The focus of dementia prevention and management is shifting to the mild cognitive impairment (MCI) stage. This change is driven by government initiatives to identify and manage at-risk groups before dementia onset, coupled with advances in early diagnostic technologies like blood tests. However, experts caution that we must ensure adequate treatment and management options are available for patients following early diagnosis.
A key concern is the ongoing clinical re-evaluation of choline alfoscerate, a drug prescribed to MCI patients for over two decades. This raises questions about how to maintain medication options while expanding early diagnosis efforts.
The government is pushing to make mild cognitive impairment the new starting point for dementia prevention. In February, the Department of Health and Human Services unveiled its 5th Comprehensive Dementia Management Plan (2026-2030), outlining a strategy to implement proactive prevention measures beginning at the MCI diagnosis stage.
This approach aims to go beyond simply providing care after dementia onset, focusing instead on managing at-risk groups before the disease develops. The plan includes developing specialized diagnostic tools for use in memory care centers to better identify MCI, as well as strengthening support systems through initiatives like distributing self-management guides.
MCI is characterized by a decline in cognitive functions while maintaining relatively normal daily living skills. An estimated 3 million Koreans are affected by MCI. While not all cases progress to dementia, some individuals may eventually develop the condition. Early interventions such as exercise, cognitive training, and managing vascular risk factors are crucial.
This shift reflects a broader change in the government’s dementia strategy, moving from a focus on patient care to emphasizing prevention and management before dementia onset.
Blood Tests Now Detect Alzheimer’s-Related Markers, Making Early Diagnosis More Accessible
Advances in diagnostic technology are also contributing to earlier dementia management. Recent developments have led to blood-based tests that can identify Alzheimer’s-related biomarkers through simple blood draws.
Last year, the U.S. Food and Drug Administration (FDA) approved a blood test that measures levels of phosphorylated tau protein (pTau217) and beta-amyloid to assess Alzheimer’s-related amyloid pathology. This new method could significantly improve access to diagnostics compared to previous techniques like amyloid positron emission tomography scan (PET) scans or spinal fluid analysis.
Korean healthcare companies are working to introduce blood-based Alzheimer’s biomarker tests and establish related services. Ongoing research aims to develop additional biomarkers and diagnostic tools for early detection.
These technologies are expected to help pinpoint the causes of cognitive decline and more accurately identify those at risk for dementia. However, experts caution that test results alone cannot definitively predict dementia onset, emphasizing the need for comprehensive management and treatment tailored to each patient’s condition.
As early diagnosis expands, the re-evaluation of choline alfoscerate introduces new variables.
Choline alfoscerate has long been a go-to oral medication for MCI patients. Prescribed for over 20 years to individuals with MCI and dementia, it’s currently undergoing a clinical re-evaluation by the Ministry of Food and Drug Safety. The agency will review recent trial data to determine whether to maintain the drug’s approval for MCI treatment.
A 48-week clinical trial conducted for this re-evaluation failed to meet predefined statistical criteria for primary efficacy across all patients. However, among participants who strictly followed the trial protocol and medication guidelines, the choline alfoscerate group showed significantly higher rates of maintained or improved cognitive function compared to the placebo group.
Real-world evidence is also emerging. A large-scale cohort study of approximately 510,000 MCI patients, published in 2025, found that those taking choline alfoscerate had a 10.1% lower risk of progressing to Alzheimer’s dementia and a 16.8% lower risk of vascular dementia compared to non-users. However, as an observational study, it cannot definitively prove a causal relationship between the medication and reduced dementia risk.
Medical experts argue that the re-evaluation process should consider not only clinical trial results but also long-term prescription data and large-scale cohort analyses from real-world clinical settings.
A leading neurologist emphasized that identifying MCI patients earlier is a crucial step forward. To fully realize the potential of early diagnosis and prevention strategies, it must ensure that a range of management and treatment options are available, tailored to each patient’s specific needs and underlying causes.