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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.

ABSTRACT: 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.

SUBMITTER: Pendlebury ST

PROVIDER: S-EPMC5593099 | biostudies-literature | 2013 Jan

REPOSITORIES: biostudies-literature

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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.

Pendlebury Sarah T ST Welch Sarah J V SJ Cuthbertson Fiona C FC Mariz Jose J Mehta Ziyah Z Rothwell Peter M PM

Stroke 20121108 1

<h4>Background and purpose</h4>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.<h4>Methods</h4>In a population-based study, consecutive community-dwelling patients underwent the ...[more]

PMID: 23138443

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Project description:IntroductionPostoperative delirium (POD) affects 10-70% of patients 60 years or older and has been linked to increasing length of hospitalization, mortality, and morbidity. Pre-existing cognitive impairment is a predictor of POD. COVID-19 restricted use of in-person cognitive screens. The Telephone Montreal Cognitive Assessment (T-MoCA) can screen for cognitive dysfunction remotely. We evaluated the feasibility of administering T-MoCA in a multiethnic population during pre-operative testing televisits.MethodsPatients scheduled for surgery between July 2020 and August 2020 were asked to participate in the T-MoCA at the end of their preadmission testing (PAT) televisit. A retrospective chart review was conducted to collect patient comorbidities and demographics. Patients were stratified by negative (T-MoCA≥19) or positive (T-MoCA<19) for mild cognitive impairment (MCI) and compared using 2-tailed χ2-tests. Univariate logistic regression was used to identify associations between patient characteristics and positive T-MoCA result.ResultsFifty out of 65 (77%) patients who consented to the T-MoCA completed the test. The average time to complete the assessment was 10.5 mins. Twenty two (44%) had a negative score and 28 (56%) had a positive score. Patients who had a positive T-MoCA were older (70.04±7.61 yrs) compared to those with a negative T-MoCA (67.68±4.69 yrs, p=0.007), although the distribution of patients above and below age 65 was not different (p=0.243). The two groups did not vary by gender, race/ethnicity, obesity, surgery type, or medical co-morbidities. When we examined our population for predictors of a positive T-MoCA, we found a trend toward men being less likely to score positive on T-MoCA (OR=0.33, 95% CI: 0.10-1.10, p=0.07) compared to women; and that patients with Hispanic race/ethnicity were more likely to test positive on the T-MoCA (OR=4.13, 95% CI: 0.84-20.28, p=0.08) compared to Non-Hispanic Whites.ConclusionsImplementation of the T-MoCA in a telemedicine-based PAT setting is feasible. In our cohort, most people who consented to the assessment completed it, and more than half scored positively, which may have important implications on the surgical plan and post-operative recovery. There may be limitations in using T-MoCA in certain populations, such as non-English preferred language, hearing difficulties, lack of focus, and use of external aids, which would need to be explored in a larger sample size.

Dataset Information

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.

Publications

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.

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