Work

Association of area-level deprivation with cognitive test scores, in older adults with cognitive symptoms attending primary care: a secondary data analysis

Year: 2026

Type: article

Abstract: Background Dementia poses a growing health burden in an ageing population. This study explores the association between area-level deprivation and cognitive test scores in older adults with cognitive symptoms attending primary care. The aims were to examine whether cognitive test scores varied by area-level deprivation and to explore the impact of deprivation on the diagnostic accuracy of tests commonly used to screen for dementia in primary care. Methods Data from the TIMeLi diagnostic accuracy study were used, which recruited prospective participants attending a General Practitioner with cognitive symptoms, without a prior diagnosis of dementia. Participants aged > 70 underwent multiple cognitive tests, including the Addenbrooke’s Cognitive Examination-III (ACE-III), Montreal Cognitive Assessment (MoCA), and others. Area-level deprivation was defined using the Index of Multiple Deprivation (IMD). Multivariate linear regressions assessed the association between IMD rank and cognitive test scores, adjusting for age, sex and dementia diagnosis. The diagnostic accuracy for each cognitive test was reported for each IMD quintile. Results Of 240 patients, 229 had IMD data available. The difference in mean age between quintile V (most-deprived) and quintile I for those diagnosed with dementia was 1.7 years (83.5 years and 81.8 years respectively). Lower area-level deprivation correlated with higher scores on ACE-III (β = 2.89, 95% CI: 1.27 to 4.50 ) and MoCA (β = 1.12, 95% CI: 0.39 to 1.87). ACE-III and MoCA are highly sensitive tests for the diagnosis of dementia irrespective of IMD quintile. Conclusions This exploratory analysis highlights an association between greater area-level deprivation and lower scores in ACE-III and MoCA, adjusting for age, sex and dementia diagnosis. Area-level deprivation was not shown to impact the diagnostic accuracy of these tests. Despite high sensitivity for both ACE-III and MoCA for the diagnosis of dementia across all IMD quintiles, no other consistent pattern on the diagnostic accuracy of cognitive tests were observed. Further research is warranted to assess the diagnostic accuracy of cognitive screening tests in participants from areas of high deprivation and the reasons driving the difference in mean age of presentation between the least and most deprived areas.

Source: BMC Family Practice

DOI: 10.1186/s12875-026-03573-2