MoCA Scores Vary by Sex-Linked Factors in CVD Study

Key Takeaways

• Among patients with cardiovascular diseases, older age was associated with lower MoCA scores in both sexes; hypertension was associated with lower scores in unadjusted analyses, but not significantly in males after multiple-comparison correction.
• Depression, dyslipidemia, higher BMI, and fewer years of education were associated with lower MoCA scores only among female participants. After multivariable adjustment, only age and years of education remained significant predictors among female participants.
• Mean MoCA scores did not differ significantly between male and female participants in the same age groups.

Cognitive testing among people with cardiovascular diseases takes place against shared risk factors for cardiovascular disease and cognitive decline. Which characteristics accompany lower scores is separate from whether similarly aged women and men have different average scores. Both questions require examining cognitive performance alongside patient characteristics and age.

Prentakis and colleagues conducted a cross-sectional Brain Sciences study of cognitive performance in cardiovascular disease involving 246 patients with cardiovascular diseases. They assessed cognition with the Montreal Cognitive Assessment (MoCA) and evaluated risk factors, comorbid depression and anxiety disorders, and frailty scores. Investigators stratified participants by sex and age to compare cognitive performance across groups and examine characteristics associated with scores within each sex.

Older age was associated with lower MoCA scores in both sexes. Hypertension was associated with lower scores in unadjusted analyses, although the association in males did not remain significant after multiple-comparison correction, and hypertension was not significant in either sex after multivariable adjustment. Among female participants, depression (diagnosis or PHQ-4 symptoms), dyslipidemia, higher body mass index (BMI), and fewer years of education were also associated with lower MoCA scores in unadjusted analyses; after multivariable adjustment, only age and years of education remained significant predictors.

Mean MoCA scores did not differ statistically significantly between male and female participants within the same age groups. This comparison of group averages is distinct from the associations between patient characteristics and scores within each sex.

Because the data are cross-sectional, lower scores reflect measured associations rather than evidence that any factor caused cognitive impairment or that cognition declined over time. An association reported among female participants but not male participants does not, by itself, demonstrate a statistically significant difference in that association between sexes. These findings do not establish different cognitive screening or treatment approaches by sex; the authors suggest that sex-specific approaches may warrant consideration in future clinical guidance.

The authors conclude that shared risk factors and sex-stratified patterns may both be relevant when considering cognitive performance in patients with cardiovascular diseases.

Clinician Questions

Were anxiety disorders or frailty linked to lower MoCA scores in patients with cardiovascular disease?

Higher frailty scores correlated with lower MoCA scores in female participants (r = −0.20, p = 0.019) but not males; frailty was not a significant predictor after multivariable adjustment. No association between anxiety disorders and MoCA scores was reported.

How large were the MoCA score associations with cardiovascular risk factors in patients with cardiovascular disease?

In sex-stratified multivariable regression, each additional year of age was associated with a 0.052-point (males) and 0.057-point (females) lower MoCA score; each additional year of education was associated with a 0.230-point higher score in females only. Unadjusted correlations between age and MoCA were r = −0.36 (males) and r = −0.45 (females).