Accuracy of the Mini-Mental State Examination and Montreal Cognitive Assessment in Detecting Cognitive Impairment in Older Adults: A Comparative Study Adjusted for Educational Level

Early detection of cognitive decline in older adults is essential for implementing timely interventions. This study aimed to compare the accuracy of the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in identifying cognitive impairment in community-dwelling older adults, while considering the effect of educational level. A cross-sectional, analytical study was conducted with 101 individuals aged 60 years or older, classified into cognitively intact and cognitively impaired non-demented (CIND) groups. Cognitive performance was assessed using the MMSE and MoCA, and the results were adjusted for years of schooling. Diagnostic accuracy was analyzed using Receiver Operating Characteristic (ROC) curves. The MoCA showed superior performance compared to the MMSE, with a significantly larger area under the ROC curve (AUC = 0.861 vs. 0.782; p = 0.037), particularly among participants with ≤ 8 years of education. These findings suggest that the MoCA is more sensitive in detecting early cognitive impairment and should be considered a preferable screening tool in clinical and research settings, especially in populations with heterogeneous educational backgrounds.