Is Global Cognition Associated with Sociodemographic and Lifestyle Factors, and with Mental Health in Older Adults Living in Rural Ecuador? Insights from the EcuAging Study

Little is known about the cognitive health of older adults living in rural Ecuador, where more than 70% of the rural population experiences multidimensional poverty. Using cross-sectional data from the EcuAging study, we examined the associations of sociodemographic characteristics, lifestyle factors, and anxiety and depressive symptoms with global cognition, measured with a modified Spanish version of the Mini-Mental State Examination (MMSE), among 238 adults aged 55 years and older living in rural communities of Loja province. In fully adjusted linear regression models, higher educational attainment was associated with better cognitive performance: compared with participants without formal education, those who had completed primary (B = 3.76; 95% CI 2.49 to 5.03), secondary (B = 4.62; 95% CI 2.52 to 6.72) and tertiary education (B = 5.98; 95% CI 3.53 to 8.44) scored higher on the MMSE. More than 2 h of daily physical activity was also associated with higher scores (B = 2.60; 95% CI 0.56 to 4.63), whereas each additional depressive symptom was associated with lower scores (B = − 0.22; 95% CI − 0.42 to − 0.02). Alcohol, tobacco and coffee consumption were not associated with cognition. After excluding participants with MMSE scores ≤ 11, the associations with education and depressive symptoms persisted, whereas the association with physical activity did not. In this rural, low-income population, educational attainment showed the strongest and most robust association with cognitive performance. Expanding lifelong learning and integrating the detection and management of depressive symptoms into rural primary care may help promote cognitive health.