Age-friendly environments and incident motoric cognitive risk syndrome in older adults: A prospective cohort study.

INTRODUCTION: Motoric cognitive risk syndrome (MCR) is a predementia condition that predicts multiple adverse health outcomes. Age-friendly environments (AFE) represent a key strategy for promoting healthy aging and may reduce MCR risk. However, little is known about the association between AFE status and MCR risk. METHODS: This prospective cohort study used data from the National Health and Aging Trends Study. AFE status was assessed across eight domains based on the World Health Organization (WHO) framework. MCR was evaluated annually from 2011 to 2019. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs); restricted cubic spline regressions were used to examine dose-response relationships. RESULTS: A total of 7,608 older adults (mean age: 76.81 ± 7.53 years; 57.32% female) without baseline MCR were included. Over a median follow‑up of 4 years, 801 incident MCR cases occurred. Compared with participants in the lowest quartile (Q1) of AFE scores, those in Q3 (HR 0.75, 95% CI: 0.61-0.91) and Q4 (HR 0.62, 95% CI: 0.50-0.78) had significantly lower MCR risks. Additionally, a dose-response association was observed between higher AFE scores and lower risk of incident MCR (HR 0.96, 95% CI: 0.94-0.98). DISCUSSION: AFE was associated with a decreased risk of incident MCR among older adults. These findings suggest that creating AFE may be a feasible population‑based strategy to delay pre‑dementia syndromes, thereby contributing to dementia prevention.