title: Telephone-based identification of mild cognitive impairment and dementia in a multicultural cohort.
abstract: BACKGROUND
  Telephone-based interviews can be used for screening and to obtain key study outcomes when participants in longitudinal studies die or cannot be seen in person, but must be validated among ethnically and educationally diverse people.
  
  
  OBJECTIVE
  To determine the accuracy of a telephone interview in classifying (1) demented from nondemented participants, (2) cognitively impaired participants from cognitively normal participants, and (3) participants with mild cognitive impairment (MCI) from those with normal cognition or (4) MCI from dementia among an ethnically and educationally diverse community-based sample.
  
  
  METHODS
  The sample consisted of 377 (30.5% non-Hispanic white, 34.7% non-Hispanic black, and 33.7% Caribbean Hispanic) older adults. The validation standard was diagnosis of dementia and MCI based on in-person evaluation. The Telephone Interview for Cognitive Status (TICS) and the Dementia Questionnaire (DQ) were administered within the same assessment wave.
  
  
  RESULTS
  The sample included 256 people (67.9%) with normal cognition, 68 (18.0%) with MCI, and 53 (14.1%) with dementia. Validity of the TICS was comparable among non-Hispanic whites, non-Hispanic blacks, and Hispanics. Among non-Hispanic whites, the DQ had better discrimination of those with dementia from those without dementia and from those with MCI than among other racial/ethnic groups. Telephone measures discriminated best when used to differentiate demented from nondemented participants (88% sensitivity and 87% specificity for the TICS; 66% sensitivity and 89% specificity for DQ) and when used to differentiate cognitively normal participants from those with cognitive impairment (ie, MCI and dementia combined; 73% sensitivity and 77% specificity for the TICS; 49% sensitivity and 82% specificity for DQ). When demographics and prior memory test performance were used to calculate pretest probability, consideration of the telephone measures significantly improved diagnostic validity.
  
  
  CONCLUSIONS
  The TICS has high diagnostic validity for identification of dementia among ethnically diverse older adults, especially when supported by the DQ and prior visit data. However, telephone interview data were unable to reliably distinguish MCI from normal cognition.
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center, 630 W 168th Street, New York, NY 10032, USA. jjm71@columbia.edu
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Manly
authors.forename: Nicole
authors.initials: N
authors.lastname: Schupf
authors.forename: Yaakov
authors.initials: Y
authors.lastname: Stern
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brickman
authors.forename: Ming-X
authors.initials: MX
authors.lastname: Tang
authors.forename: Richard
authors.initials: R
authors.lastname: Mayeux
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis* / Q000208:ethnology* / Q000523:psychology; D015331:Cohort Studies; D018864:Cultural Diversity; D003704:Dementia / Q000175:diagnosis* / Q000208:ethnology* / Q000523:psychology; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007406:Interview, Psychological; D007802:Language; D008297:Male; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013689:Telephone; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data