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Abstract
The sustained increase in global life expectancy has driven up the risk of neurodegenerative disorders. In Latin America, dementia prevalence reaches approximately 11% among individuals over sixty-five. The Mini-Mental State Examination (MMSE) remains the most widely used screening tool; however, it is heavily biased by non-cognitive demographic factors, primarily formal education, and age, which leads to high false-positive rates in low-literacy or rural populations. To analyze MMSE scores in older adults (?65 years) from rural areas in Ecuador and examine their relationship with sociodemographic, health, and lifestyle variables. A cross-sectional, analytical observational study was conducted with 314 older adults residing in the rural parishes of Sinincay, Ricaurte, and El Valle (Cuenca, Ecuador). The 30-point MMSE adapted for rural Spanish-speaking populations was administered. Univariate (ANOVA, Pearson's r) and multivariate analyses were executed to identify correlations with sociodemographic, clinical, and lifestyle factors. The mean age was 74.3 ± 7.6 years, and the mean MMSE score was 22.7 ± 7.0 points. Regarding cognitive status, 30.6% scored within the normal range, 27.1% showed pathological suspicion, 34.1% had cognitive impairment, and 8.3% fell into the dementia range. Univariate analysis revealed significant differences based on educational level (p = 0.000), socioeconomic status (p = 0.000), chronic illness (p = 0.007), and physical activity (p = 0.009). However, in the final multivariate model, only educational level (p = 0.001) and age (p = 0.014) retained a statistically significant correlation with the MMSE score. Formal education and age are the sole independent predictors of global cognitive performance via the MMSE in this rural population. Low education acts as a critical vulnerability factor, reinforcing the cognitive reserve theory.
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