Published: 2017-01-04

Cognitive function and its association with level of education and work status in adults in Saudi Arabia: a cross-sectional study

Mohammed Alarabi, Abdullah Al-Turki, Mohammed Mahasin, Abdulrahman Al-Sehly, Faisal Al-Dawood, Saleh Al-Kurini, Shahid Bashir


Background: Cognitive decline is not inevitable with age; studies have shown that it can be affected by a number of education and work related factors. We explored this association by carrying out a cross-sectional study in King Khalid University Hospital and King Abdulaziz University Hospital in Riyadh, Saudi Arabia.

Methods: We enrolled 202 adults, whose ages ranged between 40 and 85 years. Data was collected using a validated Arabic translation of a standardized test assessing cognitive function, known as the Mini Mental State Examination (MMSE). Subjects were also inquired about their level of education and work status.

Results: The results showed that in our subjects of adults above the age of 40, the mean MMSE score was 23.45 (SD=4.203). Females (n=94) had lower scores than their male counterparts (n=108) (mean difference: 3.11, 95% CI 2 to 4.22; p<0.001). There was a strong negative correlation between Age and MMSE scores (r=-0.308; p<0.001). Higher levels of education were associated with higher MMSE scores (p<0.001). Having no education was associated with a major decline in scores compared to a college education (mean difference: 8.16, 95% CI 6.76 to 9.56; p<0.001). Being employed was associated with higher scores (p<0.001). This was irrespective of gender, although females were more likely to have had no education or work (p<0.001).

Conclusions: Higher levels of education and employment both seem to be associated with higher cognitive function scores in the studied demographic. Further research is required for population generalization and to establish a causal relationship.



Cognitive function, Mini mental state examination, Education

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National Institute on Aging, U.S. Department of Health and Human Services. Memory/Cognitive Health. 2013. Available at

Fillit HM, Butler RN, O'Connell AW, Albert MS, Birren JE, Cotman CW et al. Achieving and maintaining cognitive vitality with aging. In Mayo Clinic Proceedings. 2002;77(7):681-96.

Kurlowicz L, Wallace M. The mini mental state examination (MMSE). Journal of Gerontological Nursing. (1999);25(5):8-9.

Williams K, Kemper S. Exploring interventions to reduce cognitive decline in aging. Journal of psychosocial nursing and mental health services, 2010;48(5):42.

Inzelberg R, Schechtman E, Abuful A, Masarwa M, Mazarib A, Strugatsky R, et al. Education effects on cognitive function in a healthy aged Arab population. International psychogeriatrics 2007;19(3):593-604.

Al-Rajeh S, Ogunniyi A, Awada A, Daif A, Zaidan, R. Preliminary assessment of an Arabic version of the Mini-Mental state examination. Annals of Saudi medicine. 1999;19(2):150-2.

Lou MF, Dai YT, Huang GS, Yu PJ. Identifying the most efficient items from the Mini-Mental State Examination for cognitive function assessment in older Taiwanese patients. J Clin Nurs. 2007;16(3):502-8.

Furuäng L, Wollmer P, Siennicki-Lantz A, Elmståhl S. Cardiac ventricular dimensions predict cognitive decline and cerebral blood flow abnormalities in aging men. BMC Geriatr. 2013;13:45.

Lavner Y, Rabinowitz I. Increasing stimulus duration improves attention and memory performance in elderly with cognitive impairment. SAGE Open Med. 2015;3:2050312115621566.

Farag I, Howard K, O'Rourke S, Ferreira ML, Lord SR, Close JC, et al. Health and social support services in older adults recently discharged from hospital: service utilisation and costs and exploration of the impact of a home-exercise intervention. BMC Geriatr. 2016;16(1):82.

Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician.Journal of psychiatric research. 1975;12(3):189-98.

IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.