Cognitive impairment and labour market participation: trends in MCI and dementia in Sweden 2005–2022

Background

Longer life expectancy and extended working lives mean that more people remain employed at ages with increasing risk of cognitive impairment. Early‑onset dementia and mild cognitive impairment (MCI) may therefore increasingly affect employment participation and social insurance systems, yet population‑based evidence for individuals below retirement ages in Sweden remain limited.

Methods

Swedish register data were used to estimate annual incidence and prevalence of dementia and MCI diagnoses among adults aged 30–65 years, between 2005 and 2022. Employment indicators - based on main source of income - were income from work, sickness absence (SA), disability pension (DP), unemployment, old-age pension (OaP) and other benefits. Proportions were calculated for each category.

Results

The annual incidence of diagnosed dementia declined from 0.29% in 2005 to 0.18% in 2022, whereas diagnosed MCI incidence increased significantly, from 0.38% to 1.18%. In the same period, dementia prevalence rose modestly from 0.10% to 0.13%, while MCI prevalence increased, from 0.16% to 0.85%. For dementia patients, the most common income source was DP though declining from 65.6% to 48.9%, while income from work increased from 12.3% to 20.9%. Marginal increases were observed in OaP and SA, while unemployment and other benefits remained stable. Employment trends in the MCI cohort were similar but more pronounced: DP declined from 44.1% to 22.7%, while paid work increased from 32.0% to 46.7%, becoming the most common status by 2022. Other employment indicators showed minimal change.

Conclusions

Diverging trends in dementia and MCI diagnoses may be partly explained by improvements in population health and by earlier identification of cognitive impairment at the MCI stage. Employment trends indicate that some individuals with MCI remain economically active around the time of diagnosis, whereas employment participation tends to be much lower among those with dementia.

Key messages

• Rising MCI incidence alongside declining dementia incidence suggests shifts in diagnosis, detection, and disease management, with important public‑health implications for working‑age populations.

• Around diagnosis, many people with MCI remained employed, whereas those with dementia exit employment faster, underscoring the need for early detection and support.