Montreal Cognitive Assessment Scores and Associated Factors among Adults Living with HIV in Mexico: A Cross-Sectional Study

Background: The Montreal Cognitive Assessment (MoCA) is frequently used for cognitive screening, but a fixed cutoff cannot establish HIV-associated neurocognitive disorder and may perform differently across demographic and cultural settings. We described MoCA scores obtained during the study and examined factors associated with lower scores among adults receiving HIV care in Mexico. Methods: This analytical cross-sectional study included 242 adults with confirmed HIV infection who received outpatient care in Querétaro, Mexico, during 2021. Participants were enrolled through consecutive non-probability sampling as they attended consultations. MoCA was administered once after consent and enrollment, and the total score was analyzed as a continuous outcome. Multivariable linear regression with HC3 robust standard errors included age, schooling of 12 years or less, and AIDS at initial diagnosis as prespecified covariates. Results: Median age was 31 years, 96.3% of participants were male, and 94.3% of those with interpretable viral-load data had 50 copies/mL or less or an undetectable result. The median MoCA score was 26 (interquartile range, 24 - 28; range, 15 - 30); 114 participants (47.1%) scored below 26. In the primary model (n = 191), age (beta = ？0.020 points/year; 95% CI, ？0.071 to 0.032), schooling of 12 years or less (beta = ？0.687; 95% CI, ？1.963 to 0.589), and AIDS at initial diagnosis (beta = ？0.445; 95% CI, ？1.306 to 0.417) were not clearly associated with MoCA score. Conclusion: No factor demonstrated a robust independent association with MoCA performance in the primary model. The percentage scoring below 26 should not be interpreted as the prevalence of a neurocognitive disorder. Population-appropriate norms, functional assessment, comprehensive neuropsychological testing, and systematic measurement of relevant confounders are required for diagnostic inference.