Diagnostic accuracy of the telephone interview for cognitive status (TICS) for the detection of dementia in primary care in the Netherlands

Abstract

AbstractBackgroundDementia is underdiagnosed in primary care, partly due to limited time and lack of simple diagnostic tools. In the Netherlands, the Mini‐Mental State Examination (MMSE) is the most frequently used diagnostic tool for cognitive screening in clinical practice. The MMSE has several limitations in primary care. The telephone interview for cognitive status (TICS), might be a simple and accurate alternative for cognitive screening, particularly when in‐person testing is not feasible.Methods810 community‐dwelling older people, aged 86.4 years (±2.4SD), with no dementia at baseline, recruited from the prevention of Dementia by Intensive Vascular care (preDIVA) observational extended (POE) trial, and were administered the TICS. Electronic health records of all participants with a TICS ≤30, and a random sample of participants with a TICS‐score >30, were screened for the presence of a dementia diagnosis. Multiple imputation was performed to manage missing data and to correct for verification bias.Results19.1% (155/810) of participants had a TICS‐score ≤30, vs 82.1% (655/810) of participants with a TICS‐score >30. Electronic health records reported 8.4% (13/154) of participants with TICS ≤30 had been diagnosed with dementia, versus none of the participants with a TICS‐score >30. The optimal TICS cut‐off score of the imputed data was at ≤30, with a sensitivity of 86.9%, specificity of 94.9%, positive predictive value of 77.4%, negative predictive value 97.2%, and an area under the curve of 90.9% (95%CI=81.2‐90.9).ConclusionThe TICS seems to be a valid and reliable screening instrument for excluding dementia in primary care, particularly when face‐to‐face screening is not feasible. The ability of TICS to reach large numbers of people at low cost, could contribute to more efficient medical management in primary care.