P4–242: The effect of education and literacy on performance on the Montreal Cognitive Assessment among cognitively normal elderly

The Montreal Cognitive Assessment (MoCA) is a cognitive screening instrument for mild cognitive impairment (Nasreddine et al., 2005). Education and literacy status may contribute to test performance affecting diagnostic accuracy. This study aimed to assess education and literacy effect on the MoCA performance among cognitively normal elderly. The healthy volunteer aged 60–90 years who had Clinical Dementia Rating scale of 0.0 and did not have mental and physical disorders affecting cognitive status were recruited from the community of Bangkok metropolitan region of Thailand. They were divided to illiterate (E1; n = 33), 4 years (E2; n=32) and more than 4 years of education (E3; n=28) group. The MoCA was administered by well-trained physicians. The ANOVA was used to compare the mean scores of MoCA sub-items among three groups. There was no significant difference of age among three groups (means 69.71 ± 5.05 years; F(2,90)=0.49, p=.61). For the MoCA sub-item performance, three-education group differences (E1 vs E2 vs E3) or high-low educated group differences (E3 vs E2 and/or E1) were found in trail-B, cube copy, clock drawing test, abstraction, repetition, letter fluency, delayed recall and total MoCA scores. The literate-illiterate group differences (E3 and/or E2 vs E1) were reported in naming, digit forwards, digit backwards, vigilance test, serial-7 subtraction and total orientation score and its sub-items (date, month, year). There was no significantly different performance in day, place and province orientation. The literacy effects, regardless of education level, were found on language-related and attention/working memory-required tasks. While the tasks assessing executive, memory, visuo-spatial function were performed better among higher educated elderly. Education and literacy status should be considered while interpreting the MoCA results performed by education-limited population. Moreover, the suitable cognitive screening test for illiterate and low educated elderly should be developed.