Clinical Manifestations.

Area of Science:

• Neuroscience
• Gerontology
• Public Health

Background:

• Cognitive screening tools aim for reliable detection of cognitive impairment.
• Black American (BA) and Hispanic/Latino (H/L) adults often score lower on these tools due to demographics and social determinants of health (SSDoH).
• This study examined Montreal Cognitive Assessment (MoCA) performance in diverse, cognitively normal adults to understand misclassification factors.

Purpose of the Study:

• To characterize MoCA performance in ethnoracially diverse, cognitively normal adults.
• To identify sociodemographic and biological factors contributing to potential misclassification of cognitive impairment.
• To evaluate the impact of adjusted MoCA cutoffs for BA and H/L subgroups.

Main Methods:

• 105 cognitively normal BA and H/L participants underwent neurological assessment, neuropsychological testing, and neuroimaging (MRI, amyloid- and tau-PET).
• Demographically adjusted MoCA cutoffs were applied: ≤22 for BA and ≤24 for H/L.
• Hierarchical logistic regression analyzed predictors of low MoCA scores, including age, education, Area Deprivation Index (ADI), and amyloid burden.

Main Results:

• 40% of H/L and 17% of BA participants scored below demographically adjusted MoCA cutoffs.
• For H/L, age, education, ADI, and amyloid burden best predicted low MoCA scores (R²=0.43).
• For BA, age, education, and ADI were the main predictors (R²=0.47), with education approaching significance.

Conclusions:

• Sociodemographic factors continue to influence MoCA performance in cognitively normal individuals, even with adjusted cutoffs.
• These factors differentially affect BA/AA and WH/L participants.
• Clinical and research settings must carefully consider these factors to avoid overdiagnosing cognitive impairment in diverse populations.