A total of 144 patients aged 65 years and older were recruited. Of these patients, 6 (4.2%) declined to participate in the study and 5 (3.5%) were excluded from the final cohort. Of the 133 patients included in the study, 46 (34.6%) had a MoCA score below the cut-off of 23, indicating certain level of cognitive impairment (Table 1). Thirty-three participants (24.8%) were in the MCI category. The mean MoCA score was 23.24 (min: 9, max: 30).
Table 1
Levels of cognitive function classified by MoCA scores and number of patients (n = 133) found in each classification
MoCA Classification | Number of patients (percentage) |
No Cognitive Impairment (≥ 23) | n = 87 (65.4%) |
Mild Cognitive Impairment (18–22) | n = 33 (24.8%) |
Mild Dementia (11–17) | n = 10 (7.5%) |
Moderate Dementia (6–10) | n = 3 (2.3%) |
Severe Dementia (< 6) | n = 0 (0%) |
The average age of our cohort was 75.19 years (range: 65–93 years). There were 75 females (56.4%) and 58 males (43.6%). The average years of education was 12.64 years (range: 0–18 years). Ninety-two participants (69.2%) received the MoCA in a version concordant with their first language (English or Mandarin). Other participants reported a first language other than English or Mandarin, including 8 European languages, 7 Asian/Southeast Asian languages, and 2 African languages. Mean MoCA score was relatively lower in the oldest age group, and mean MoCA score was also relatively lower in the language discordant group (Table 2). In our cohort, 98 participants (73.7%) had hypertension, 49 (30.8%) had diabetes, 85 (63.9%) had hypercholesterolemia, 16 (12.0%) had depression or other psychiatric disorders, and 3 (2.26%) had known family history of dementia.
Table 2
MoCA scores categorized by age, gender, and years of education
Demographic characteristics | Number of patients (percentage) | Mean MoCA score (+/- SD) |
Age (years) | | |
65–74 | 63 (47.4%) | 23.16 ± 4.136 |
75–84 | 59 (44.4%) | 23.66 ± 4.671 |
≥ 85 | 11 (8.3%) | 21.45 ± 6.669 |
Gender | | |
Female | 75 (56.4%) | 23.30 ± 4.878 |
Male | 58 (43.6%) | 23.16 ± 4.280 |
Education in years | | |
≤ 12 | 64 (49.14%) | 22.41 ± 5.401 |
13–15 | 37 (19.83%) | 23.54 ± 3.548 |
≥ 16 | 32 (31.03%) | 24.56 ± 3.689 |
Language (test version = mother tongue or the most fluent language) | | |
Y (concordant) | 92 (69.2%) | 23.99 ± 4.356 |
N (discordant) | 41 (30.8%) | 21.56 ± 4.801 |
Using independent t-test analysis, there was no significant difference in MoCA scores between males and females (p = 0.678), with or without DM (p = 0.057), with or without hypercholesterolemia (p = 0.893), with or without depression or other psychiatric disorder (p = 0.058), and with or without family history of dementia (p = 0.272). There is borderline statistical significance in the MoCA scores between participants with or without hypertension (p = 0.047). However, the p values in the analysis of hypertension (p = 0.047), DM (p = 0.057), and mental health issues (p = 0.058) were all minimally above or below the statistically significant cut point of p < 0.05 which may be affected by a much larger sample size. Nonetheless, significant difference was noted between participants who received the MoCA with a language version concordant versus not in concordance with the test-takers’ first language (p < 0.005).
Using one-way ANOVA, we found that there was no significant difference in MoCA scores among different age groups (p = 0.343). Though the ≥ 85 years age group had a slightly lower mean MoCA score, Post Hoc tests did not identify significant difference (p = 0.261 vs 75–84 years age group, and p = 0.148 vs 65–74 years age group). Among different education level groups, Post Hoc tests showed a statistical difference between the participants with ≤ 12 years of education versus ≥ 16 years of education (p = 0.031). There was no significant difference between other comparisons among different education level groups.
Using two-way ANOVA, we saw no significant difference among the different age groups stratified by education level, and no interaction between the age and education level. Significant difference was between different language groups (p < 0.001), and there was significant interaction of the language factor on the age groups (p = 0.021), mostly with the ≥ 85 years age group. There was significant difference in MoCA scores among different education groups (p = 0.011) and language factors (p = 0.007). There was no significant interaction of language with education level (p = 0.211).