The NHANES program suspended field operations in March 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. As a result, data collection for the NHANES 2019-2020 cycle, including the cognitive functioning assessment, was not completed. Data collected in 2019-March 2020 can be accessed as convenience samples through the NCHS Research Data Center (RDC). Any analyses based solely on the 2019-March 2020 data would not be generalizable to the U.S. civilian non-institutionalized population. Please refer to the Analytic Notes section for more details on the use of the data.
Cognitive functioning (variable name prefix CFQ) testing was performed using the survey-adapted Montreal Cognitive Assessment (MoCA-SA), developed, and administered for the National Social Life, Health and Aging Project (Shega et al.). The MoCA-SA is based on Montreal Cognitive Assessment (MoCA), a multidimensional cognitive screening instrument frequently used by clinical health professionals to detect mild cognitive impairment and Alzheimer's disease (Nasreddine et al.). The MoCA-SA incorporates items from 8 MoCA cognitive subdomains: (1) orientation (2) naming: (3) executive function; (4) visuo-construction; (5) memory; (6) attention; (7) language; and (8) abstraction. Scores for the MoCA-SA (ranging from 0 to 20) are highly correlated with full MoCA scores (Kotwal et al., Dale et al.). This instrument was selected for NHANES to shorten administration time and respondent burden while preserving the sensitivity of the original MoCA.
The data file contains variables that provide scores for each MoCA-SA item. Information obtained during test administration that may be related to cognitive performance (e.g., speech, hearing and visual difficulties) or to the testing environment were coded and included in the data set. Analysts may make their own determinations about which variable responses to use when calculating MoCA-SA scores, or may choose to only analyze scores from individual subdomains.
Participants aged 60 years and older, who spoke English or Spanish, in the NHANES 2019-March 2020 convenience sample were eligible. Persons requiring a proxy informant, or a language interpreter were not eligible.
Questions and tasks were administered at the mobile examination center (MEC), by trained interviewers, using the Computer-Assisted Personal Interview (CAPI) system during the MEC interview session. Interviewers closely followed the administration guidelines of the MoCA. Survey participants orally agreed to audio record the testing session before the administration of any questions or tasks.
Tests were administered by four primary interviewers. After each interview, two interviewers independently assigned points for each item in the assessment according to MoCA scoring criteria (MoCA Version 8.1). Scoring was usually conducted on the same day as the assessment. Interviewers entered itemized scores and verbatim responses into an electronic scoring application and the scores of the two interviewers were compared. Any differences in scores were adjudicated by a reviewer who completed MoCA certification and training.
Approximately 5% of audio-recorded interviews were independently reviewed over the course of the data collection cycle to evaluate consistency in administration of instructions, to determine accuracy in scoring, and to examine differences in scoring by interviewers.
Edits were made, as necessary, to ensure the completeness, consistency, and analytic usefulness of the data. Recordings of approximately 4% of participants with refusal and don’t know responses were evaluated to ensure the consistent application of response codes. Summary variables with test administration notes including instructions not understood or nonperformance due to a physical impairment were created for some tasks.
The COVID-19 pandemic required suspension of NHANES 2019-2020 field operations in March 2020 after data were collected in 18 of the 30 survey locations in the 2019-2020 sample. Data collection was cancelled for the remaining 12 locations. Calculation of survey weights for this partial cycle is not possible due to incomplete data collection. Therefore, data from survey components that were only collected in 2019-March 2020 (including CFQ) are made available as convenience samples through NCHS's Research Data Center (RDC) because unbiased estimates for the NHANES target population cannot be produced with these samples.
CFDSTAT (CFQ Completion Status): This variable provides the overall status for the cognitive functioning component completion. About 9% of persons aged 60 years and older who attended a MEC session were not administered the cognitive functioning assessment. Some of the participants were not eligible for the assessment because they required a proxy informant or only spoke a language other than English or Spanish. For those who were eligible, the main reasons this component was not done were due to arriving late or leaving MEC session early, refusing a the MEC interview (which included the CFQ assessment), or equipment failure. Participants coded as “Not Eligible” or “Not Done” in CFDSTAT are missing all CFQ variables. Analysts should be aware that a small number of participants completed most, but not all CFQ tasks.
CFDCLOCK (Clock drawing – administration): Overall completion codes for the clock drawing exercise (face, numbers, hands) coded by interviewer at time of administration. Participants who were unable to understand instructions, unable to do because of a visual or physical impairment or refused (n=12) have missing scores for CFDCFACE, CFDCNUM and CFDCHAND.
CFDWORD (Verbal fluency – administration): Overall completion codes for verbal fluency exercise naming words starting with letter F coded by interviewer at time of administration. Participants who used the full time for the exercise, and those who started but stopped early have scores for CFDFWCNT.
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | All or some tasks completed | 1022 | 1022 | |
2 | Not Eligible - Proxy | 23 | 1045 | End of Section |
3 | Not Eligible - Language | 18 | 1063 | End of Section |
4 | Not done | 60 | 1123 | End of Section |
. | Missing | 0 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Incorrect | 32 | 32 | |
1 | Correct | 981 | 1013 | |
7 | Refused | 1 | 1014 | |
9 | Don't know | 8 | 1022 | |
. | Missing | 101 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Incorrect | 188 | 188 | |
1 | Correct | 813 | 1001 | |
7 | Refused | 1 | 1002 | |
9 | Don't know | 20 | 1022 | |
. | Missing | 101 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Incorrect | 177 | 177 | |
1 | Correct | 819 | 996 | |
7 | Refused | 0 | 996 | |
9 | Don't know | 26 | 1022 | |
. | Missing | 101 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Incorrect | 31 | 31 | |
1 | Correct | 979 | 1010 | |
. | Missing | 113 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Incorrect | 155 | 155 | |
1 | Correct | 855 | 1010 | |
. | Missing | 113 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Incorrect | 431 | 431 | |
1 | Correct | 579 | 1010 | |
. | Missing | 113 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Completed task | 1010 | 1010 | |
4 | Unable to understand instructions | 1 | 1011 | |
6 | Visual or Physical Impairment | 9 | 1020 | |
7 | Refused | 2 | 1022 | |
. | Missing | 101 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Incorrect | 492 | 492 | |
1 | Correct | 510 | 1002 | |
4 | Unable to understand instructions | 8 | 1010 | |
6 | Visual or Physical Impairment | 10 | 1020 | |
7 | Refused | 0 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 238 | 238 | |
1 | Recalled | 782 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 165 | 165 | |
1 | Recalled | 855 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 203 | 203 | |
1 | Recalled | 817 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 287 | 287 | |
1 | Recalled | 733 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 162 | 162 | |
1 | Recalled | 858 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | 0 | 7 | 7 | |
1 | 1 | 21 | 28 | |
2 | 2 | 80 | 108 | |
3 | 3 | 181 | 289 | |
4 | 4 | 334 | 623 | |
5 | 5 | 397 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 156 | 156 | |
1 | Recalled | 864 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 96 | 96 | |
1 | Recalled | 924 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 47 | 47 | |
1 | Recalled | 973 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 128 | 128 | |
1 | Recalled | 892 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 78 | 78 | |
1 | Recalled | 942 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | 0 | 7 | 7 | |
1 | 1 | 5 | 12 | |
2 | 2 | 19 | 31 | |
3 | 3 | 73 | 104 | |
4 | 4 | 247 | 351 | |
5 | 5 | 669 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Incorrect answer | 182 | 182 | |
1 | Correct answer (2,1,8,5,4) | 820 | 1002 | |
3 | Tried, unable to do | 18 | 1020 | |
4 | Unable to understand instructions | 0 | 1020 | |
7 | Refused | 0 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Incorrect answer | 309 | 309 | |
1 | Correct answer (2,4,7) | 708 | 1017 | |
3 | Tried, unable to do | 3 | 1020 | |
4 | Unable to understand instructions | 0 | 1020 | |
7 | Refused | 0 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | No correct subtractions | 130 | 130 | |
1 | 1 correct subtraction | 118 | 248 | |
2 | 2-3 correct subtractions | 252 | 500 | |
3 | 4-5 correct subtractions | 502 | 1002 | |
. | Missing | 121 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | 0 | 109 | 109 | |
1 | 1 | 118 | 227 | |
2 | 2 | 88 | 315 | |
3 | 3 | 164 | 479 | |
4 | 4 | 186 | 665 | |
5 | 5 | 316 | 981 | |
7 | Refused | 18 | 999 | |
9 | Don't know | 21 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Incorrect recall | 654 | 654 | |
1 | Correct recall | 357 | 1011 | |
3 | Tried unable to do | 8 | 1019 | |
4 | Unable to understand instructions | 1 | 1020 | |
7 | Refused | 0 | 1020 | |
. | Missing | 103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Completed task | 974 | 974 | |
2 | Stopped before 60 sec elapsed | 37 | 1011 | |
4 | Unable to understand instructions | 5 | 1016 | |
7 | Refused | 3 | 1019 | |
. | Missing | 104 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 to 28 | Range of Values | 1011 | 1011 | |
. | Missing | 112 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
1 | Measuring instruments | 68 | 68 | |
2 | Used to measure | 441 | 509 | |
3 | They have numbers | 356 | 865 | |
4 | Other explanation | 134 | 999 | |
7 | Refused | 3 | 1002 | |
9 | Don't know | 17 | 1019 | |
. | Missing | 104 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 498 | 498 | |
1 | Recalled | 521 | 1019 | |
. | Missing | 104 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 409 | 409 | |
1 | Recalled | 610 | 1019 | |
. | Missing | 104 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 393 | 393 | |
1 | Recalled | 626 | 1019 | |
. | Missing | 104 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 677 | 677 | |
1 | Recalled | 342 | 1019 | |
. | Missing | 104 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | Did not recall | 443 | 443 | |
1 | Recalled | 576 | 1019 | |
. | Missing | 104 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
0 | 0 | 149 | 149 | |
1 | 1 | 109 | 258 | |
2 | 2 | 179 | 437 | |
3 | 3 | 249 | 686 | |
4 | 4 | 204 | 890 | |
5 | 5 | 129 | 1019 | |
. | Missing | 104 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
2 | Hearing problem | 92 | 92 | |
. | Missing | 1031 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
3 | Vision problem | 15 | 15 | |
. | Missing | 1108 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
4 | Physical limitation affecting writing/drawing | 20 | 20 | |
. | Missing | 1103 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
5 | Unable to read/write (literacy) | 12 | 12 | |
. | Missing | 1111 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
6 | Does not understand English well | 23 | 23 | |
. | Missing | 1100 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
7 | SP reported cognitive limitation | 13 | 13 | |
. | Missing | 1110 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
8 | SP reported taking medications | 2 | 2 | |
. | Missing | 1121 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
9 | SP was restless or fidgety | 38 | 38 | |
. | Missing | 1085 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
10 | SP reported wanting to quit | 9 | 9 | |
. | Missing | 1114 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
11 | Interruptions/distraction during testing | 8 | 8 | |
. | Missing | 1115 | 1123 |
Code or Value | Value Description | Count | Cumulative | Skip to Item |
---|---|---|---|---|
317 to 1909 | Range of Values | 1022 | 1022 | |
. | Missing | 101 | 1123 |