Telehealth equivalence of the Montreal cognitive assessment (MoCA): Results from the Emory healthy brain study (EHBS).

Abstract

We investigated potential differences between in-person cognitive testing and video telehealth administration of the Montreal Cognitive Assessment (MoCA). In addition to the MoCA, the Patient Health Questionnaire-8 (PHQ-8) and Generalized Anxiety Disorder-7 (GAD-7) were administered. MoCA scores from participants in the Emory Health Brain Study (EHBS) were contrasted based upon whether they were administered the MoCA in the standard face-to-face (F2F) assessment setting (n=1205) or using a video telehealth administration (n=491). All EHBS participants were self-reported to be cognitively normal. MoCA scores did not differ across administration method (F2F MoCA=26.6, SD=2.4; telehealth MoCA=26.5, SD=2.4). The 95% confidence interval for difference in administration was small (CI=-0.16 to 0.34). When examining MoCA domain scores, administration differences were either associated with no statistically significant effect, or if present due to large sample sizes, were associated with small effects and differences <0.5 point. Telehealth patients reported slightly lower PHQ-8 scores (F2F PHQ-8=2.0, SD=2.5; telehealth PHQ-8=1.6, SD=2.1), although these scores are well within the normal range. No group difference in GAD-7 scores was present (F2F GAD-7=1.4, SD=2.4; telehealth PHQ-8=1.4, SD=2.4). This report with its large sample size and between subject cohort provides complementary evidence to smaller test-retest studies, further supporting equivalence of MoCA telehealth testing to F2F MoCA administration. These findings provide additional reassurance that administration mode does not introduce systematic performance differences for MoCA test administration, thereby permitting telehealth MoCA testing to be applied confidently for both clinical and research applications.