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Cognitive Function and its Risk Factors Among Older US Adults Living at Home

Dale, William, MD, PhD*; Kotwal, Ashwin A., MD, MS; Shega, Joseph W., MD; Schumm, L. Philip, MA§; Kern, David W., PhD; Pinto, Jayant M., MD; Pudelek, Kelly M., BA#; Waite, Linda J., PhD**; McClintock, Martha K., PhD††

Alzheimer Disease & Associated Disorders: July-September 2018 - Volume 32 - Issue 3 - p 207–213
doi: 10.1097/WAD.0000000000000241
Original Articles

Background: The Montreal Cognitive Assessment (MoCA) has not been administered to a representative national sample, precluding comparison of patient scores to the general population and for risk factor identification.

Methods: A validated survey-based adaptation of the MoCA (MoCA-SA) was administered to a probability sample of home-dwelling US adults aged 62 to 90, using the National Social Life, Health, and Aging Project (n=3129), yielding estimates of prevalence in the United States. The association between MoCA-SA scores and sociodemographic and health-related risk factors were determined.

Results: MoCA-SA scores decreased with age, and there were substantial differences among sex, education, and race/ethnicity groups. Poor physical health, functional status, and depression were also associated with lower cognitive performance; current health behaviors were not. Using the recommended MoCA cut-point score for Mild Cognitive Impairment (MoCA score <26; MoCA-SA score <17), 72% (95% confidence interval, 69% to 74%) of older US adults would be classified as having some degree of cognitive impairment.

Conclusions: Our results provide an important national estimate for interpreting MoCA scores from individual patients, and establish wide variability in cognition among older home-dwelling US adults. Care should be taken in applying previously-established MoCA cut-points to the general population, especially when evaluating individuals from educationally and ethnically diverse groups.

*Department of Supportive Care Medicine, City of Hope Medical Center, Duarte, CA

Department of Medicine, Brigham and Women’s Hospital, Harvard University, Boston, MA

Vitas Hospice, Miami, FL

Departments of §Public Health Sciences

Otolaryngology

**Sociology

††Comparative Human Development and Institute for Mind and Biology, University of Chicago

College of Arts and Sciences, Northeastern Illinois University

#NORC at the University of Chicago, Chicago, IL

Supported by funding for MERIT Award R37 AG030481 (PI: Waite) from the National Institute on Aging, and from the National Institutes of Health, including the National Institute on Aging, the Office of Women’s Health Research, the Office of AIDS Research, the Office of Behavioral and Social Sciences Research, and the National Institute on Child Health and Human Development for the National Health, Social Life, and Aging Project (NSHAP R01AG021487, R37AG030481) and the NSHAP Wave 2 Partner Project (R01AG033903). The National Social Life, Health, and Aging Project is supported by the National Institutes of Health, including the National Institute on Aging, the Office of Women’s Health Research, the Office of AIDS Research, and the Office of Behavioral and Social Sciences Research (R01AG021487, R37AG030481; R01AG033903).

The authors declare no conflicts of interest.

Reprints: William Dale, MD, PhD, Department of Supportive Care Medicine, City of Hope Medical Center, 1500 East Duarte Road, Northwest B-5 Office, Duarte, CA 91010 (e-mail: wdale@coh.org).

Received March 24, 2017

Accepted December 10, 2017

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