Impending Surge in Multi-Billion-Dollar Cognitive Impairment Screening Market: Four Regional Models Lead the Way
With the rapid aging of the population structure, the risk of cognitive impairment in China is becoming increasingly prominent. Based on sample estimates, the prevalence of mild cognitive impairment (MCI) in general screening reaches as high as 20%. Without intervention, approximately 40% of individuals with normal baseline cognition may progress to MCI within seven years, and the probability of developing Alzheimer’s disease within six years exceeds 90%!
It is for this reason that China has vigorously promoted cognitive impairment screening in recent years. The Work Plan for Exploring Characteristic Services for the Prevention and Treatment of Dementia in the Elderly explicitly stipulates the “Two 80s” targets—namely, raising public awareness of dementia prevention and treatment knowledge to 80% and increasing the rate of cognitive function screening among older adults in communities (villages) to 80% by 2022.
Currently, extensive screening for cognitive impairment is being rolled out across various regions. Following discussions with industry experts, VCBeat (WeChat ID: VCBeat) believes that the exploratory efforts in certain areas are highly representative and offer valuable lessons for reference.
Shanghai initiated its cognitive impairment screening system at an early stage and is widely recognized within the industry as the most comprehensive model for the construction of cognitive impairment screening, prevention, and treatment systems in China.
Given the severe aging population in Shanghai, where individuals aged 65 and above account for 17% of the total population—with some districts and counties exceeding 20%—the city places high priority on screening for cognitive impairments. In 2020, the Shanghai Municipal Health Commission led the release of the Three-Year Action Plan for Strengthening Public Health System Construction in Shanghai (2020–2022), which emphasizes focusing on the health of key populations, implementing risk screening and intervention programs for cognitive impairments among the elderly, and advancing the management of common chronic diseases, degenerative conditions, and psychological issues in older adults.
During this period, the Shanghai Mental Health Center, which was primarily responsible for the relevant work, collaborated with multiple hospitals over three years to jointly develop an efficient, large-scale implementable screening and prevention model for cognitive impairment, known as the “Infiltration Model.”
Shanghai Tehuofen Intelligent Technology Co., Ltd. has been deeply involved in cognitive impairment screening in Shanghai. Its founder and CEO, Du Yijie, believes that the cognitive impairment screening in Shanghai mainly has the following characteristics.
First, the “Shanghai Model,” led by the medical sector, is recognized as China’s first rigorously medically certified model for the prevention and control of cognitive impairment.
“Shanghai’s screening, prevention, and treatment system for cognitive disorders was not built on speculation; every step has undergone rigorous medical validation. How should health education and screening be specifically conducted? What is the referral process after screening? How is diagnosis made? How should interventions be implemented post-diagnosis? How are pharmacological and non-pharmacological interventions respectively delivered, and what are their outcomes? Each of these components was separately tested and validated before being integrated into an effective prevention and control model,” he introduced to VCBeat.
Second, built upon this scientific model, Shanghai has been progressively transitioning toward standardization at every stage, having established as many as 12 sets of operational specifications and standards for community-based screening and intervention.
For example, Shanghai is developing two municipal-level local standards: “Requirements for the Establishment and Services of Care Units for Older Adults with Cognitive Impairment” and “Guidelines for Building Dementia-Friendly Communities for Older Adults.” The former specifies the requirements for setting up specialized cognitive impairment care zones in elderly care institutions, as well as service requirements for specialized assessments, daily living assistance, dietary nutrition, sleep care, medical nursing, cultural and recreational activities, and psychosocial support. The latter further clarifies requirements for building dementia-friendly communities for older adults in areas such as facility and space construction, creation of supportive environments, and digital enablement.
Third, the use of digital screening tools, such as digital therapeutics, during the screening process enables universal screening of large community populations and facilitates tiered screening. According to reports, after implementing digital screening tools, the community universal screening rate reached 93.6%, with general practice diagnosis and intervention provided to the 19.8% of individuals identified as having moderate-to-high risk for brain health. Subsequently, 15.2% of patients required preliminary diagnosis and treatment by specialists, leaving approximately 3.4% of patients to receive confirmed diagnoses and interventions at specialized hospitals.
“This is a tiered system; it is not feasible to concentrate all identified at-risk individuals into a single medical institution. It functions like a funnel, whereby patients who pass through the screening process can ultimately receive definitive diagnosis and intervention at specialized facilities, thereby achieving true maximization of healthcare resources. From the utilization of medical resources and screening methodologies to the selection of screening tools and diagnostic and interventional protocols, each step follows a standardized medical administrative pathway. This is likely the only model in China that has been medically validated.” Du Yijie spoke highly of the “Shanghai Model.”
Du Yijie believes that the key to the Shanghai model lies in establishing a funnel-like, tiered screening and standardized intervention system, the implementation of which is highly challenging. “You need to achieve triage and patient rotation among communities, secondary hospitals, tertiary hospitals, and medical-nursing alliances. Patients move from communities to hospitals, but ultimately, most return to communities or elderly care institutions during the intervention phase.”
It is evident that the overall pathway of the Shanghai Model is clear and feasible, with its core framework having been replicated in multiple regions. According to reports, large-scale cohort studies on the Shanghai Model are currently underway. It is projected that, under the intervention of the screening and intervention system, the progression to cognitive impairment can be reduced by 25% among patients, and 25% of individuals with Mild Cognitive Impairment (MCI) can be reversed to normal cognitive status.
Currently, this system has taken shape. By the end of 2021, Shanghai had established 7,302 care beds for individuals with cognitive disorders, and planned to add 2,000 more such beds through renovations by 2023. According to the plan, the city’s total number of care beds for individuals with cognitive disorders will reach 15,000 by the end of the 14th Five-Year Plan period.
Furthermore, since September 2019, Shanghai has taken the lead nationwide in launching the development of dementia-friendly communities for the elderly. As of September 2022, 170 subdistricts and towns in Shanghai had initiated such community-building efforts, accounting for 80% of all subdistricts and towns in the city; full coverage across all subdistricts and towns is set to be achieved by the end of the 14th Five-Year Plan period. By promoting care services through a “dedicated zones + community” model, Shanghai has gradually established the “Shanghai Model” for dementia care services for the elderly.
Certainly, given Shanghai’s robust economic strength and abundant medical resources, other regions may not be able to simply replicate its model. Beyond Shanghai, the pilot initiatives in the following regions are also noteworthy and deserve mention.
Jiangxi Province in Central China is also piloting cognitive impairment screening, with its distinctive feature being “government-led, digitally enabled.”Zhangshu City, a pilot city, utilized digital screening tools to achieve large-scale, rapid screening of residents aged 65 and older across the entire municipality. Within just over two months, cognitive function screenings were completed for more than 50,000 elderly individuals, achieving a remarkable screening rate of over 90%.
“If we were to conduct screenings one by one using traditional scales, the desired efficiency would be unattainable under any circumstances. The success of this pilot demonstrates that, by leveraging digital technology, the 80% screening rate proposed by the National Health Commission is fully achievable with the current human, material, and financial resources,” said Du Yijie.
Notably, while completing screening efforts, Zhangshu City also established a Digital Diagnosis and Treatment Center for Cognitive Disorders integrating Traditional Chinese Medicine (TCM) and Western medicine. Elderly individuals identified as at moderate-to-high risk during cognitive screening were referred to this center for diagnosis and treatment, thereby truly empowering primary healthcare institutions with digital technology and pioneering a three-tier prevention and control model for cognitive disorders that combines TCM, Western medicine, and digital technologies.
According to reports, this tiered diagnosis and treatment system can achieve a county-level consultation rate of over 94% for cognitive disorders, realizing the goal of “minor illnesses treated within villages, major illnesses treated within counties,” thereby serving as an exemplary model for deepening healthcare system reform and advancing the development of tiered diagnosis and treatment systems.
As a representative of South China, Shenzhen is vigorously advancing its cognitive impairment screening initiatives.Guided by the Chinese Academy of Sciences’ strategic layout in Shenzhen’s brain science sector, the city’s screening initiatives exhibit a distinct “brain science-led” characteristic.
It is reported that Shenzhen, led by the Institute of Brain Cognition and Brain Diseases of the Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, has launched a pilot program to establish an industry-academia-research-application service and demonstration platform for brain health. This initiative focuses on early screening, assessment, and prevention of cognitive disorders, practices a positive view of aging, explores scientific models for elderly care, and has established the Changqing-CAS Brain Health Studio.
This model integrates the principles of cognitive neuroscience with the practical needs for preventing and treating cognitive impairments in the elderly population, creating technology-enabled and smart elderly care application scenarios. It explores the use of cutting-edge scientific technologies to achieve early disease prevention and intervention, such as digital cognitive impairment screening products combined with brain science, MCI auxiliary diagnostic products based on olfactory and eye-tracking technologies, and intervention and treatment products based on acoustic, optical, electrical, and magnetic stimulation.
Hainan Province is the first region to incorporate cognitive impairment screening for the elderly into its public welfare initiatives.As early as 2022, the Hainan Provincial Committee of the Communist Party of China and the Hainan Provincial People’s Government designated pilot screening for cognitive impairment among the elderly as one of their key initiatives to deliver tangible benefits to the public. In 2023, Hainan continued this pilot program and proposed incorporating a pilot initiative on digital therapeutics for cognitive rehabilitation targeting at-risk populations into its list of practical projects for public welfare.
It is reported that in 2023, Hainan Province will implement cognitive impairment screening services for residents aged 60 and above across the province, adhering to the principles of “informed consent, voluntary participation, and free of charge.” In light of actual conditions and public needs, the scope of services may be appropriately expanded to include middle-aged and elderly permanent residents with such needs. The local authorities aim to ensure that all eligible elderly individuals are screened on an equal and voluntary basis, thereby further increasing screening coverage and advancing the development of Hainan’s brain health database for the elderly.
Among these initiatives, the pilot program for digital therapeutics in cognitive rehabilitation will deploy professional screening tools and digital therapeutic facilities in selected healthcare institutions—specifically, medical institutions with specialties in geriatrics, neurology, and psychiatry, as well as primary healthcare institutions engaged in building cognitive impairment-friendly communities. This program aims to provide professional screening, follow-up, and digital therapeutic services to individuals identified with cognitive decline or impairment during the 2022 pilot screening for cognitive disorders.
Meanwhile, Hainan will provide intervention services to a subset of individuals with cognitive decline or cognitive impairment identified during the 2022 pilot program for cognitive disorder screening among the elderly, based on the principles of “voluntary participation, informed consent, and free of charge.” The annual service capacity is estimated at 20,000 individuals. Medical and health institutions implementing the project will deliver professional screening and follow-up services. For those willing to receive treatment, interventions or digital therapeutics will be administered. Individuals requiring pharmacological intervention or treatment will be referred into the standard medical care system of healthcare institutions for routine diagnosis and treatment.
By implementing this project, we aim to promote the application of digital therapeutics in the rehabilitation of cognitive impairment among the elderly, establish a provincial monitoring and management network for cognitive impairment in older adults, and advance the development of health databases for the elderly. Through the creation of dementia-friendly communities, we will implement early community-based prevention and intervention strategies for cognitive impairment, slow its progression, and tangibly improve the quality of life for this elderly population.
An examination of regions in China with distinctive approaches to cognitive impairment screening reveals that these representative areas invariably rely on digital technologies, including digital therapeutics and brain science, as their foundational support. This is because digital technology can significantly lower the skill requirements for primary care screening personnel, improve adherence to screening protocols, and thereby substantially enhance screening efficiency.
According to VCBeat, digital technologies had not been introduced in a previous screening pilot program in a certain region, resulting in prolonged training periods for primary healthcare workers and limited proficiency. In traditional screening approaches, primary healthcare workers were required to administer questionnaire surveys to elderly individuals using standardized scales, with each session lasting at least 30 minutes, leading to extremely poor compliance. After the introduction of digital technologies in the locality, similar population-wide screenings could be completed in just 3–5 minutes, significantly improving both efficiency and quality.
Meanwhile, digital technology also holds significant importance in the intervention of cognitive impairment. Given the scarcity of existing medical resources for cognitive impairment and the limitations and shortcomings of pharmacological interventions, digital technology can provide standardized services and expand service accessibility, thereby reducing the development cycle that would originally take more than a decade to just two to three years. This undoubtedly creates a win-win situation for all stakeholders.