Age-friendly environments were associated with a decreased risk of incident motoric cognitive risk syndrome among older adults, suggesting that creating age-friendly environments may be a feasible population-based strategy to delay pre-dementia syndromes.
Key Findings
Results
Higher age-friendly environment scores in the third and fourth quartiles were significantly associated with lower risk of incident motoric cognitive risk syndrome compared to the lowest quartile.
Participants in Q3 had HR 0.75 (95% CI: 0.61–0.91) for incident MCR compared to Q1
Participants in Q4 had HR 0.62 (95% CI: 0.50–0.78) for incident MCR compared to Q1
Q2 did not reach statistical significance, suggesting a threshold effect at moderate-to-high AFE scores
AFE status was assessed across eight domains based on the WHO framework
Results
A significant dose-response relationship was observed between higher age-friendly environment scores and lower risk of incident motoric cognitive risk syndrome.
Each unit increase in AFE score was associated with HR 0.96 (95% CI: 0.94–0.98) for incident MCR
Restricted cubic spline regressions were used to examine the dose-response relationship
The association was continuous and monotonic, indicating that greater age-friendliness corresponds to progressively lower MCR risk
Methods
Over the follow-up period, 801 incident cases of motoric cognitive risk syndrome occurred among 7,608 older adults without baseline MCR.
Total sample: 7,608 older adults (mean age 76.81 ± 7.53 years; 57.32% female)
Median follow-up was 4 years
MCR was evaluated annually from 2011 to 2019 using data from the National Health and Aging Trends Study
All participants were free of MCR at baseline
Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals
Methods
The study used a prospective cohort design with annual MCR assessments and a multi-domain AFE measurement framework.
Data were drawn from the National Health and Aging Trends Study (NHATS)
AFE was assessed across eight domains consistent with the WHO Age-Friendly Environments framework
MCR was assessed annually across an 8-year window (2011–2019)
Median follow-up of 4 years was used in survival analyses
Conclusions
The findings suggest that age-friendly environments may serve as a population-based strategy to delay pre-dementia syndromes and contribute to dementia prevention.
Motoric cognitive risk syndrome (MCR) is described as a predementia condition that predicts multiple adverse health outcomes
Authors conclude that 'creating AFE may be a feasible population-based strategy to delay pre-dementia syndromes, thereby contributing to dementia prevention'
The study is among the first to examine the association between AFE status and MCR risk prospectively
What This Means
This research suggests that living in an 'age-friendly environment' — one designed to support the health and participation of older adults across areas like housing, transportation, social inclusion, and community services — is linked to a meaningfully lower chance of developing a condition called motoric cognitive risk syndrome (MCR). MCR is an early warning sign for dementia, characterized by slow walking speed and memory complaints. The study followed over 7,600 older Americans for a median of four years and found that those living in the most age-friendly environments were about 38% less likely to develop MCR compared to those in the least age-friendly environments.
The study also found a dose-response relationship, meaning the more age-friendly someone's environment was, the lower their risk of developing MCR — even small improvements in environmental age-friendliness were associated with reduced risk. The researchers measured age-friendliness across eight categories defined by the World Health Organization, making this a broad and comprehensive measure of how well a community supports older residents.
This research suggests that improving the environments where older adults live — rather than focusing solely on individual medical or behavioral interventions — could be an effective public health approach to slowing the progression toward dementia at a population level. Because MCR often precedes dementia by years, intervening at this stage through environmental design and policy may offer an important window for prevention.
Zhang H, Hu Z, Ding C, Xu Y, Jiang S, Li Y, et al.. (2026). Age-friendly environments and incident motoric cognitive risk syndrome in older adults: A prospective cohort study.. Alzheimer's & dementia : the journal of the Alzheimer's Association. https://doi.org/10.1002/alz.71816