Factors influencing the cognitive performance in cognitively unimpaired older adults and people living with Alzheimer’s disease: Insights from a middle-income Latin American country

Low- and middle-income countries, such as Brazil, often face higher dementia risk due to factors like lower education levels, with up to 90% of dementia cases remaining undiagnosed. Understanding factors that contribute to the cognitive performance of older adults may support healthcare professionals from these countries in their decision-making process when screening for cognitive decline in their communities. This study investigates factors associated with cognitive performance in older adults from a Latin American country. This cross-sectional and analytical study involved 137 participants (84 cognitively unimpaired older adults and 53 people with Alzheimer's Disease) from Brazil. The assessment included a sociodemographic questionnaire, the Addenbrooke's Cognitive Examination-Revised (ACE-R), the Mini-Mental State Examination (MMSE), the Memory Complaint Scale (MCS), Clinical Dementia Rating (CDR), Geriatric Depression Scale (GDS-15), Geriatric Anxiety Inventory (GAI-5), Katz scale, Lawton and Brody scale, and Pfeffer Functional Activity Questionnaire (PFAQ). Data were analyzed using descriptive statistics, linear regression, and mediation analysis, with a significance level set at <i>p</i><0.05. AD participants were older, had fewer years of formal education, showed poorer cognitive performance, and had lower functionality. Age, education, and functionality were significantly associated with cognitive performance. Mediation analysis showed that years of education mediated the relationship between functionality and cognitive performance. This study underscores the significance of age, education, and functionality as key factors in cognitive performance among older adults in Brazil, providing valuable knowledge for improving cognitive assessment practices in Latin American countries.