Comparison of the Telephone‐Montreal Cognitive Assessment (T‐MoCA) and Telephone Interview for Cognitive Status (TICS) as Remote Screening Tests for Early Alzheimer’s Disease.

Abstract

AbstractBackgroundThe number of Americans with Alzheimer’s disease (AD) is expected to rise to nearly 14 million by 2060. This alarming number shows a critical need for brief mental status tests that can be administered remotely (e.g., by telephone or videoconferencing) to large numbers of individuals while maintaining the ability to reliably detect cognitive impairment related to AD. Therefore, we sought to validate a recently developed, remotely administered cognitive screening measure, the T‐MoCA, against an established remote measure, the TICS, and prior in‐person clinical and cognitive assessment that provided clinical diagnosis. Relationships with CSF biomarkers of AD were also examined.MethodsThe TICS and T‐MoCA were completed approximately one‐week apart by 215 participants at the UCSD ADRC. Test order was partially counterbalanced. Extensive in‐person clinical and neuropsychological assessment had been completed on average 1.5 years prior and participants classified as cognitively normal (CN; n = 167), mild cognitive impairment (MCI; n = 25) or dementia (n = 23). CSF had been obtained from 79 participants within 48 months of remote testing and levels of Aβ 1–40 and 1–42, phosphorylated tau (p‐tau), and total tau were measured.ResultsTICS and T‐MoCA scores were highly correlated overall (r = .787;p<.001), and moderately within specific MCI (r = .657;p<.001) and dementia (r = .673,p = .001) groups (r = .309, p<.001 for CN only). Groups differed significantly on TICS (F(2,212) = 156.66;p<.001) and T‐MoCA (F(2,210) = 143.72;p<.001), with dementia<MCI<NC on both (p’s<.001). TICS and T‐MoCA had excellent ability to discriminate CN from cognitively impaired (i.e., MCI/dementia) with ROC areas under the curve of .889 and .902, respectively. Optimal cut‐off scores were <17/22 for T‐MoCA (90.4% sensitivity, 76.6% specificity) and <34/41 for TICS (91.0% sensitivity, 74.5% specificity). A composite CSF biomarker of AD (total tau/Aβ 1–42 ratio) was negatively correlated with TICS (r = ‐.372;p = .001) and T‐MoCA (r = ‐.480;p<.001).ConclusionThe T‐MoCA and TICS are valid brief cognitive screening tests with remote administration that can distinguish individuals with cognitive impairment from those who are cognitively normal. The two tests have similar discriminative ability and degree of association with levels of AD biomarkers in CSF. Thus, the T‐MoCA and TICS are promising measures to meet the growing need for remote cognitive screening for AD.