Undiagnosed cognitive impairment and willingness to seek help: Community-representative study from Singapore

ABSTRACT This study challenges the assumption that undiagnosed cognitive impairment (CI) is driven primarily by patient-level barriers like poor awareness. In a population-weighted cohort of 1,856 older Singaporeans, CI prevalence was 24.7% (95%CI 18.8–31.8); yet the undiagnosed rate was high (81.4%, 95%CI 65.6–90.9), especially for mild CI (97.9%, 95%CI 94.1–99.3). This diagnostic gap persisted despite high symptom awareness (81.3%, 95%CI 63.6–91.5) and help-seeking intent (63.3%, 95%CI 47.5–76.7), with informants becoming key as CI worsened. Findings suggest successful public health campaigns have shifted the bottleneck from community awareness to healthcare system capacity, creating an opportunity for a policy shift to meet rising demand for diagnosis—by empowering primary care with efficient case-finding tools, formalizing integrated diagnostic pathways, and establishing channels for family informants’ involvement. From these findings, we conceptualized a ‘paradox of success’ model, providing a framework for other health systems to adapt policy as public engagement grows.