Risk of Fall-Related Injuries in Patients with MCI: A Nationwide Cohort Study

Background

Mild Cognitive Impairment (MCI) is a prodromal dementia phase linked to cognitive decline and neuromotor impairments like gait variability. While fall-related injuries create significant burdens, long-term evidence in MCI remains limited. This study estimated cumulative probabilities and identified risk determinants for fall-related injuries using a nationwide database.

Methods

This nationwide retrospective cohort study used NHIS–NHID claims data (2010–2022). Following a washout period, 82,934 newly diagnosed MCI patients (age > = 45) were followed for up to 2,190 days. Injuries were defined via ICD-10 codes (W00–W19) and major trauma codes. Kaplan-Meier and Cox regression models were used to analyze cumulative probabilities and risk factors.

Results

Overall, 24.08% (n = 19,970) experienced fall-related injuries. The cumulative probability rose from 10.6% at 1 year to 36.0% at 6 years. Multivariate analysis identified significant predictors: female sex (HR = 1.243, p < .0001), older age (HR = 1.029, p < .0001), CCI > = 3 (HR = 1.444, p < .0001), long-term care insurance eligibility (HR = 1.432, p < .0001), and Grade 2 disability (HR = 1.211, p < .0001). Low income (HR = 1.045) and regional factors (HR = 1.076) also increased risk.

Conclusions

Fall-related injuries represent a critical long-term clinical trajectory among patients with MCI, affecting over one-third of patients within six years of diagnosis. MCI management should extend beyond cognitive monitoring to include fall prevention and physical function preservation. High-risk groups, including women, older adults, and patients with multiple comorbidities or disabilities, should be prioritized for regular fall-risk assessment and tailored preventive interventions within dementia prevention and community-based integrated care systems.

Key messages

• Falls are a clinical trajectory for MCI; risk grows from 10.6% to 36% in 6 years. This confirms injuries are consequences of disease progression rather than random, isolated accidents.

• MCI care must shift beyond cognitive monitoring to screen high-risk groups like women. Integrated prevention is vital to preserve functional independence and reduce healthcare burden.