Educational level and its Association with the domains of the Montreal Cognitive Assessment Test

Objective: To explore the association between educational level and the scores obtained in each of the domains of the Montreal Cognitive Assessment test. Methods: This is a secondary analysis of the SABE/2012 Bogotá survey; a cross-sectional study including 2000 subjects aged ≥60years. The MoCA test was the dependent variable and was stratified by cognitive domains, incorrect answers and scores were considered. Educational level was assessed through years of formal education. Age, sex and selected medical conditions were also included to adjust the multivariate models. Bivariate analyses, fitted logistic and linear regression models were employed for analyzing association between these variables. Results: The proportion of incorrect answers increased as schooling years decreased and as age increased. In the multivariate analysis, visuospatial and executive function were the most affected domains. Educational level displayed less influence than age on short memory-recall task (standardized beta 0.19 vs -0.24). Educational level showed a greater influence than age on no-memory tasks (the sum of all other domains; standardized beta 0.50 vs -0.29). Conclusions: It seems logical to consider that performance in most domains of the MoCA is influenced by years of education. Therefore, low scores on these tasks could lead to low total MoCA scores and thus to bias and over diagnosis of cognitive impairment in patients with lower educational levels. Memory-recall domain is not affected much by education and applying it separately could be useful in patients with low educational level in whom we suspect memory impairment.