title: 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: OBJECTIVE
  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.affiliation: MRCP, DPhil, Stroke Prevention Research Unit, John Radcliffe Hospital, Oxford OX3 9DU, UK. sarah.pendlebury@ndcn.ox.ac.uk
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Pendlebury
authors.forename: Sarah J V
authors.initials: SJ
authors.lastname: Welch
authors.forename: Fiona C
authors.initials: FC
authors.lastname: Cuthbertson
authors.forename: Jose
authors.initials: J
authors.lastname: Mariz
authors.forename: Ziyah
authors.initials: Z
authors.lastname: Mehta
authors.forename: Peter M
authors.initials: PM
authors.lastname: Rothwell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic / Q000379:methods* / Q000592:standards; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D011792:Quebec / Q000453:epidemiology; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology