Labour market participation before and after dementia and MCI diagnosis: a Swedish register study

Background

Cognitive impairment can occur before normative retirement age, affecting adults during their prime working years. This study aims to examine labour market participation leading up to and following diagnosis among people diagnosed with mild cognitive impairment (MCI) or dementia before age 65 and, to assess the timing and pathways of labour market exit.

Methods

We conducted a matched cohort study using Swedish register data, including individuals aged 40–65 years with incident dementia or MCI and matched population references. Eligibility was assessed at baseline, defined as 11 years before diagnosis. Participants were required to be in paid employment (>50% income from work, and <50% sickness absence or disability pension (DP)). Follow-up continued until labour market exit (full‑time DP or old‑age pension (OAP)), death, or until end of study (31 December 2022). Associations were estimated using cause‑specific time-dependent Cox models, and restricted mean survival time was calculated over 22 years.

Results

Individuals with dementia and MCI showed significantly higher risks of labour market exit than matched references, particularly around the time of diagnosis. Risk for DP was already elevated 11 to 5 years before diagnosis (dementia HR 2.24; MCI HR 2.20), increased further in the 5 years before diagnosis (HR 4.62 and 3.90), and peaked 0–5 years after diagnosis (HR 96.53 and 35.13), after which it declined but remained elevated. Risks of OAP increased both 0–5 and 5–10 years post‑diagnosis (dementia HR 1.56–1.61; MCI HR 1.28–1.31). Mean survival time showed substantially reduced time to exit when compared to matched references: DP -7.36 years (dementia) and -3.18 years (MCI); OAP -0.87 and -0.32, respectively.

Conclusions

Dementia and MCI during working age are associated with vulnerability in labour market participation long before diagnosis, driven largely by a sharply increased risk of disability pension around diagnosis.

Key messages

• Labour market exit risk is elevated among people with cognitive impairment even before diagnosis, pointing to missed opportunities for earlier identification, workplace adaptation, and policy support.

• MCI represents a critical window for intervention, as labour market vulnerability emerges early, suggesting potential for targeted workplace measures to prolong employment.