were developed in accordance with the official technical protocol for the Dementia Prevention and Control Promotion Initiative for Older Adults [2023–2025] (24,27) and were adapted to local elderly-care resources in Wuhan following expert consultation (19). The consultation consisted of one structured meeting involving five experts (two psychiatrists, one neurologist, one public health professor, and one CHSC director), who reviewed and refined the campaign materials.

Eligible participants were registered community residents who had lived in the selected communities for at least six months before the survey, were aged ≥65 years, and provided voluntary written informed consent. Individuals were excluded if they were unable to complete the questionnaire due to severe physical illness or cognitive impairment, or if they could not be contacted after three home visits on different days. In China, individuals who have lived in a community for at least six months are officially classified as permanent residents, a criterion commonly used in community-based epidemiological studies (28,29). This requirement helps ensure population stability and that participants had adequate exposure to local health services, including dementia screening programs. If a selected individual declined to participate or could not be contacted after three visits, no replacement participant was drawn. These cases were recorded as non-response.

The study protocol was approved by the Medical Ethics Committee of the Wuhan Mental Health Center (approval No. KY2023.0725.01). The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. All participants were informed about the purpose of the study, assured of confidentiality, and provided written consent prior to participation. Participation was voluntary, and respondents could withdraw at any time without consequence.

Procedures and instruments

The survey was conducted through face-to-face household interviews by trained primary care providers (PCPs). The questionnaire is provided online: https://cdn.amegroups.cn/static/public/jphe-2026-1-0005-1.pdf. It was administered on-site during home visits. Participants completed the questionnaire themselves whenever possible. For individuals with illiteracy or difficulty reading, PCPs read each question aloud and recorded the participant’s responses verbatim.

Sociodemographic variables included sex, age group, education, marital status, self-rated household economic status, and chronic medical conditions. Exposure to dementia was assessed by asking about prior contact with a person living with dementia (PLWD), having friends or relatives living with dementia, and having a family member living with dementia. Concern about developing dementia was assessed with the question, “Do you worry that you may get dementia?”. Participation in the public campaign was assessed by asking whether, in the past year, participants had attended dementia-related lectures, read dementia promotional materials, or watched dementia promotional videos in their residential communities.

Dementia knowledge was assessed using the validated Dementia Knowledge Scale (DKS), which covers clinical manifestations, prognosis, and modifiable risk factors/prevention (19). The DKS comprises 22 items with three response options (“agree”, “don’t know”, and “disagree”). Each correct response is scored as 1, whereas incorrect or “don’t know” responses are scored as 0. Total DKS scores range from 0 to 22, with higher scores indicating greater dementia knowledge.

Attitudes toward dementia were measured using two items: (I) “Do you agree that early detection of dementia is beneficial, for example, because it allows patients and their families to prepare in advance (e.g., by making future care plans and managing financial affairs)?” and (II) “Do you agree that everyone is the first person responsible for their own brain health and should actively adopt healthy lifestyles and behaviors to help prevent dementia?”.

Uptake of dementia screening was assessed using a single item: “In the past 12 months, have you undergone dementia screening or a cognitive function test?”.

Statistical analysis

The uptake rate of dementia screening was calculated. Chi-squared tests and independent-samples t-tests were used, as appropriate, to compare characteristics between participants who underwent screening (uptakers) and those who did not (non-uptakers). Multivariable logistic regression was performed to identify factors independently associated with uptake; variables significant in the univariate analyses were entered as candidate predictors, and the final model was selected using a Backward (Wald) procedure. To facilitate interpretation of the association between dementia knowledge and uptake, DKS score was dichotomized at median. Associations are quantified as odds ratios (ORs) with 95% CIs. All analyses were conducted using SPSS version 15.0 (SPSS Inc., Chicago, IL, USA), with statistical significance set at P<0.05 (two-sided).

Results

A total of 1,332 participants completed the survey questionnaire. Of these, 685 (51.4%) were men. Participants aged 65–74, 75–84, and ≥85 years accounted for 42.8%, 47.4%, and 9.8% of the sample, respectively. In addition, 359 (27.0%) reported at least one chronic medical condition, and 202 (15.2%) reported having a family member diagnosed with dementia. In the past year, 291 (21.8%) had attended community lectures about dementia, 1,042 (78.2%) agreed that early detection is beneficial, and the mean DKS score was 14.2 [standard deviation (SD) =7.3]. Detailed sociodemographic characteristics, dementia exposure, and campaign participation are presented in Table 1.

Overall, 232 participants (17.4%) reported having undergone dementia screening or a cognitive function test in the past year. Compared with non-uptakers, uptakers were more likely to be aged 75–84 years; have a middle school education; be currently married; rate their family economic status as “good”; have chronic medical conditions; report contact with PLWD; have friends or relatives living with dementia; worry about developing dementia; attend dementia-related lectures; read dementia-related materials; watch dementia-related videos; agree that early detection of dementia is beneficial; agree that they are primarily responsible for their brain health; and have a DKS score >17 (all P<0.001) (Table 1).

In multivariable logistic regression analysis, factors significantly associated with uptake of dementia screening included educational attainment of primary school or below (vs. college and above; OR =4.00, P<0.001) and middle school (vs. college and above; OR =1.93, P=0.009), being currently married (vs. not currently married; OR =4.06, P<0.001), good family economic status (vs. poor; OR =4.08, P=0.008), worrying about developing dementia (OR =1.67, P=0.02), attending dementia-related lectures (OR =10.44, P<0.001), watching dementia-related videos (OR =6.90, P<0.001), and having a DKS score >17 (vs. ≤17; OR =2.01, P=0.002) (Table 2).

Discussion

This study provides one of the first empirical evaluations of dementia screening uptake in urban China following the release of the National Action Plan for Addressing Dementia in the Elderly [2024–2030]. Strikingly, only 17.4% of community-dwelling older adults reported undergoing dementia screening in the preceding 12 months, indicating that fewer than one in five eligible individuals accessed available services. This low participation rate represents a central finding of the present study and highlights a substantial implementation gap between policy ambition and real-world practice. Although the existence of screening participation suggests that basic community cognitive health services are operational, the observed uptake remains approximately 62.6 percentage points below the national target of achieving 80% screening coverage by 2030. This gap underscores that the current system, while functionally established, has not yet translated into broad population engagement. The observed uptake rate is broadly consistent with baseline participation levels reported in other urban Chinese settings, where spontaneous screening participation typically ranges between 18% and 24% in the absence of structured mobilization (19). However, it remains considerably lower than coverage levels observed in integrated primary care systems in high-income countries (30), underscoring that China’s dementia screening framework is still transitioning from a passive, opportunistic model to a more proactive, population-based management system. Moreover, although CHSCs in Wuhan maintain registries for chronic diseases such as hypertension and diabetes, cognitive screening has not yet been uniformly embedded into these routine management systems, which may partially explain the limited coverage observed.

Without strengthened community mobilization strategies, structured follow-up mechanisms, and integration of cognitive screening into routine chronic disease management, achieving the 2030 national coverage target may prove challenging. Given that Wuhan is a central Chinese metropolis with relatively dense primary care networks and established CHSCs, the persistently low uptake suggests that structural barriers—rather than mere service availability—may be limiting population engagement. Although screening programs are formally embedded within community health services, they may not yet be systematically integrated into routine chronic disease registries or proactively triggered through primary care follow-up systems.

A critical finding of this study is the presence of significant health inequities driven by socioeconomic status. Our results demonstrated that older adults with “good” self-rated family economic status were 4.08 times more likely to undergo screening than those with “poor” economic status. This corroborates the “Inverse Care Law” frequently observed in global health, where those with the greatest health needs often utilize the fewest resources (31,32). In the context of dementia care in China, economic vulnerability acts as a potent barrier to screening, likely due to the “rational avoidance” of a diagnosis that carries significant downstream financial risks (33). Although the screening service itself is free under the National Action Plan for dementia, the subsequent costs of diagnosis, pharmacotherapy, and long-term care fall heavily on households (8). Without the assurance of affordable post-diagnosis support, economically disadvantaged older adults may view screening as a gateway to financial strain rather than health protection. This finding aligns with recent evidence indicating that out-of-pocket costs remain a primary deterrent to healthcare utilization among low-income Chinese seniors (10). In a city like Wuhan, where socioeconomic stratification coexists with relatively advanced medical infrastructure, such disparities further indicate that the mere presence of services does not guarantee equitable utilization.

Conversely, we observed a paradoxical association regarding education: participants with primary school education or below were four times more likely to screen than those with a college education. This inverse association diverges from the typical “cognitive reserve” literature, which generally posits that higher education correlates with better health literacy and preventive service uptake (34). However, this anomaly likely reflects the structural segmentation of China’s healthcare system. CHSCs, the primary sites for these screenings, predominantly serve local residents with lower socioeconomic mobility, while highly educated and affluent older adults often bypass community-level care in favor of tertiary hospitals (35). Consequently, the “low uptake” among the highly educated in our sample may represent a preference for specialized care settings rather than a lack of health consciousness. Furthermore, public health campaigns utilizing plain language may have successfully engaged lower-literacy groups, whereas such messaging might fail to resonate with a more intellectual cohort who perceive general community screenings as insufficiently sophisticated. Future implementation efforts may need to incorporate parallel strategies that engage higher socioeconomic groups through hospital-based services, digital health platforms, or employer-sponsored health programs, rather than relying solely on community-level mobilization.

The strong association between dementia literacy and screening uptake reinforces the pivotal role of health education. Participants with higher DKS scores were significantly more likely to engage in screening, validating the National Action Plan’s emphasis on science popularization. More notably, active engagement in health education—specifically attending lectures and watching promotional videos—was the strongest predictor of uptake, increasing odds by approximately ten-fold and seven-fold, respectively. This suggests that dementia screening is not yet a normative behavior but an “activated” one, requiring external stimuli to convert latent awareness into action. This finding is consistent with the Health Belief Model, where “cues to action” (such as lectures) are essential for triggering health behaviors in asymptomatic populations (36). The significant link between “worrying about dementia” and screening further suggests that emotional appraisal and risk perception are critical levers for behavioral change, though excessive anxiety without self-efficacy must be managed to avoid avoidance behaviors (37).

Social isolation emerged as another critical barrier, with unmarried individuals showing significantly lower screening rates. This “spouse effect” highlights the role of family members as essential health advocates and memory aids (38). The lack of screening among the unmarried suggests that current outreach mechanisms, which rely heavily on social diffusion and family mobilization, are failing to reach the “solo ager” (39). This group represents a double vulnerability: they are at higher epidemiological risk for dementia due to social isolation and are simultaneously less likely to be detected by the healthcare system.

This study has two strengths. First, it provides timely baseline evidence on dementia screening uptake in urban China following the implementation of the National Action Plan [2024–2030], offering an important reference for monitoring policy progress. Second, by integrating sociodemographic factors, dementia literacy, and health education exposure, the study provides a comprehensive analysis of both structural and behavioral determinants of screening uptake. However, several limitations of this study should be noted. First, the cross-sectional design precludes causal inferences regarding the relationship between knowledge and screening behavior. Second, the reliance on self-reported screening status may be subject to recall bias, particularly among participants with possible cognitive impairment. Third, this study was conducted in a single metropolitan city. Although Wuhan is a resource-advantaged urban setting, findings from one city cannot represent the national situation. Given the substantial urban–rural disparities in healthcare resources across China (21), screening uptake may differ considerably in other regions, particularly in rural areas. Therefore, caution is needed when comparing our results with the national target of 80% coverage or generalizing them to the country as a whole. Finally, the exclusion of individuals with severe impairments may have underestimated the true burden of undiagnosed dementia.

Conclusions

This study establishes a baseline dementia screening uptake rate of 17.4% among community-dwelling older adults in urban Wuhan, revealing a substantial gap between current practice and the national 80% coverage target. Screening participation is socially patterned, with higher uptake observed among economically secure, socially integrated individuals and those exposed to health education, highlighting persistent structural and behavioral inequities.

These findings suggest that achieving the goals of the National Action Plan will require stronger integration of cognitive screening into routine primary care and targeted strategies to reduce socioeconomic and social barriers to participation (40). Future research should replicate similar studies across diverse regions of China to monitor regional implementation progress and incorporate qualitative approaches to better understand the barriers and facilitators of screening uptake, thereby informing more effective public health strategies.

Acknowledgments

The authors thank all the research staff for their team collaboration work and all the residents and primary care workers involved in this study for their cooperation and support.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://jphe.amegroups.com/article/view/10.21037/jphe-2026-1-0005/rc

Data Sharing Statement: Available at https://jphe.amegroups.com/article/view/10.21037/jphe-2026-1-0005/dss

Peer Review File: Available at https://jphe.amegroups.com/article/view/10.21037/jphe-2026-1-0005/prf

Funding: This study was supported by Academician Song Weihong Workstation in Yunnan Province (grant No. 202305AF150180), the Wuhan Municipal Health Commission and Bureau of Science and Technology Innovation of Wuhan Municipality (grant No. WX23A99), National Natural Science Foundation of China (grant No. 71774060), and the Young Top Talent Program in Public Health from Health Commission of Hubei Province (grant No. EWEITONG [2021]74, PI: B.L.Z.).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jphe.amegroups.com/article/view/10.21037/jphe-2026-1-0005/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study protocol was approved by the Medical Ethics Committee of the Wuhan Mental Health Center (approval No. KY2023.0725.01). The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. All participants were informed about the purpose of the study, assured of confidentiality, and provided written consent prior to participation. Participation was voluntary, and respondents could withdraw at any time without consequence.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Alzheimer’s Disease International. Dementia facts & figures 2024. Available online: https://www.alzint.org/about/dementia-facts-figures/. Accessed on 4 March 2026.
2. Zhong BL, Chiu HF. Ageism, dementia, and culture. Int Psychogeriatr 2023;35:1-2. [Crossref] [PubMed]
3. Ding Y, Duan M, Shen J, et al. Associations of physical frailty, depression and their interaction with incident all-cause dementia among older adults: evidence from three prospective cohorts. Gen Psychiatr 2025;38:e102172. [Crossref] [PubMed]
4. Ren Z, Nie L, Du Y, et al. Intertwined depressive and cognitive trajectories and the risk of dementia and death in older adults: a competing risk analysis. Gen Psychiatr 2024;37:e101156. [Crossref] [PubMed]
5. Zhi N, Ren R, Qi J, et al. The China Alzheimer Report 2025. Gen Psychiatr 2025;38:e102020. [Crossref] [PubMed]
6. Wang ZQ, Fei L, Xu YM, et al. Prevalence and correlates of suspected dementia in older adults receiving primary healthcare in Wuhan, China: A multicenter cross-sectional survey. Front Public Health 2022;10:1032118. [Crossref] [PubMed]
7. Jia L, Du Y, Chu L, et al. Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: a cross-sectional study. Lancet Public Health 2020;5:e661-71. [Crossref] [PubMed]
8. Jia L, Quan M, Fu Y, et al. Dementia in China: epidemiology, clinical management, and research advances. Lancet Neurol 2020;19:81-92. [Crossref] [PubMed]
9. Zhao M, Lv X, Tuerxun M, et al. Delayed help seeking behavior in dementia care: preliminary findings from the Clinical Pathway for Alzheimer’s Disease in China (CPAD) study. Int Psychogeriatr 2016;28:211-9. [Crossref] [PubMed]
10. Gong N, Yang D, Zou J, et al. Exploring barriers to dementia screening and management services by general practitioners in China: a qualitative study using the COM-B model. BMC Geriatr 2023;23:55. [Crossref] [PubMed]
11. Zhong BL, Xiang YT. Challenges to and Recent Research on the Mental Health of Older Adults in China During the COVID-19 Pandemic. J Geriatr Psychiatry Neurol 2022;35:179-81. [Crossref] [PubMed]
12. Lu P, Lin X, Liu X, et al. A mini review of transforming dementia care in China with data-driven insights: overcoming diagnostic and time-delayed barriers. Front Aging Neurosci 2025;17:1554834. [Crossref] [PubMed]
13. Chen M, Lin GR, Wang GY, et al. Stigma toward mental disorders and associated factors among community mental health workers in Wuhan, China. Asia Pac Psychiatry 2023;15:e12542. [Crossref] [PubMed]
14. Mc Ardle R, Dsouza A, Hagan A, et al. Attitudes and Preferences Towards Screening for Dementia From the Perspectives of Healthcare Professionals: An Updated Systematic Review. Int J Geriatr Psychiatry 2025;40:e70057. [Crossref] [PubMed]
15. Wan J, Yang D, Xi L, et al. Factors Associated with Acceptance of Screening and Knowledge About Dementia in Older Adults in China: A Cross-Sectional Study. Healthcare (Basel) 2025;13:1477. [Crossref] [PubMed]
16. National Health Commission of China. Joint Announcement of the National Action Plan for Addressing Dementia in the Elderly (2024-2030) by the National Health Commission and 14 Other National Ministries of China Beijing, China: National Health Commission of China; 2025. Available online: https://www.nhc.gov.cn/lljks/c100158/202501/4b4476877f21467fbfcea71bc90d8313.shtml. Accessed on 4 March 2026.
17. Wuhan Municipal Statistical Bureau. Wuhan Statistical Yearbook, 2024. Wuhan: China Statistics Press; 2025.
18. Yuan MD, Liu JF, Zhong BL. Prevalence of prolonged grief disorder and its symptoms among bereaved individuals in China: a systematic review and meta-analysis. Gen Psychiatr 2024;37:e101216. [Crossref] [PubMed]
19. Wang J, Zeng HY, Gao JX, et al. Enhancing Dementia Awareness and Screening, and Reducing Stigmatizing Attitudes towards Dementia in Urban China: The Role of Opinion Leader Intervention in Community-Dwelling Older Adults. Alpha Psychiatry 2025;26:38857. [Crossref] [PubMed]
20. Wu RY, Ge LF, Zhong BL. Media consumption patterns and depressive and anxiety symptoms in the Chinese general population during the COVID-19 outbreak. World J Psychiatry 2025;15:104625. [Crossref] [PubMed]
21. Zhou RQY, Zhong BL. A narrative review of health inequalities in dementia care in China: exploring mHealth’s potential. Mhealth 2025;12:12. [Crossref] [PubMed]
22. Zhong BL, Ruan YF, Xu YM, et al. Prevalence and recognition of depressive disorders among Chinese older adults receiving primary care: A multi-center cross-sectional study. J Affect Disord 2020;260:26-31. [Crossref] [PubMed]
23. Luo Y, Li Y, Yang X, et al. Research on Smart City Construction Strategies from the Perspective of Industrial Transformation and Upgrading——A Case Study of Wuhan Economic and Technological Development Zone. Intelligent Building & Smart City 2024;4:19-21.
24. National Health Commission of China. Notice from the General Office of the National Health Commission on Promoting the Prevention and Treatment of Dementia in the Elderly (2023-2025) Beijing, China: National Health Commission of China; 2023. Available online: https://www.nhc.gov.cn/lljks/c100158/202306/6a4c7f7a6f0c47cbb609a07e7f78582d.shtml. Accessed on 4 March 2026.
25. Fleiss JL, Levin B, Paik MC. Statistical Methods for Rates and Proportions. Third Edition. New York: John Wiley & Sons; 2003.
26. Zhong B. How to calculate sample size in randomized controlled trial? J Thorac Dis 2009;1:51-4.
27. China CDC NCD Center, Peking University Sixth Hospital. Technical Protocol (2024) for the Dementia Prevention and Control Promotion Initiative for Older Adults (2023–2025). Beijing: Department of Aging and Health, National Health Commission of the People’s Republic of China; 2024.
28. Liu B, Cheng J, Liu Z, et al. Prevalence of obsessive-compulsive disorder and related healthcare utilisation in China: a cross-sectional epidemiological survey. Gen Psychiatr 2025;38:e102013. [Crossref] [PubMed]
29. Zhong BL, Ding J, Chen HH, et al. Depressive disorders among children in the transforming China: an epidemiological survey of prevalence, correlates, and service use. Depress Anxiety 2013;30:881-92. [Crossref] [PubMed]
30. Patnode CD, Perdue LA, Rossom RC, et al. Screening for Cognitive Impairment in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020;323:764-85. [Crossref] [PubMed]
31. The Lancet. 50 years of the inverse care law. Lancet 2021;397:767. [Crossref] [PubMed]
32. Zhang YB, Chen C, Pan XF, et al. Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies. BMJ 2021;373: [Crossref] [PubMed]
33. Chen S, Boyle LL, Conwell Y, et al. The challenges of dementia care in rural China. Int Psychogeriatr 2014;26:1059-64. [Crossref] [PubMed]
34. Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet 2024;404:572-628. [Crossref] [PubMed]
35. Yip W, Fu H, Chen AT, et al. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. Lancet 2019;394:1192-204. [Crossref] [PubMed]
36. An H, Hong I, Han DS, et al. A Program for Reinforcing Lifestyle Change Motivation and Lifestyle Behavior to Prevent Dementia in Community-Dwelling Middle-Aged and Older Adults: Applying the Health Belief Model. Inquiry 2025;62:469580251324046. [Crossref] [PubMed]
37. Khalil MIM, Shaala RS, Mousa EFS, et al. Dementia health matters: Influence of literacy, fears, and endorsements on dementia risk mitigation and screening among community-dwelling older adults. Geriatr Nurs 2025;61:513-25. [Crossref] [PubMed]
38. Sheehan OC, Graham-Phillips AL, Wilson JD, et al. Non-spouse companions accompanying older adults to medical visits: a qualitative analysis. BMC Geriatr 2019;19:84. [Crossref] [PubMed]
39. Jones-Cobb B, Lee C, Jones S, et al. Older adults without care partners: a scoping review of their precarities, outcomes and interventions. Ageing Soc 2026;46:e11.
40. Li T, Lei T, Xie Z, et al. Determinants of basic public health services provision by village doctors in China: using non-communicable diseases management as an example. BMC Health Serv Res 2016;16:42. [Crossref] [PubMed]