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

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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.
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Keywords: cognition; dementia; epidemiology; geriatric assessment; older adults; population

Document Type: Research Article

Affiliations: 1: Department of Supportive Care Medicine, City of Hope Medical Center, Duarte, CA 2: Department of Medicine, Brigham and Women’s Hospital, Harvard University, Boston, MA 3: Vitas Hospice, Miami, FL 4: Departments of Public Health Sciences 5: College of Arts and Sciences, Northeastern Illinois University 6: Otolaryngology 7: NORC at the University of Chicago, Chicago, IL 8: Sociology 9: Comparative Human Development and Institute for Mind and Biology, University of Chicago

Publication date: July 1, 2018

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