Background
Methods
Study population
Cognitive assessment
Domains | MMSE | MoCA | ||
---|---|---|---|---|
Items/maximum scores | Cutoffs of dysfunction | Items/maximum scores | Cutoffs of dysfunction | |
Orientation | Orientation to time and place/10 | ≤9/10 | Orientation to time and place/6 | ≤5/6 |
Executive function | 3-step command test/3 | ≤3/4 | Trail-making test/1 | ≤5/6 |
Reading command test/1 | Digit span test/2 | |||
Verbal fluency/1 | ||||
Abstraction test/2 | ||||
Calculation | Serial 7 substractions/5 | ≤4/5 | Serial 7 substractions/3 | ≤2/3 |
Naming | Naming (pencil, cellphone)/2 | ≤1/2 | Naming (lion, giraffe, camel)/3 | ≤2/3 |
Repetition | 1 short sentence/1 | 0/1 | 2 longer sentences/2 | ≤1/2 |
Visuoconstructional skills | Copy intersecting pentagons/1 | 0/1 | Copy cube/1 | ≤3/4 |
Draw clock face/3 | ||||
Registration | Repeat 3 words/3 | ≤2/3 | ||
Recall | Recall 3 words/3 | ≤2/3 | Recall 5 words/5 | ≤4/5 |
Writing | Write a sentence/1 | 0/1 | ||
Attention | Vigilance test for number ‘1’/1 | 0/1 |
Sociodemographic and health-related characteristics
Statistical analysis
Results
Characteristics of study population
N (%) | Score of cognitive assessment | Positive screening for MCI | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
MMSE | p-value | MoCA | p-value | MMSE | MoCA | ||||||
mean ± SD | P50 (P25, P75) | mean ± SD | P50 (P25, P75) | n (%) | p-value | n (%) | p-value | ||||
Age group (years) | < 0.0001 | < 0.0001 | < 0.0001 | < 0.0001 | |||||||
55–64 | 2042 (41.5) | 26.5 ± 4.1 | 28 (25, 30) | 23.8 ± 5.5 | 25 (20, 29) | 496 (24.3) | 650 (31.8) | ||||
65–74 | 2004 (40.7) | 25.5 ± 4.7 | 27 (23, 29) | 22.5 ± 5.9 | 23 (19, 27) | 550 (27.5) | 708 (35.3) | ||||
75- | 877 (17.8) | 23.2 ± 6.0 | 24 (20, 28) | 20.0 ± 6.8 | 21 (15, 25) | 363 (41.4) | 423 (48.2) | ||||
Gender | < 0.0001 | < 0.0001 | 0.1478 | 0.5845 | |||||||
male | 2162 (43.9) | 26.0 ± 4.3 | 27 (24, 29) | 23.2 ± 5.5 | 24 (20, 28) | 596 (27.6) | 773 (35.8) | ||||
female | 2761 (56.1) | 25.1 ± 5.2 | 27 (22, 29) | 22.1 ± 6.5 | 23 (18, 28) | 813 (29.5) | 1008 (36.5) | ||||
Educational level | < 0.0001 | < 0.0001 | 0.1124 | 0.0004 | |||||||
below elementary school | 1554 (31.6) | 23.0 ± 5.9 | 24 (19, 28) | 19.4 ± 7.0 | 20 (14, 25) | 521 (33.5) | 545 (35.1) | ||||
elementary school | 1211 (24.6) | 25.8 ± 4.3 | 27 (24, 29) | 22.6 ± 5.5 | 23 (19, 27) | 228 (18.8) | 340 (28.1) | ||||
middle school | 1262 (25.6) | 26.9 ± 3.4 | 28 (25, 29) | 24.5 ± 4.7 | 25 (21, 29) | 425 (33.7) | 572 (45.3) | ||||
high school and above | 896 (18.2) | 27.5 ± 3.1 | 29 (26, 30) | 25.5 ± 4.0 | 26 (23, 29) | 235 (26.2) | 324 (36.2) | ||||
Current employment | < 0.0001 | < 0.0001 | 0.0046 | 0.0009 | |||||||
yes | 849 (17.3) | 26.2 ± 4.4 | 28 (25, 29) | 23.6 ± 5.8 | 25 (20, 28) | 209 (24.6) | 265 (31.2) | ||||
no | 4074 (82.8) | 25.4 ± 4.9 | 27 (23, 29) | 22.4 ± 6.1 | 23 (19, 28) | 1200 (29.5) | 1516 (37.2) | ||||
Monthly household income per capital (Chinese yuan) | < 0.0001 | < 0.0001 | < 0.0001 | < 0.0001 | |||||||
< 1000 | 1107 (22.5) | 23.1 ± 5.7 | 24 (20, 28) | 19.3 ± 6.3 | 20 (15, 24) | 458 (41.4) | 534 (48.2) | ||||
1000–3999 | 3015 (61.2) | 25.9 ± 4.5 | 27 (24, 29) | 23.0 ± 5.8 | 24 (19, 28) | 831 (27.6) | 1072 (35.6) | ||||
4000- | 801 (16.3) | 27.6 ± 3.2 | 29 (27, 30) | 25.8 ± 4.6 | 27 (23, 30) | 120 (15.0) | 175 (21.9) | ||||
Residence area | < 0.0001 | < 0.0001 | < 0.0001 | < 0.0001 | |||||||
urban | 1321 (26.8) | 27.5 ± 3.3 | 29 (26, 30) | 25.7 ± 4.5 | 27 (23, 30) | 261 (19.8) | 325 (24.6) | ||||
suburban | 1095 (22.2) | 26.7 ± 3.4 | 29 (28, 30) | 24.3 ± 4.7 | 25 (21, 28) | 228 (20.8) | 312 (28.5) | ||||
county town | 1183 (24.0) | 25.0 ± 5.3 | 27 (23, 29) | 21.5 ± 6.0 | 22 (18, 26) | 347 (29.3) | 482 (40.7) | ||||
village | 1324 (26.9) | 23.0 ± 5.5 | 24 (20, 27) | 19.1 ± 6.4 | 19 (15, 24) | 573 (43.3) | 662 (50.0) | ||||
Current smoking | 0.5812 | 0.3050 | 0.0261 | 0.0202 | |||||||
yes | 770 (15.6) | 25.7 ± 4.2 | 27 (23, 29) | 22.6 ± 5.5 | 23 (19, 27) | 246 (32.0) | 307 (39.9) | ||||
no | 4153 (84.4) | 25.5 ± 5.0 | 27 (23, 29) | 22.6 ± 6.2 | 23 (19, 28) | 1163 (28.0) | 1474 (35.5) | ||||
Alcohol intake | < 0.0001 | < 0.0001 | 0.2011 | 0.6954 | |||||||
yes | 843 (17.1) | 26.4 ± 3.8 | 28 (25, 29) | 23.6 ± 5.1 | 24 (20, 28) | 226 (26.8) | 300 (35.6) | ||||
no | 4080 (82.9) | 25.3 ± 5.0 | 27 (23, 29) | 22.4 ± 6.3 | 23 (18, 28) | 1183 (29.0) | 1481 (36.3) | ||||
Meeting sleep duration recommendation | < 0.0001 | < 0.0001 | 0.0049 | 0.0031 | |||||||
yes | 3346 (68.0) | 25.8 ± 4.8 | 27 (24, 29) | 22.9 ± 5.9 | 24 (19, 28) | 916 (27.4) | 1164 (34.8) | ||||
no | 1577 (32.0) | 25.0 ± 4.9 | 26 (22, 29) | 21.9 ± 6.3 | 23 (18, 27) | 493 (31.3) | 617 (39.1) | ||||
Hypertension history | < 0.0001 | < 0.0001 | < 0.0001 | < 0.0001 | |||||||
yes | 1567 (31.8) | 24.8 ± 5.4 | 26 (22, 29) | 21.6 ± 6.5 | 22 (18, 27) | 519 (33.1) | 628 (40.1) | ||||
no | 3356 (68.2) | 25.9 ± 4.5 | 27 (24, 29) | 23.0 ± 5.8 | 24 (19, 28) | 890 (26.5) | 1153 (34.4) | ||||
Diabetes history | 0.4925 | 0.5552 | 0.2211 | 0.2125 | |||||||
yes | 477 (9.7) | 25.5 ± 4.7 | 27 (23, 29) | 22.6 ± 5.8 | 23 (19, 27) | 148 (31.0) | 185 (38.8) | ||||
no | 4446 (90.3) | 25.5 ± 4.9 | 27 (23, 29) | 22.6 ± 6.1 | 23 (19, 28) | 1261 (28.4) | 1596 (35.9) | ||||
Stroke history | 0.6533 | 0.7690 | 0.7364 | 0.5581 | |||||||
yes | 96 (2.0) | 25.6 ± 4.5 | 27 (23, 29) | 22.9 ± 5.8 | 24 (19, 28) | 26 (27.1) | 32 (33.3) | ||||
no | 4827 (98.1) | 25.5 ± 4.9 | 27 (23, 29) | 22.6 ± 6.1 | 23 (19, 28) | 1383 (28.7) | 1749 (36.2) | ||||
Myocardial infarction history | 0.6396 | 0.8370 | 0.4333 | 0.4272 | |||||||
yes | 93 (1.9) | 25.6 ± 4.6 | 27 (23, 29) | 22.9 ± 5.4 | 24 (20, 26) | 30 (32.3) | 30 (32.3) | ||||
no | 4830 (98.1) | 25.5 ± 4.9 | 27 (23, 29) | 22.6 ± 6.1 | 23 (19, 28) | 1379 (28.6) | 1751 (36.3) | ||||
Depression | < 0.0001 | < 0.0001 | 0.0013 | 0.0293 | |||||||
yes | 424 (8.6) | 24.1 ± 5.7 | 26 (21, 29) | 21.2 ± 7.0 | 22 (16, 27) | 150 (35.4) | 174 (41.0) | ||||
no | 4499 (91.4) | 25.6 ± 4.7 | 27 (23, 29) | 22.7 ± 6.0 | 23 (19, 28) | 1259 (28.0) | 1607 (35.7) | ||||
Totala | 4923 (100) | 25.5 ± 4.9 | 27 (23, 29) | 22.6 ± 6.1 | 23 (19, 28) | 1409 (28.6) | 1781 (36.2) |
Comparison of cognitive assessment between MMSE and MoCA, and cognitive function by sociodemographic and health-related factors
MMSE | MoCA | ||
---|---|---|---|
MCI, n (%) | no MCI, n (%) | Total | |
MCI, n (%) | 1158 (23.5) | 251 (5.1) | 1409 (28.6) |
no MCI, n (%) | 623 (12.7) | 2891 (58.7) | 3514 (71.4) |
Total | 1781 (36.2) | 3142 (63.8) | 4923 (100.0) |
Subscores of cognitive domains assessed by MMSE and MoCA
Domains | MMSE | MoCA | ||||
---|---|---|---|---|---|---|
Items/maximum scores | mean ± SD | P50 (P25, P75) | Items/maximum scores | mean ± SD | P50 (P25, P75) | |
Orientation | Orientation to time and place/10 | 9.4 ± 1.4 | 10 (9, 10) | Orientation to time and place/6 | 5.5 ± 1.1 | 6 (5, 6) |
Executive function | 3-step command test/3 | 3.6 ± 0.9 | 4 (4, 4) | Trail-making test/1 | 3.7 ± 1.7 | 4 (2, 5) |
Reading command test/1 | Digit span test/2 | |||||
Verbal fluency/1 | ||||||
Abstraction test/2 | ||||||
Calculation | Serial 7 substractions/5 | 3.7 ± 1.7 | 5 (2, 5) | Serial 7 substractions/3 | 2.4 ± 0.9 | 3 (2, 3) |
Naming | Naming (pencil, watch)/2 | 1.9 ± 0.3 | 2 (2, 2) | Naming (lion, giraffe, camel)/3 | 2.7 ± 0.7 | 3 (3, 3) |
Repetition | 1 short sentence/1 | 0.9 ± 0.3 | 1 (1, 1) | 2 longer sentences/2 | 1.2 ± 0.8 | 1 (0, 2) |
Visuoconstructional skills | Copy intersecting pentagons/1 | 0.6 ± 0.5 | 1 (0, 1) | Copy cube/1 | 2.6 ± 1.4 | 3 (2, 4) |
Draw clock face/3 | ||||||
Registration | Repeat 3 words/3 | 2.7 ± 0.7 | 3 (3, 3) | na | na | |
Recall | Recall 3 words/3 | 2.3 ± 1.0 | 3 (2, 3) | Recall 5 words/5 | 3.0 ± 1.7 | 3 (2, 5) |
Writing | Write a sentence/1 | 0.5 ± 0.5 | 1 (0, 1) | na | na | |
Attention | na | na | Vigilance test for number ‘1’/1 | 0.6 ± 0.5 | 1 (0, 1) |
Potential factors associated with MCI risk detected by MMSE and MoCA
Predictors | MCI by MMSE | MCI by MoCA | ||||
---|---|---|---|---|---|---|
Coefficient β | Adjusted OR (95% CI) | p-value | Coefficient β | Adjusted OR (95% CI) | p-value | |
Age group (years) | ||||||
65–74 | 0.0916 | 1.096 (0.944, 1.273) | 0.2295 | 0.0840 | 1.088 (0.947, 1.249) | 0.2343 |
75- | 0.7291 | 2.073 (1.727, 2.489) | < 0.0001 | 0.6256 | 1.869 (1.570, 2.227) | < 0.0001 |
Gender (females) | 0.2472 | 1.280 (1.106, 1.485) | 0.0010 | 0.1508 | 1.163 (1.014, 1.334) | 0.0308 |
Current employment (yes) | −0.3203 | 0.726 (0.600, 0.876) | 0.0009 | −0.3386 | 0.713 (0.597, 0.849) | 0.0002 |
Monthly household income per capital (Chinese yuan) | ||||||
1000–3999 | − 0.3387 | 0.713 (0.608, 0.835) | < 0.0001 | − 0.2035 | 0.816 (0.700, 0.950) | 0.0089 |
4000- | −0.8954 | 0.408 (0.316, 0.526) | < 0.0001 | −0.6360 | 0.529 (0.420, 0.666) | < 0.0001 |
Residence area | ||||||
suburban | −0.0109 | 0.989 (0.805, 1.214) | 0.9172 | 0.1602 | 1.174 (0.974, 1.414) | 0.0917 |
county town | 0.3262 | 1.386 (1.132, 1.697) | 0.0016 | 0.6217 | 1.862 (1.546, 2.244) | < 0.0001 |
village | 0.9476 | 2.579 (2.125, 3.136) | < 0.0001 | 1.0012 | 2.721 (2.266, 3.273) | < 0.0001 |
Current smoking (yes) | 0.3169 | 1.373 (1.128, 1.669) | 0.0015 | 0.2535 | 1.288 (1.072, 1.548) | 0.0068 |
Meeting sleep duration recommendation (yes) | 0.0031 | 1.003 (0.871, 1.156) | 0.9658 | −0.0480 | 0.953 (0.835, 1.089) | 0.4785 |
Hypertension history (yes) | 0.2452 | 1.278 (1.113, 1.466) | 0.0005 | 0.1893 | 1.208 (1.061, 1.376) | 0.0044 |
Depression (yes) | 0.3821 | 1.465 (1.167, 1.836) | 0.0009 | 0.3000 | 1.350 (1.085, 1.676) | 0.0068 |