title: Global cortical atrophy (GCA) associates with worse performance in the Montreal Cognitive Assessment (MoCA). A population-based study in community-dwelling elders living in rural Ecuador.
abstract: OBJECTIVE
  Increasing numbers of individuals with cognitive impairment are posing economic threads to the developing world. Proper assessment of this condition may be complicated by illiteracy and cross-cultural factors. We conducted a population-based study in elders living in rural Ecuador to evaluate whether the MoCA associated with structural brain damage in less-educated populations.
  
  
  METHODS
  Atahualpa residents aged ≥60 years were identified during a door-to-door survey and invited to undergo MRI for grading GCA. Using a multivariate generalized linear model, we evaluated whether MoCA scores correlates with GCA, after adjusting for demographics, education, cardiovascular health (CVH) status, depression and edentulism.
  
  
  RESULTS
  Out of 311 eligible persons, 241 (78%) were enrolled. Mean age was 69.2±7.5 years, 141 (59%) were women, 199 (83%) had primary school education, 175 (73%) had poor CVH status, 30 (12%) had symptoms of depression and 104 (43%) had edentulism. Average MoCA scores were 18.5±4.7 points. GCA was mild in 108, moderate in 95, and severe in 26 persons. Total and most domain-specific MoCA scores were significantly worse in persons with moderate to severe GCA. In the multivariate model, mean MoCA score was associated with GCA severity (β=2.38, SE=1.07, p=0.027).
  
  
  CONCLUSIONS
  MoCA scores associate with severity of GCA after adjusting for potential confounders, and may be used as reliable estimates of structural brain damage. However, a lower cut-off than that recommended for developed countries, would be better for recognizing cognitive impairment in less educated populations.
authors.affiliation: School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador; Department of Neurology, Hospital-Clínica Kennedy, Guayaquil, Ecuador. Electronic address: oscardelbrutto@hotmail.com.
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Del Brutto
authors.affiliation: Gastroenterology Department, Vanderbilt University, Nashville, TN, United States.
authors.forename: Robertino M
authors.initials: RM
authors.lastname: Mera
authors.affiliation: Community Center, The Atahualpa Project, Atahualpa, Ecuador.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Zambrano
authors.affiliation: Community Center, The Atahualpa Project, Atahualpa, Ecuador.
authors.forename: Francisco
authors.initials: F
authors.lastname: Soriano
authors.affiliation: Department of Imaging, Hospital-Clínica Kennedy, Guayaquil, Ecuador.
authors.forename: Julio
authors.initials: J
authors.lastname: Lama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001927:Brain Diseases / Q000208:ethnology / Q000473:pathology* / Q000523:psychology; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology; D004484:Ecuador; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D011159:Population Surveillance / Q000379:methods; D011569:Psychiatric Status Rating Scales; D012111:Residence Characteristics; D012424:Rural Population
keywords: Atahualpa project; Ecuador; Global cortical atrophy; Montreal cognitive assessment; Population-based study