Educational attainment and Montreal Cognitive Assessment performance among adults in southern Ecuador

Objective To examine educational differences in Montreal Cognitive Assessment performance in a community health project in southern Ecuador. Results The analysis included 174 adults recruited by convenience sampling. Median raw scores were 19.0, 23.0, and 25.0 for primary, secondary, and higher education, respectively (Kruskal–Wallis H(2) = 36.65; p < 0.001). In linear regression with heteroscedasticity-consistent standard errors, primary education was associated with a 5.30-point lower score than higher education after adjustment for age and recorded gender (95% confidence interval − 7.22 to − 3.37). The corresponding difference for secondary education was − 1.83 points (− 3.68 to 0.02). Using the education correction recorded in the dataset, 137 of 174 participants (78.7%) scored below 26. The primary–higher difference persisted in sensitivity analyses, while the secondary–higher comparison varied across specifications. These findings support considering educational context when interpreting screening scores. They do not establish cognitive decline or the prevalence of clinically diagnosed cognitive impairment.