Telephone cognitive screening with older Aboriginal Australians: A preliminary study.

Abstract

Cognitive screening via telehealth is increasingly employed, particularly during the COVID-19 pandemic. Telephone adaptations of existing cognitive screening tests must be validated across diverse populations. The 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 telephone adaptation of the urban version of the Kimberley Indigenous Cognitive Assessment short-form (tKICA screen). A sub-sample (n=20) of participants (aged 55-69 years; 11 women) who had completed an in-person cognitive assessment (MMSE and KICA screen) within the past 6months as part of the Koori Growing Old Well Study completed telephone-based cognitive testing without an assistant. There was moderate correlation and reasonable agreement between MMSE versions (rs =0.33; p=0.2), although the limits of agreement were unacceptably wide (-4.1 and 4.8 points difference). Poorer performance was seen on the tMMSE for Season (p=0.02) and Phrase (p=0.02) items, and better performance for three-word Recall (p=0.03). KICA-screen versions were poorly correlated (rs =0.20; p=0.4) with telephone scoring a mean of 2.17 points below the face-to-face score, greater bias observed at the lower end of the performance and worse scores for Season (p=0.02) and Recall (p=0.001) items. Age and education were not associated with telephone screening performance. Hearing impairment was associated with poorer performance on the tKICA screen (p=0.04) but not the tMMSE (p=0.6). Results indicate that telephone administration of the MMSE and/or KICA screen is not equivalent to in-person testing for older Aboriginal people, and further revision and evaluation are required.