Voluntary cognitive screening: characteristics of participants in an Asian setting

Figures & data

Table 1 Demographic, risk factor, and cognitive profiles of all subjects

	Whole cohort (n=1,243)
Demographic profile
Age, years (mean ± SD)	61.3±8.08
Sex, n (%)
Male	410 (33.0)
Female	833 (67.0)
Ethnicity, n (%)
Chinese	1,133 (91.2)
Malay	17 (1.4)
Indian	65 (5.2)
Eurasian	28 (2.2)
Years of education, years (mean ± SD)	11.0±3.85
Level of education, n (%)
No formal education	38 (3.06)
Primary	125 (10.0)
Secondary	534 (43.0)
Tertiary	546 (44.0)
Housing type, n (%)
Public	416 (71.1)
Private	169 (28.9)
Employment, n (%)
Employed	487 (39.2)
Unemployed	756 (60.8)
Level of occupation, n (%)
High	597 (55.7)
Low	475 (44.3)
Risk factor profile
Diabetes mellitus, n (%)	154 (12.4)
Hypertension, n (%)	444 (35.7)
High cholesterol, n (%)	494 (39.7)
Heart disease, n (%)	83 (6.7)
Stroke, n (%)	15 (1.2)
Smoking, n (%)	46 (4.3)
Cognitive profile
Subjective cognitive symptoms, n (%)	699 (56.2)
MMSE (n=968), mean ± SD	28.0±2.31
MoCA (n=1,072), mean ± SD	25.9±2.99
FAB (n=704), mean ± SD	16.4±1.48

Abbreviations: FAB, Frontal Assessment Battery; MoCA, Montreal Cognitive Assessment; MMSE, Mini-Mental State Examination; SD, standard deviation.

Table 2 Demographic, risk factor, and cognitive profiles of subjects by year

	2008 (n=342)	2009 (n=119)	2010 (n=93)	2011 (n=171)	2012 (n=275)	2013 (n=243)	P-value
Demographic profile
Age, years (mean ± SD)	59.2±9.02	60.9±7.22	58.8±5.63	62.7±6.44	61.7±8.27	63.9±7.66	<0.001
Sex, n (%)							0.0253 (with ties)
Male	132 (38.6)	33 (27.7)	35 (37.6)	52 (30.4)	94 (34.2)	64 (26.3)
Female	210 (61.4)	86 (72.3)	58 (62.4)	119 (69.6)	181 (65.8)	179 (73.7)
Ethnicity, n (%)							0.0204 (with ties)
Chinese	304 (88.9)	112 (94.2)	80 (86.0)	157 (91.8)	247 (89.8)	233 (95.9)
Malay	0	0	2 (2.2)	1 (0.6)	11 (4.0)	3 (1.2)
Indian	34 (9.9)	4 (3.4)	10 (10.8)	5 (2.9)	9 (3.3)	3 (1.2)
Eurasian	4 (1.2)	3 (2.5)	1 (1.1)	8 (4.7)	8 (2.9)	4 (1.6)
Years of education, years (mean ± SD)	10.0±3.74	10.9±3.40	11.6±3.21	11.9±3.56	11.6±4.49	11.0±3.57	<0.01
Level of education, n (%)							<0.01
No formal education	15 (4.4)	1 (0.8)	0	4 (2.3)	6 (2.2)	12 (4.9)
Primary	67 (19.6)	13 (10.9)	7 (7.5)	8 (4.7)	21 (7.6)	9 (3.7)
Secondary	143 (41.8)	57 (47.9)	37 (39.8)	62 (36.3)	101 (36.7)	134 (5.5)
Tertiary	117 (34.2)	48 (40.3)	49 (52.7)	97 (56.7)	147 (53.5)	88 (36.2)
SES, n (%)							<0.01
High	100 (29.2)	116 (97.5)	86 (92.5)	141 (82.5)	244 (88.7)	73 (30.0)
Low	242 (70.8)	3 (2.5)	7 (7.5)	30 (7.5)	31 (11.3)	170 (70.0)
Housing type (n=585), n (%)
Public	254 (74.3)					162 (66.7)
Private	88 (25.7)					81 (33.3)
Employment, n (%)							0.0154
Employed	158 (46.2)	38 (31.9)	38 (40.9)	55 (32.2)	126 (45.8)	85 (35.0)
Unemployed	184 (53.8)	81 (68.1)	55 (59.1)	116 (67.8)	149 (54.2)	158 (65.0)
Level of occupation (n=1,072), n (%)							<0.01
High	36 (10.5)	100 (84.0)	77 (82.8)		209 (76.0)	175 (72.0)
Low	306 (89.5)	19 (16.0)	16 (17.2)		66 (24.0)	68 (28.0)
Risk factor profile
Diabetes mellitus, n (%)	50 (14.6)	14 (11.8)	10 (10.8)	19 (11.1)	37 (13.5)	24 (9.9)	0.941
Hypertension, n (%)	118 (34.5)	43 (36.1)	26 (28.0)	65 (38.0)	98 (35.6)	94 (38.7)	0.739
High cholesterol, n (%)	132 (38.6)	55 (46.2)	29 (31.2)	74 (43.3)	107 (38.9)	97 (39.9)	0.497
Heart disease, n (%)	26 (7.6)	8 (6.7)	4 (4.3)	11 (6.4)	17 (6.2)	17 (7.0)	0.998
Stroke, n (%)	5 (1.5)	2 (1.7)	1 (1.1)	2 (1.2)	3 (1.1)	2 (0.8)	1
Smoking (n=1,072), n (%)	27 (7.9)	8 (6.7)	4 (4.3)		4 (1.5)	3 (1.2)	<0.01 (with ties)
Cognitive profile
Subjective cognitive symptoms, n (%)	154 (45.0)	70 (58.8)	76 (81.7)	133 (77.8)	122 (44.4)	144 (59.3)	<0.01
MMSE (n=968), mean ± SD	27.6±2.84	28.7±2.04	28.6±0.247	28.2±2.88		27.9±2.30	<0.01
MoCA (n=1,072), mean ± SD	24.0±2.47	27.6±3.11	27.3±3.44		26.5±3.30	26.5±2.78	<0.01
FAB (n=704), mean ± SD	16.3±2.22	16.8±0.133				16.4±1.77	0.0749
Mild cognitive impairment, n (%)	129 (37.7)	9 (7.9)	11 (11.8)	14 (8.3)	27 (9.8)	24 (9.9)	<0.01
Depression (n=797), n (%)	65 (19.0)	21 (18.5)	10 (10.8)			47 (19.3)	0.637

Notes: MMSE and MoCA range 0–30; FAB range 0–18.

Abbreviations: FAB, Frontal Assessment Battery; MoCA, Montreal Cognitive Assessment; MMSE, Mini-Mental State Examination; SD, standard deviation; SES, socioeconomic status.

Table 3 Normal cognition versus mild cognitive impairment

	NC (n=1,029)	MCI (n=214)	P-value	Adjusted OR (95% CI)	P-value
Demographic profile
Age, years (mean ± SD)	61.00±7.57	62.8±10.0	0.0314	1.04 (1.02–1.06)	0.00002
Sex, n (%)			0.822	1.54 (1.08–2.19)	0.71017
Male	338 (32.8)	72 (33.6)
Female	691 (67.2)	142 (66.4)
Ethnicity, n (%)			0.0017
Chinese	950 (92.3)	183 (85.5)		Reference point
Malay	15 (1.5)	2 (0.9)		2.63 (0.89–7.79)	0.08006
Indian	39 (3.8)	26 (12.1)		2.07 (1.15–3.73)	0.0015
Eurasian	25 (2.4)	3 (1.4)		0.91 (0.30–2.72)	0.86533
Years of education, years (mean ± SD)	11.4±3.63	9.12±4.32	<0.01	1.04 (1.00–1.09)	0.03666
Level of education, n (%)			<0.01
No formal education	21 (2.0)	17 (7.9)		0.91 (0.28–2.97)	0.87191
Primary	74 (7.2)	51 (23.8)		1.49 (0.51–4.36)	0.46456
Secondary	447 (43.4)	87 (40.7)		1.47 (0.50–4.31)	0.48670
Tertiary	487 (47.3)	59 (27.6)		Reference point
Housing type, n (%)	(n=432)	(n=153)	0.408
Public	300 (69.4)	116 (75.8)		1.01 (0.48–2.13)	0.98033
Private	132 (30.6)	37 (24.2)		Reference point
SES, n (%)			<0.01		0.88626
Low	346 (33.6)	137 (64.0)		Reference point
High	683 (66.4)	77 (36.0)		0.98 (0.69–1.38)
Employment, n (%)			0.436
Employed	610 (59.3)	133 (62.1)		Reference point
Unemployed	419 (40.7)	81 (37.9)		1.09 (0.76–1.56)	0.64729
Level of occupation, n (%)	(n=872)	(n=200)	<0.01
High	597 (68.5)	0		Reference point
Low	275 (31.5)	200 (100)		1.31 (0.94–1.82)	0.10577
Risk factor profile
Diabetes mellitus, n (%)	116 (11.3)	38 (17.8)	0.0088	1.16 (0.75–1.79)	0.51083
Hypertension, n (%)	357 (34.8)	87 (40.7)	0.0979	1.14 (0.83–1.57)	0.42791
High cholesterol, n (%)	400 (38.9)	94 (43.9)	0.170	0.97 (0.71–1.33)	0.865
Heart disease, n (%)	64 (6.2)	19 (8.9)	0.156	1.65 (0.97–2.81)	0.06483
Stroke, n (%)	12 (1.2)	3 (1.4)	0.774	3.57 (1.24–10.26)	0.01842
Smoking, n (%)	(n=872) 31 (3.6)	(n=200) 15 (7.5)	0.0131	1.14 (0.83–1.57)	0.42791
Cardiovascular risk factors, n (%)			0.0039		0.91931
0	426 (41.4)	73 (34.1)		Reference point
1	334 (32.5)	65 (30.4)		1.02 (0.75–1.39)
2	177 (17.2)	42 (19.6)
3	79 (7.7)	29 (13.6)
4	11 (1.1)	5 (2.3)
5	1 (0.01)	0
6	1 (0.01)	0
Cognitive profile
Depression, n (%)	(n=624) 107 (17.1)	(n=173) 36 (20.8)	0.267	1.11 (0.73–1.68)	0.62634
MMSE, mean ± SD	28.47 (2.12)	25.66 (3.45)	<0.001	1.44 (1.32–1.57)	0.00001
MoCA, mean ± SD	27.56 (2.91)	24.76 (4.76)	<0.001	1.20 (1.13–1.27)	0.00001
FAB, mean ± SD	16.72 (1.56)	15.48 (2.95)	<0.001	1.22 (1.10–1.36)	0.00014

Notes: In the multivariate logistic regression model, ORs were adjusted for covariates of years of education, ethnicity, socioeconomic status, and occupation.

Abbreviations: FAB, Frontal Assessment Battery; MoCA, Montreal Cognitive Assessment; MMSE, Mini-Mental State Examination; SD, standard deviation; SES, socioeconomic status; NC, normal cognition; MCI, mild cognitive impairment; OR, odds ratio; CI, confidence interval.

Table 4 Comparison of age groups based on median split

Total (n=1,243) Median 61.00	≤60 years (n=608)	≥61 years (n=635)	P-value	Multivariate OR (95% CI)	P-value
Demographic profile
Age, years (mean ± SD)	54.83±3.85	67.52±5.89	0.00001	NA	NA
Sex, n (%)			0.00005	1.84 (1.43–2.37)	0.00001
Male	167 (27.47)	243 (38.27)
Female	441 (72.53)	392 (61.73)
Ethnicity, n (%)			0.09777
Chinese	560 (92.11)	573 (90.24)		Reference point
Malay	12 (1.97)	5 (0.79)		0.39 (0.13–1.14)	0.08418
Indian	25 (4.11)	40 (6.30)		1.52 (0.89–2.59)	0.12951
Eurasian	11 (1.81)	17 (2.67)		1.82 (0.81–4.08)	0.1499
Years of education, years (mean ± SD)	11.52±3.42	10.56±4.10	0.00189	1.09 (1.06–1.13)	0.00001
Level of education, n (%)			0.14232
No formal education	21 (3.45)	17 (2.68)		Reference point
Primary	58 (9.54)	67 (10.55)		1.53 (0.72–3.27)	0.2734
Secondary	279 (45.89)	255 (40.16)		1.13 (0.57–2.26)	0.72892
Tertiary	250 (41.12)	296 (46.61)		1.16 (0.57–2.33)	0.67777
Housing type, n (%)	(n=345)	(n=240)	0.38680
Public	250 (72.46)	166 (69.17)		Reference point
Private	95 (27.54)	74 (11.65)		1.06 (0.66–1.71)	0.80746
SES, n (%)			<0.00001		<0.00001
Low	286 (47.04)	197 (31.02)		Reference point
High	322 (52.96)	438 (68.98)		2.21 (1.73–2.81)
Employment, n (%)			<0.00001		<0.00001
Employed	351 (57.73)	136 (21.42)		Reference point
Unemployed	257 (42.27)	499 (78.58)		5.41 (4.15–7.05)
Level of occupation, n (%)			<0.00001		0.00736
High	359 (59.05)	287 (45.20)		Reference point
Low	249 (40.95)	358 (54.80)		1.41 (1.10–1.80)
Risk factor profile
Diabetes mellitus, n (%)	52 (8.55)	102 (16.06)	0.00006	1.96 (1.35–2.85)	0.00045
Hypertension, n (%)	156 (25.66)	288 (45.35)	<0.00001	2.33 (1.82–3.00)	<0.00001
High cholesterol, n (%)	210 (34.54)	284 (44.72)	0.00024	1.52 (1.20–1.93)	0.00062
Heart disease, n (%)	29 (4.77)	54 (8.40)	0.00838	1.66 (1.01–2.72)	0.0457
Stroke, n (%)	6 (0.99)	9 (1.42)	0.48716	1.18 (0.40–3.51)	0.76294
Smoking, n (%)	25 (4.11)	21 (3.31)	0.45227	0.83 (0.43–1.59)	0.57118
Cardiovascular risk factors, n (%)			0.19019
0	238 (39.14)	261 (41.10)		Reference point
1	201 (33.06)	198 (31.18)		0.87 (0.66–1.15)	0.32757
2	101 (16.61)	118 (18.58)		1.11 (0.80–1.55)	0.54278
3	61 (10.03)	47 (7.40)		0.71 (0.46–1.09)	0.11745
4	5 (0.82)	11 (1.73)		2.36 (0.79–7.09)	0.12647
5	1 (0.16)	0 (0.00)		0	0.99958
6	1 (0.16)	0 (0.00)		0	0.99959
Cognitive profile
MCI, n (%)	77 (12.66)	130 (20.47)	0.00022	1.72 (1.25–2.38)	0.00096
Depression, n (%)	(n=415) 208 (49.88)	(n=382) 189 (49.48)	0.85584	1.06 (0.77–1.45)	0.75044
MMSE, mean ± SD	28.42±1.90	27.58±3.12	<0.00001	1.12 (1.05–1.19)	0.00029
MoCA, mean ± SD	27.60±2.72	26.45±4.09	<0.00001	1.09 (1.04–1.15)	0.00092
FAB, mean ± SD	16.82±1.57	16.16±2.22	<0.00001	1.19 (1.08–1.31)	0.00046

Notes: In the multivariate logistic regression model, ORs were adjusted for covariates of years of education, ethnicity, socioeconomic status, and occupation.

Abbreviations: FAB, Frontal Assessment Battery; MoCA, Montreal Cognitive Assessment; MMSE, Mini-Mental State Examination; SD, standard deviation; SES, socioeconomic status; MCI, mild cognitive impairment; OR, odds ratio; CI, confidence interval.