# My patient might be depressed – can I still screen for MCI? Exploring cognitive performance on the MoCA in older people screened for depressive symptoms with the PHQ-9

## TL;DR

This study shows that the MoCA cognitive test can be used to screen for mild cognitive impairment in older adults, even if they have depression symptoms.

## Contribution

The study demonstrates that depression symptoms do not affect MoCA performance, supporting its use in cognitive screening.

## Key findings

- No differences in MoCA total scores or subscores were found across depression symptom levels.
- Sensitivity analyses confirmed the robustness of MoCA results regardless of depression status.
- MoCA appears reliable for cognitive screening in older adults with or without depressive symptoms.

## Abstract

The aim of this study was to compare the Montreal Cognitive Assessment (MoCA) performances of people who report no, subclinical, and clinical symptoms of depression.

Data was collected for the randomized controlled trial BrainFit-Nutrition. A secondary data analysis of 1,111 participants (age ≥ 60 years; M = 68.4 years; 55.1% female) was performed. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), cognitive performance was assessed via the MoCA. Performance differences were tested with Kruskal-Wallis tests. Two sensitivity analyses were conducted, one with data from people with MCI and one with the original item structure of the MoCA.

No differences were found in the MoCA total score or in visuospatial, executive functioning, attention, memory, or orientation subscores between individuals with no, subclinical, or clinical symptoms of depression. A sensitivity analysis also showed no differences.

Cognitive screening with the MoCA seems to be robust against depression and could therefore be used to screen for MCI regardless of depression level.

The study was prospectively registered at the International Standard Randomized Controlled Trial Number Registry on 23/11/2021 (ISRCTN 10560738).

The online version contains supplementary material available at 10.1186/s12877-025-06004-6.