Telephone assessment of cognition after transient ischemic attack and stroke: modified telephone interview of cognitive status and telephone Montreal cognitive assessment versus face-to-face Montreal cognitive assessment and neuropsychological battery

Journal article

Background and Purpose—

Face-to-face cognitive testing is not always possible in large studies. Therefore, we assessed the telephone Montreal Cognitive Assessment (T-MoCA: MoCA items not requiring pencil and paper or visual stimulus) and the modified Telephone Interview of Cognitive Status (TICSm) against face-to-face cognitive tests in patients with transient ischemic attack (TIA) or stroke.

Methods—

In a population-based study, consecutive community-dwelling patients underwent the MoCA and neuropsychological battery >1 year after TIA or stroke, followed by T-MoCA (22 points) and TICSm (39 points) at least 1 month later. Mild cognitive impairment (MCI) was diagnosed using modified Petersen criteria and the area under the receiver-operating characteristic curve (AUC) determined for T-MoCA and TICSm.

Results—

Ninety-one nondemented subjects completed neuropsychological testing (mean±SD age, 72.9±11.6 years; 54 males; stroke 49%) and 73 had telephone follow-up. MoCA subtest scores for repetition, abstraction, and verbal fluency were significantly worse (P<0.02) by telephone than during face-to-face testing. Reliability of diagnosis for MCI (AUC) were T-MoCA of 0.75 (95% confidence interval [CI], 0.63–0.87) and TICSm of 0.79 (95% CI, 0.68–0.90) vs face-to-face MoCA of 0.85 (95% CI, 0.76–0.94). Optimal cutoffs were 18 to 19 for T-MoCA and 24 to 25 for TICSm. Reliability of diagnosis for MCI (AUC) was greater when only multi-domain impairment was considered (T-MoCA=0.85; 95% CI, 0.75–0.96 and TICSm=0.83, 95% CI, 0.70–0.96) vs face-to-face MoCA=0.87; 95% CI, 0.76–0.97).

Conclusions—

Both T-MoCA and TICSm are feasible and valid telephone tests of cognition after TIA and stroke but perform better in detecting multi-domain vs single-domain impairment. However, T-MoCA is limited in its ability to assess visuoexecutive and complex language tasks compared with face-to-face MoCA.

Authors: Pendlebury, ST; Welch, SJV; Cuthbertson, FC; Mariz, J; Mehta, Z

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Heart Association
• Journal: Stroke
• Volume: 44
• Issue: 1
• Pages: 227-229
• Publication date: 2012-11-08
• DOI: 10.1161/STROKEAHA.112.673384
• EISSN: 1524-4628
• ISSN: 0039-2499
• Language: English
• Keywords: vascular cognitive impairment; modified Telephone Interview of Cognitive Status; Montreal Cognitive Assessment; mild cognitive impairment; telephone testing