Telephone cognitive screening with older aboriginal Australians: A preliminary study

Abstract

AbstractBackgroundCognitive assessment via telehealth is being increasingly employed, particularly in the context of the COVID‐19 pandemic. Widespread access to video call software has improved the availability and quality of telehealth services however inequity of access to such technologies remains for some communities, especially when restricted to home‐based telehealth options. As such, telephone adaptations of existing cognitive screening tests need to be validated across diverse populations.MethodThe present study sought to evaluate an existing 26‐point telephone adaptation of the Mini Mental State Examination (TMMSE) in a sample of older Aboriginal Australians. Additionally, we aimed to evaluate a novel urban telephone adaptation of the Aboriginal‐specific Kimberly Indigenous Cognitive Examination short form (TKICA‐screen). A sub‐sample (n=20) of participants (age range: 55‐69 years; MMSE range: 23‐30), who had completed in‐person cognitive assessment (MMSE and KICA‐screen) within the past 6 months as part of the Koori Growing Old Well Study, completed telephone‐based cognitive testing using the TMMSE and TKICA‐screen.ResultThere was a moderate positive correlation between MMSE versions (r=.583; p=.011) with poorer performance on the TMMSE for Season (p=.016) and Phrase (p=.016) items. A weak correlation was observed between the KICA‐screen and TKICA‐screen (r=.196; p=.407) with participant’s performing significantly worse on the TKICA‐screen for Season (p=.016) and Picture Recall (p=0.001). Demographic factors, including age, sex and education were not associated with telephone screening performance. Participants with hearing problems performed worse than those without on the TKICA‐screen (p=.042), but there was no significant difference found on TMMSE (p=.609).ConclusionThis small pragmatic study had a number of limitations, but preliminary results indicate that the TMMSE may be a suitable alternative to the in‐person test in this population. However, the TKICA‐screen requires further revision and evaluation. Clinically, service‐to‐service video telehealth has enabled the continuation of geriatric medicine and dementia outreach clinics to rural Aboriginal community controlled health services throughout pandemic‐related public health restrictions. There is potential for telehealth services to enhance remote access to culturally safe dementia assessment, diagnosis and specialist care services for older Aboriginal Australians, but further research is required, particularly validation of cognitive assessment approaches.