Latest data from a territory-wide, population-based, cross-sectional study in Hong Kong showed high prevalence of neurocognitive disorders (NCD) among older adults in both community and long-term care (LTC) settings. Health-related factors associated with NCD have been identified for early intervention in primary care.
The Hong Kong Mental Morbidity Survey for Older People (HKMMSOP), conducted between January 2019 and January 2023, involved 4,368 community-dwelling and 503 residential care home residents aged ≥60 years. [Hong Kong Med J 2026;32:98-113] It provides up-to-date local data on NCD following a prior community-based study conducted in 2008. [Int Psychogeriatr 2008;20:135-148]
HKMMSOP’s participants (mean age, 69.6 years; born in Hong Kong, 53.6 percent; secondary school education or above, 66.1 percent; married or cohabiting, 67.5 percent; economically inactive, 78.1 percent) underwent cognitive function and mental status assessments, and completed health and lifestyle questionnaires. NCD prevalence and associated factors were evaluated with reference to Hong Kong’s population in 2022.
NCD prevalent in community & LTC settings
The overall age- and gender-adjusted prevalence of mild and major NCD was 21.8 and 9.7 percent, respectively.
Among community-dwelling older adults (aged <75 years, 77.7 percent; female, 56.3 percent), 21.8 percent had mild NCD, and 7.4 percent had major NCD.
Among LTC facility residents (mean age, 80.3 years; female, 54.5 percent), 68.8 percent had major NCD, while 24.3 percent had mild NCD.
Community-dwelling participants with scores that crossed the NCD threshold were assessed by clinicians for NCD subtyping. Results revealed a predominance of vascular NCD (43.5 percent), followed by mixed vascular NCD and Alzheimer’s disease (AD) (23.7 percent), while 22.0 percent met the diagnostic criteria for AD.
Associated health-related factors for early intervention
The high prevalence of mild NCD warrants attention on early management to reduce progression to functionally dependent states of major NCD, the researchers noted.
Several health-related factors found to be associated with NCD provide opportunities for early intervention. For example, cardiovascular (CV) disease, poorer postural balance, higher sarcopenia scores, visual and hearing impairment, and oral health problems were associated with both mild and major NCD. A higher number of comorbidities was associated with major NCD, while poor sleep quality was associated with mild NCD.
On the other hand, regular participation in physical and intellectual activities, being socially active, and maintaining good sleep quality were associated with better cognitive function. Consumption of ≥3 portions of vegetables per day was associated with a lower likelihood of major NCD.
“Primary care platforms focused on early detection and management of chronic diseases should adopt a multidimensional approach – particularly addressing CV health, stroke prevention, sensorimotor function, physical activity, sleep hygiene, and leisure engagement – to achieve long-term cognitive benefits,” the researchers suggested.
Support for those with NCD
HKMMSOP also revealed a low rate (<40 percent) of utilization of specialized medical services (psychiatric, neurological and psychological outpatient care) among community-dwelling participants with major NCD. “Promoting awareness of early assessment may help reduce the risk of secondary complications and improve long-term health outcomes associated with NCD,” the researchers wrote.
The high prevalence of major NCD among LTC facility residents underscore the importance of addressing their complex needs and those of their caregivers through coordinated efforts and multidisciplinary care.