Ethnoracial Characterization of Cognitive Function and Activities of Daily Living in Neurodegenerative Diseases

Objective: Neurodegenerative diseases, such as Alzheimer's disease (AD), lead to progressive cognitive and functional decline, which significantly affects individuals’ ability to perform their everyday Activities of Daily Living (ADLs). Occupational Therapist (OTs) assess cognitive impairments and their impact on daily function by utilizing tools like the Montreal Cognitive Assessment (MoCA) to guide intervention planning. However, research on the MoCA’s effectiveness across ethnoracial groups is limited, raising potential biases in the accuracy of cognitive assessments. This study examines the relationship between cognitive function, measured by the MoCA, and functional impairment, assessed using the Functional Activities Questionnaire (FAQ), among ethnoracial older adults with neurodegenerative diseases. This research aims to investigate potential disparities in those with differing levels of cognition and the overall effectiveness of cognitive screening tools. Methods: A stratified random sample was identified to analyze data from 600 participants drawn from the National Alzheimer’s Coordinating Center (NACC) Uniform Data Set (UDS). Participants included community-dwelling older adults aged 55 and above, representing three ethnoracial groups: Non-Hispanic White, Hispanic White, and Black Non-Hispanic. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA), while functional abilities were measured through the Functional Assessment Questionnaire (FAQ). Statistical analyses included Pearson Correlation Coefficient to examine the relationship between cognitive and functional performance and one-way ANOVA to identify potential differences in MoCA and FAQ scores across ethnoracial groups. Robust methods were applied to account for statistical assumption violations, ensuring accurate results interpretation. Results: Analyses included 600 participants divided into three ethnoracial groups: Non-Hispanic White (n = 200), Hispanic White (n = 200), and Black Non-Hispanic (n = 200). A one-way ANOVA revealed no statistically significant differences in MoCA scores among the groups, F(2, 597) = 2.11, p = .123. However, Levene’s test indicated unequal variances (p < .001), and robust tests (Welch’s and Brown-Forsythe) confirmed the non-significant findings. For FAQ scores, a significant group difference was observed, F(2, 597) = 9.15, p < .001, and robust tests supported this result (Welch’s F = 10.92; Brown-Forsythe F = 9.15, both p < .001). NHW participants had the highest mean FAQ score, indicating greater functional impairment. A Pearson correlation revealed a strong negative relationship between MoCA and FAQ scores in the overall sample (r = -0.623, p < .001), with similarly significant negative correlations within each group. Fisher’s r-to-z transformation indicated that the strength of the correlation between cognitive and functional scores differed significantly between NHW and both Black Non-Hispanic (z = 2.156, p < .05) and Hispanic White participants. Conclusion: The results indicate that MoCA total scores are largely consistent across Non-Hispanic White (NHW), Hispanic White, and Black Non-Hispanic older adults, with no significant differences in the overall analysis. However, Fisher’s r-to-z transformation revealed significant differences in the relationship between cognitive performance and functional abilities when comparing NHW participants to Hispanic White and Black Non-Hispanic participants. These findings suggest that the MoCA remains a reliable tool for cognitive screening across ethnoracial populations. Further research is needed to explore additional factors, including cultural and contextual influences, that may shape cognitive performance and ratings of functional outcomes