The Montreal Cognitive Assessment (MoCA) in a population-based sample of Turkish migrants living in Germany

Figures & data

Table 1. Sociodemographic, lifestyle and medical characteristics of the study sample (282 Berliners with Turkish roots)

Characteristics of study participants	Total (n = 282)
Age (mean ± standard deviation)	42.3 ± 11.9
	n (%)
Sex
Male	141 (50.0)
Female	141 (50.0)
Preferred language for Montreal Cognitive Assessment (MoCA)
German	142 (50.4)
Turkish *	140 (49.6)
Missing	0 (0)
Nationality
German	115 (40.8)
Turkish	167 (59.2)
Missing	0 (0)
Migration generation
First generation	196 (75.4)
Second generation	64 (24.6)
Missing	22 (7.8)
Chronic diseases (diagnosed by physician)
Arterial hypertension
No	194 (68.8)
Yes	62 (22.0)
Missing	26 (9.2)
Diabetes
No	216 (76.6)
Yes	27 (9.6)
Missing	39 (13.8)
Educational level
≤ 9 years	101 (35.8)
10–12 years	93 (33.0)
> 12 years	53 (18.8)
Missing	35 (12.4)
Bodyweight classified according to NRC standards (adjusted for sex and age)**
Underweight	7 (2.5)
Normal	115 (40.8)
Overweight	101 (35.8)
Obese	53 (18.8)
Smoking status
current smoker	128 (45.4)
non- or ex-smoker	146 (51.8)
Missing	8 (2.8)
Work status
currently not employed	109 (38.7)
currently employed	151 (53.5)
Missing	22 (7.8)
Physical activity
<150 min physical activity/week	207 (73.4)
≥150 min physical activity/week	36 (12.8)
Missing	39 (13.8)
Total	282 (100)

*including n = 20 who mixed Turkish and German.

**NRC = National Research Council (USA); optimal BMI of 19–24 kg/m² (19–24 years), 20–25 kg/m² (25–34 years), 21–26 kg/m² (35–44 years), 22–27 kg/m² (45–54 years), 23–28 kg/m² (55–64 years) and 24–29 kg/m² (≥65 years).

Table 2. Montreal Cognitive Assessment (MoCA) sum scores with adjustment for educational level.

MoCA sum scores	Participants n	Mean ± SD	Participants with maximal score n (%)
Raw sum score	282	23.3 ± 4.3	6 (2.1)
Raw sum score +1 point*	194	24.6 ± 3.6	12 (4.3)
Raw sum score +2 points**	93	25.0 ± 3.5	13 (4.6)

*education 10–12 years.

**education 9 years or less.

Table 3. Distribution of Montreal Cognitive Assessment (MoCA) sum scores of 247 participants by educational level and age group.

MoCA sum score
	Educational level
	≤ 9 years		10–12 years		> 12 years		Total
Age in years	Mean ± SD (participants)	Median	Mean ± SD (participants)	Median	Mean ± SD (participants)	Median	Mean ± SD (participants)	Median
20–25	24.0 ± 2.8 (n = 6)	24.5	25.0 ± 2.1 (n = 6)	24.5	27.4 ± 1.7 (n = 13)	28.0	26.0 ± 2.4 (n = 25)	26.0
26–30	24.7 ± 5.2 (n = 6)	25.0	25.3 ± 3.0 (n = 6)	25.5	26.4 ± 1.8 (n = 11)	27.0	25.6 ± 3.1 (n = 23)	26.0
31–35	23.8 ± 2.7 (n = 11)	25.0	25.2 ± 2.8 (n = 13)	25.0	27.3 ± 2.2 (n = 4)	28.0	24.5 ± 3.2 (n = 28)	25.0
36–40	23.7 ± 2.9 (n = 16)	24.0	24.1 ± 3.2 (n = 21)	24.0	27.3 ± 1.3 (n = 4)	27.0	23.7 ± 4.4 (n = 41)	24.0
41–45	23.7 ± 2.8 (n = 12)	23.5	25.8 ± 2.4 (n = 16)	26.0	25.8 ± 2.9 (n = 9)	26.0	24.6 ± 3.0 (n = 37)	25.0
46–50	21.7 ± 3.5 (n = 27)	21.0	22.8 ± 4.6 (n = 14)	23.5	20.0 ± 5.7 (n = 2)	20.0	22.2 ± 4.0 (n = 43)	22.0
51–55	19.2 ± 5.6 (n = 9)	21.0	23.3 ± 2.1 (n = 7)	23.0	24.2 ± 1.5 (n = 5)	24.0	21.4 ± 5.0 (n = 21)	22.0
56–60	19.2 ± 5.4 (n = 5)	21.0	22.0 ± 3.4 (n = 5)	21.0	23.3 ± 1.5 (n = 3)	23.0	21.3 ± 4.4 (n = 13)	22.0
61–65	21.4 ± 5.0 (n = 7)	23.0	21.0 ± 1.4 (n = 2)	21.0	24.5 ± 0.7 (n = 2)	24.5	19.1 ± 5.5 (n = 11)	20.0
66–69	19.0 ± 4.2 (n = 2)	19.0	23.0 ± 3.6 (n = 3)	24.0	– (n = 0)	–	18.9 ± 5.0 (n = 5)	18.5
Total [20–69]	22.3 ± 4.0 (n = 101)	23.0	24.2 ± 3.2 (n = 93)	24.0	26.0 ± 2.6 (n = 53)	26.0	23.3 ± 4.3 (n = 247)	24.0

Table 4. Factors associated with Montreal Cognitive Assessment (MoCA) scores in persons with Turkish roots living in Berlin (univariable and multivariable regression model; dependent variable: continuous MoCA score).

	Univariable		Multivariable, n = 204
	β-estimate	p-value	β-estimate	p-value
Female vs. male	−0.81	0. 105	−0.27	0.723
Age (in years)	−0.16	<0.001	−0.08	0.002
Hypertension vs. none	−3.78	<0.001	−0.96	0.157
Diabetes vs. none	−3.67	<0.001	−0.35	0.721
Obese vs. normal body-mass-index*	−1.89	0.004	0.41	0.523
Overweight vs. normal body-mass-index *	−0.96	0.093	0.17	0.760
Education >12 years vs. <10 years	3.58	<.001	2.68	<0.001
Education 10–12 years vs. <10 years	1.81	<.001	1.17	0.030
Currently employed vs. not employed	2.17	<.001	0.72	0.146
Current smoker vs. non smoker	0.14	0.782	−0.14	0.699
Physically activ ≥150 min/week vs. less	1.57	0.013	0.14	0.753
MoCA German vs. Turkish	2.27	<.001	1.13	0.026
Second migration generation vs. first	2.92	<.001	–**	–**

*defined by recommended age- and sex-dependent criteria (see methods).

**not included in the multivariable model because highly correlated with age.

Table 5. Subscores of the Montreal Cognitive Assessment (MoCA) by educational level, language preference and age group

	Education in years				Language preference			Age in years
	≤9 (n = 101)	10-12 (n = 93)	>12 (n = 53)		German (n = 142)	Turkish (n = 140)		≤30 (n = 51)	31-40 (n = 74)	41-50 (n = 90)	51-60 (n = 42)	>60 (n = 25)		Total (n = 282)
Domain (maximal achievable points)	Mean ± SD*			p-value	Mean ± SD*		p-value	Mean ± SD*					p-value	Mean ± SD*
Visuo-executive functions (5)	3.4 ± 1.2	3.9 ± 1.2	4.3 ± 1.1	<0.001	3.9 ± 1.1	3.4 ± 1.4	<0.001	4.1 ± 1.1	4.1 ± 1.1	3.8 ± 1.1	3.4 ± 1.4	2.2 ± 1.4	<0.001	3.7 ± 1.3
Trail B (1)	0.6 ± 0.5	0.8 ± 0.4	0.8 ± 0.4	0.029	0.8 ± 0.4	0.6 ± 0.5	<0.001	0.84 ± 0.4	0.8 ± 0.4	0.7 ± 0.4	0.5 ± 0.5	0.2 ± 0.4	<0.001	0.7 ± 0.5
Cube copying (1)	0.5 ± 0.5	0.7 ± 0.5	0.9 ± 0.3	<0.001	0.7 ± 0.4	0.5 ± 0.5	<0.001	0.78 ± 0.4	0.7 ± 0.5	0.6 ± 0.5	0.6 ± 0.5	0.3 ± 0.5	0.002	0.6 ± 0.5
Clock drawing (3)	2.3 ± 0.8	2.4 ± 0.8	2.6 ± 0.8	0.071	2.4 ± 0.8	2.3 ± 0.9	0.245	2.4 ± 0.8	2.4 ± 0.8	2.5 ± 0.8	2.3 ± 0.9	1.7 ± 0.9	0.001	2.3 ± 0.8
Naming (3)	2.7 ± 0.5	2.7 ± 0.5	2.9 ± 0.3	0.052	2.9 ± 0.4	2.5 ± 0.6	<0.001	2.9 ± 0.3	2.8 ± 0.5	2.7 ± 0.5	2.5 ± 0.7	2.5 ± 0.5	0.001	2.7 ± 0.5
Attention (6)	4.7 ± 1.3	5.1 ± 0.9	5.5 ± 0.7	<0.001	5.3 ± 1.0	4.6 ± 1.5	<0.001	5.4 ± 0.7	5.4 ± 0.7	4.9 ± 1.2	4.6 ± 1.5	3.8 ± 1.7	<0.001	4.9 ± 1.3
Numbers (fwd/backw) (2)	1.6 ± 0.6	1.6 ± 0.6	1.8 ± 0.4	0.034	1.7 ± 0.6	1.5 ± 0.6	0.011	1.8 ± 0.5	1.7 ± 0.6	1.6 ± 0.5	1.4 ± 0.7	1.1 ± 0.8	<0.001	1.6 ± 0.6
Vigilance (1)	0.8 ± 0.4	0.9 ± 0.3	0.9 ± 0.3	0.234	0.9 ± 0.3	0.8 ± 0.4	0.006	0.9 ± 0.9	0.9 ± 0.3	0.9 ± 0.3	0.9 ± 0.4	0.7 ± 0.5	0.095	0.9 ± 0.3
Serials 7 s (3)	2.3 ± 1.0	2.6 ± 0.7	2.8 ± 0.6	0.001	2.6 ± 0.7	2.3 ± 1.1	<0.001	2.8 ± 0.6	2.5 ± 0.8	2.4 ± 0.9	2.3 ± 1.1	2.0 ± 1.1	0.013	2.5 ± 0.9
Language (3)	1.3 ± 1.0	1.5 ± 1.0	2.0 ± 1.0	0.001	1.4 ± 1.1	1.5 ± 1.0	0.312	1.7 ± 1.0	1.4 ± 1.0	1.4 ± 1.1	1.3 ± 1.1	1.2 ± 1.0	0.388	1.4 ± 1.0
Sentence repetition (2)	0.8 ± 0.8	0.9 ± 0.8	1.2 ± 0.7	0.004	0.9 ± 0.8	0.9 ± 0.7	0.957	1.0 ± 0.7	0.8 ± 0.8	0.9 ± 0.8	0.7 ± 0.7	0.8 ± 0.8	0.268	0.9 ± 0.8
Verbal fluency (1)	0.5 ± 0.5	0.6 ± 0.5	0.8 ± 0.4	0.015	0.5 ± 0.5	0.6 ± 0.5	0.040	0.6 ± 0.5	0.6 ± 0.5	0.6 ± 0.5	0.6 ± 0.5	0.4 ± 0.5	0.411	0.6 ± 0.5
Abstraction (2)	1.6 ± 0.6	1.7 ± 0.5	1.9 ± 0.3	<0.001	1.7 ± 0.6	1.6 ± 0.6	0.630	1.8 ± 0.4	1.7 ± 0.5	1.6 ± 0.6	1.7 ± 0.6	1.3 ± 0.8	0.024	1.7 ± 0.6
Recall (5)	2.7 ± 1.6	3.3 ± 1.6	3.5 ± 1.4	0.005	3.5 ± 1.5	2.6 ± 1.6	<0.001	4.0 ± 1.3	3.3 ± 1.4	2.9 ± 1.5	2.1 ± 1.7	2.1 ± 1.5	<0.001	3.0 ± 1.6
Orientation (6)	6.0 ± 0.2	6.0 ± 0.2	6.0 ± 0.2	0.962	6.0 ± 0.2	5.9 ± 0.2	0.096	6.0 ± 0.0	6.0 ± 0.1	6.0 ± 0.2	5.9 ± 0.3	5.9 ± 0.4	0.020	6.0 ± 0.2
MoCA sum score (30)	22.4 ± 4.0	24.2 ± 3.2	26.0 ± 2.6	<0.001	24.5 ± 3.6	22.0 ± 4.7	<0.001	25.8± 2.7	24.0 ± 4.0	23.3 ± 3.7	21.3 ± 4.8	19.0 ± 5.2	<0.001	23.3 ± 4.3

*standard deviation.