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<p>Mild cognitive impairment (MCI) is a critical window for dementia prevention, yet integrating evidence-based interventions into community care remains a challenge. We developed and evaluated a 24-week community-based health management intervention in Shanghai primary care using a Sequential Multiple Assignment Randomized Trial (SMART). Ninety-three participants were initially randomized to cognitive training with in-person Tai Chi (CT+InTC), virtual reality Tai Chi (CT + VRTC), or a health education group. Non-responders in the intervention arms were re-randomized to either dose escalation or switch formats. Guided by a proposed integrated framework combining the Social Ecological Model and the Consolidated Framework for Implementation Research (SEM–CFIR), the intervention included digital screening, app-based training, culturally adapted Tai Chi, and WeChat peer support. Five of six adaptive pathways improved cognition, with the largest gains in the double-dose CT+InTC group. Compared with the health education group, the intervention improved Montreal Cognitive Assessment (MoCA) by 3.29 points and Memory Guard scores by 3.06 points. In adjusted difference-in-differences models, both high individual attendance and strong community partnership significantly moderated intervention outcomes, with additive and synergistic effects on cognitive improvement. This SMART, multilevel approach was feasible and effective, offering a replicable model for dementia prevention in older adults with MCI.</p>

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Adaptive community care for mild cognitive impairment: a SMART randomized trial with cognitive and implementation outcomes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月23日

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  • Dongsheng Bian,
  • Jiatao Zhang,
  • Chenhao Yu,
  • Xiao Han,
  • Ping Lu,
  • Wenjing Gong,
  • Fang Fang,
  • Lei Wang,
  • Xiyang Li,
  • Chenshu Shi,
  • Guohong Li

摘要

Mild cognitive impairment (MCI) is a critical window for dementia prevention, yet integrating evidence-based interventions into community care remains a challenge. We developed and evaluated a 24-week community-based health management intervention in Shanghai primary care using a Sequential Multiple Assignment Randomized Trial (SMART). Ninety-three participants were initially randomized to cognitive training with in-person Tai Chi (CT+InTC), virtual reality Tai Chi (CT + VRTC), or a health education group. Non-responders in the intervention arms were re-randomized to either dose escalation or switch formats. Guided by a proposed integrated framework combining the Social Ecological Model and the Consolidated Framework for Implementation Research (SEM–CFIR), the intervention included digital screening, app-based training, culturally adapted Tai Chi, and WeChat peer support. Five of six adaptive pathways improved cognition, with the largest gains in the double-dose CT+InTC group. Compared with the health education group, the intervention improved Montreal Cognitive Assessment (MoCA) by 3.29 points and Memory Guard scores by 3.06 points. In adjusted difference-in-differences models, both high individual attendance and strong community partnership significantly moderated intervention outcomes, with additive and synergistic effects on cognitive improvement. This SMART, multilevel approach was feasible and effective, offering a replicable model for dementia prevention in older adults with MCI.