Considering different Montreal Cognitive Assessment cutoff scores for older adults with asthma

Allergy Asthma Proc. 2024 Nov 1;45(6):e72-e80. doi: 10.2500/aap.2024.45.240045.

Abstract

Background: There is a greater prevalence of cognitive impairment among ethnic and/or racial minorities, and cognitive impairment is a barrier to asthma self-management (SM) behaviors and outcomes in older adults. Objective: The aim of this study was to examine the relationship between cognitive impairment, assessed by using the Montreal Cognitive Assessment (MoCA), and asthma SM behaviors and outcomes in a sample of predominantly Black and Latino participants. In addition, we evaluated whether using two different MoCA cutoff scores influenced the association between cognitive impairment and asthma outcomes. Methods: Baseline cross-sectional data were extracted from a longitudinal study of older adults with asthma (N = 165) ages ≥60 years. Cognition was assessed by using the MoCA. Asthma Control Questionnaire, asthma-related quality of life (AQOL), and inhaled corticosteroid (ICS) adherence were assessed by using self-report. ICS dosing was collected through chart review and inhaler technique was observed and rated. Results: Using established MoCA cutoff scores of 23 and 26 yielded 45% and 74% cognitive impairment rates, respectively. Cognitive impairment, defined by using the cutoff score of 23, was significantly associated with worse asthma control (p = 0.04) and worse ICS adherence (p = 0.01). With a cutoff score of 26, only AQOL was significantly associated with cognitive impairment (p = 0.03). Race and/or ethnicity moderated the relationship between cognitive impairment and asthma control with a MoCA cutoff score of 23, and between cognitive impairment and AQOL with a MoCA cutoff score of 26. Conclusion: Cognitive impairment in older adults with asthma is associated with important clinical outcomes, but this relationship is influenced by the cutoff score used to define cognitive impairment.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Aged
  • Aged, 80 and over
  • Asthma* / diagnosis
  • Asthma* / drug therapy
  • Cognitive Dysfunction* / diagnosis
  • Cognitive Dysfunction* / epidemiology
  • Cognitive Dysfunction* / etiology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Medication Adherence
  • Mental Status and Dementia Tests*
  • Middle Aged
  • Quality of Life*
  • Self-Management
  • Surveys and Questionnaires

Substances

  • Adrenal Cortex Hormones