Share this article Share with email Share with twitter Share with linkedin Share with facebook. Abstract The decline of cognitive function in old age is a great challenge for modern society. Free full text. Front Aging Neurosci. Published online Feb Prepublished online Dec 7. PMID: Palha , 1, 2 Nuno Sousa , 1, 2 and Nadine C. Joana A. Author information Article notes Copyright and License information Disclaimer. Received Oct 30; Accepted Jan The use, distribution or reproduction in other forums is permitted, provided the original author s or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice.
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Figure 1. Table 1 Telephone-based neurocognitive screening instruments. Short portable mental status questionnaire SPMSQ The SPMSQ is a item test that measures the presence and severity of cognitive impairment regarding orientation to time and place, memory for personal information and serial subtraction Roccaforte et al.
Telephone cognitive assessment battery TCAB The TCAB was designed to evaluate elderly cognitive status, which can discriminate between mild cognitively impaired and cognitively normal individuals Debanne et al. Minnesota cognitive acuity screen MCAS The MCAS comprises nine cognitive domains, including orientation to time and place, attention, delayed word recall, comprehension, sentences repetition, naming, computation, judgment, and verbal fluency Knopman et al.
Telephone adaptation of the modified mini-mental state exam T3MS The T3MS is a modified version of the 3MS for the assessment of orientation to time and place, verbal memory, mental flexibility, abstract reasoning and language. Brief screen for cognitive impairment BSCI The BSCI consists of a three-item test delayed verbal recall, frequency of help with planning everyday activities, and frequency of help remembering to take medications , which is also suitable to detect dementia Hill et al.
Telephone montreal cognitive assessment T-MoCA In order to reduce missing data for patients that cannot be physically present in a clinical context, Pendlebury et al. Figure 2. Conflict of interest statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Alexopoulos P. Progression to dementia in clinical subtypes of mild cognitive impairment.
Age-related cognitive decline during normal aging: the complex effect of education. Utility and acceptability of the modified telephone interview for cognitive status in a longitudinal study of australian women aged 85 to Validity of the telephone interview for cognitive status TICS in post-stroke subjects. Psychiatry , 19 , 75—79 Psychiatry 18 , — The Hopkins verbal learning test: development of a new memory test with six equivalent forms. The telephone interview for cognitive status.
Neuropsychiatry Neuropsychol. The association of education and socioeconomic status with the Mini Mental State Examination and the clinical diagnosis of dementia in elderly people. Age Ageing 19 , 91—96 Large-scale application of a telephone-based test of cognitive functioning in older adults.
Screening for dementia with the memory impairment screen. Neurology 52 , — A First Course in Factor Analysis. The use of multiple correspondence analysis to explore associations between categories of qualitative variables in healthy ageing. Aging Res. Validation of multistage telephone-based identification of cognitive impairment and dementia. BMC Neurol. Use of an Italian version of the telephone interview for cognitive status in Alzheimer's disease. Psychiatry 21 , — Validation of a telephone cognitive assessment battery.
A brief telephonic instrument to screen for cognitive impairment in a managed care population. Telephone screening to identify potential dementia cases in a population — based sample of older adults. An empirical test of telephone screening to identify potential dementia cases. Psychiatry Neurol. The Spanish version and pilot study of a telephone test of cognitive status for evaluation and screening in dementia assessment and follow-up. A critical review of the use of telephone tests to identify cognitive impairment in epidemiology and clinical research.
Telecare 19 , 45—54 Validation of a brief screen for cognitive impairment BSCI administered by telephone for use in the medicare population. Utility of TICSm for the assessment of cognitive function in older adults.
Characteristics of two telephone screens for cognitive impairment. A short form of the informant questionnaire on cognitive decline in the elderly IQCODE : development and cross-validation. Brief objective measures for the determination of mental status in the aged. Reliability of the blessed telephone information-memory-concentration test.
Development and validation of the cognitive telephone screening instrument COGTEL for the assessment of cognitive function across adulthood. The combining of cognitive testing and an informant questionnaire in screening for dementia. Age Ageing 32 , — Validation of the telephone interview for cognitive status-modified in subjects with normal cognition, mild cognitive impairment, or dementia.
Neuroepidemiology 34 , 34—42 Evaluation of mini-mental state examination scores according to different age and education strata, and sex, in a large Brazilian healthy sample. Effect of cardiovascular and metabolic disease on cognitive test performance and cognitive change in older adults. Psychiatry 22 , — Detecting dementia with the hopkins verbal learning test and the mini-mental state examination. Telephone — assessed mental state. Dementia 4 , — Screening for dementia by telephone using the memory impairment screen.
Reproducibility of a telephone interview assessing cognitive function and depressive symptoms in older adults in Germany. Psychiatry 23 , — Two simple questions to assess neurologic outcomes at three months after out of hospital cardiac arrest: experience from the public access defibrillation trial. Resuscitation 81 , — Telephone interview for cognitive status. Neuroepidemiology 34 , 63—64 Combining cognitive testing and informant report to increase accuracy in screening for dementia.
Validation of a telephone cognitive assessment test battery for use in chronic fatigue syndrome. Telecare 8 , — Psychiatry 16 , — Mental Status and Neuropsychological Assessment: a guide to the standardized mini-mental state examination.
The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Validation of a point telephone version of the mini-mental state examination. Telephone adaptation of the modified mini-mental state exam 3MS. The cache county study. Psychometric Theory. Ageing 25 , 89—93 Patterns of cognitive performance in healthy ageing in northern Portugal: a cross-sectional analysis.
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. Stroke 44 , — Mild cognitive impairment as a diagnostic entity.
Practice parameter: early detection of dementia: mild cognitive impairment an evidence-based review. Neurology 56 , — The memory and aging telephone screen MATS : development and preliminary validation. Validation of a cognitive assessment battery administered over the telephone. Predictors of nutritional risk in community-dwelling seniors. Validation of a telephone version of the mini-mental state examination. Reliability and validity of the short portable mental status questionnaire administered by telephone.
Selective review of cognitive aging. Mood is a key determinant of cognitive performance in community-dwelling older adults: a cross-sectional analysis. Age 35 , — The utility of the Hopkins Verbal Learning Test Chinese version for screening dementia and mild cognitive impairment in a Chinese population. What we need to know about age related memory loss. BMJ , — A review of telephone — administered screening tests for dementia diagnosis. Other Demen. Using Multivariate Statistics. Validation of a brief telephone battery for neurocognitive assessment of patients with pulmonary arterial hypertension.
Changes in anxiety and depression over 2 years in medically stable patients after myocardial infarction and their spouses in the home automatic external defibrillator trial: a longitudinal observational study. Heart 97 , — The mini-mental state examination: a comprehensive review. Use of the telephone-administered minnesota cognitive acuity screen to detect mild cognitive impairment.
Technical Report. Telephone assessment of cognitive function in adulthood: the brief test of adult cognition by telephone. Age Ageing 35 , — Associations between lifestyle and depressed mood: longitudinal results from the Maastricht Aging Study. Public Health 97 , — Relationship between changes in depressive symptoms and unhealthy lifestyles in late middle aged and older persons: results from the Longitudinal Aging Study Amsterdam. Age Ageing 32 , 81—87 Detection of memory impairment in the general population: screening by questionnaire and telephone compared to subsequent face-to-face assessment.
Validation study of a French version of the modified telephone interview for cognitive status F-TICS-m in elderly women. Psychiatry 25 , — Depressive symptoms in older people with metabolic syndrome: is there a relationship with inflammation?
Psychiatry 28 , — Detection of dementia in the elderly using telephone screening of cognitive status. Assessment of cognitive decline in old age with brief tests amenable to telephone administration. Neuroepidemiology 25 , 19—25 Educational attainment and cognitive decline in old age. Neurology 72 , — Telephone — administered cognitive tests as tools for the identification of eligible study.
Participants for population-based research in aging. Aging 28 , — Reliability and validity of the telephone version of the cantonese mini-mental state examination T-CMMSE when used with elderly patients with and without dementia in Hong Kong. Lifestyle intervention reversed cognitive function in aged people with diabetes mellitus: two-year follow up. Diabetes Res. Abstract Overview Literature review Telephone-based neurocognitive screening instruments Concluding remarks Acknowledgments References.
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Cochran's C to calculate variances of the total recall scores; Pearson test to test correlations. Statistical tests of significance involving the amnesic group were not performed because of small sample size. Depiction of the flow of information through the different phases of the review. The TICS instrument was originally purposed for the evaluation of cognitive functions in patients with Alzheimer's disease Brandt et al.
Surpassing its original intent, it is now the most frequently used telephone-based cognitive screening test in medium-to large-scale studies and epidemiologic surveys Herr and Ankri, Briefly, it assesses orientation to time and place, attention, short-term memory, sentence repetition, immediate recall, naming to verbal description, word opposites and praxis.
Both instruments have been translated into several languages, including Finnish, French, German, Hebrew, Italian, Japanese, and Spanish, serving an important role in clinical and research contexts. In epidemiological studies, both instruments detected a range of mild to moderate cognitive disorders and appeared to have comparable sensitivity and specificity as cognitive screening instruments for dementia and Alzheimer's disease Welsh et al.
There is, however, relatively little information concerning its use in longitudinal studies Lopez and Kuller, and with older individuals Baker et al.
Despite its wide use, the only information reported on its application is indicated in the TICSM validation study, in which psychometricians applied the instrument. These indicate for the possibility of lower dropout rates in trials and longitudinal studies.
Another strength relates with the fact that it addresses the lower end of the cognitive ability spectrum dementia Kliegel et al. Still, the authors also report on some important instrument limitations, namely: individuals with hearing impairment may be unable to complete the test or make errors; certain words are more difficult for participants to distinguish clearly and require careful attention to pronunciation; concentration and recall repetition may be hindered if words are not clearly heard.
It has been recommended as an instrument to examine cognitive function in patients with Alzheimer's disease, mainly regarding orientation, attention, memory recall, and calculation, and as means to reassess individuals who have been evaluated in person, allowing to assess cognitive stability or estimating decline.
Designed by Lanska et al. Instrument scores were not independent of education. The authors report the instrument as inadequate for dementia diagnosis, or to assess subtle deficits, except in the context of a comprehensive clinical evaluation. The instrument is recommended to be administered by a trained psychometrician. The SPMSQ is a item test that measures the presence and severity of cognitive impairment regarding orientation to time and place, memory for personal information and serial subtraction Roccaforte et al.
It is a brief and easy instrument to administer that allows discriminating between subjects with dementia or without dementia. The telephone-version has a greater acceptance by participants, compared with its face-to-face form, since the time needed for assessment is shorter. Despite being a potential instrument for epidemiological and longitudinal cognitive research, the authors recommend its administration in a broader and more varied population sample for further validation.
Clinical psychologists, registered nurses or other professionals with medical background carried out the screening in the validation process Gatz et al. On sensitivity and specificity measures it discriminated reliably between Alzheimer's disease patients and healthy cognitively normal individuals Gatz et al. Initially designed to address the lower end of the cognitive ability spectrum, which is considered an advantage, it is consequently not as suitable in studies addressing normal cognitive aging Kliegel et al.
The TCAB was designed to evaluate elderly cognitive status, which can discriminate between mild cognitively impaired and cognitively normal individuals Debanne et al.
It comprises six categories concerning mental status, semantic memory, reasoning, executive ability and language. This instrument requires administration by a well-trained professional, preferably from the field of neuropsychology. It is noted by the original authors that further work is needed to indicate for its applicability in wider community settings.
Developed for the NIMH Genetic Initiative Alzheimer's Disease Study Group, and administered by skilled clinicians, the STIDA is a brief telephone screening instrument designed to discriminate people with normal cognitive functioning from those with cognitive changes due to early Alzheimer's disease Go et al. A much-abbreviated version of STIDA has been developed that contains questions on cognitive abilities and functional status Go et al.
In the validation study individuals were evaluated by a neurologist, a neuropsychologist and a social worker student Lipton et al. The MCAS comprises nine cognitive domains, including orientation to time and place, attention, delayed word recall, comprehension, sentences repetition, naming, computation, judgment, and verbal fluency Knopman et al. The analysis of each domain score can be used to discriminate individuals with cognitive impairment due to MCI or Alzheimer's disease from cognitively normal subjects.
Regarding the test administration, no information is provided regarding applicants' qualifications. The HVLT questionnaire assesses various aspects of verbal memory: short and long delay recall and recognition Brandt, Six distinct forms of HVLT are available, each containing a item unique word list, which can be used to avoid practice effects due to repeated administration. Although it was designed for face-to-face application, the HVLT can also be administered by telephone Brandt, The reliability and validity of the instrument has been verified in patients with traumatic brain injuries, schizophrenia and in most common subtypes of dementia Alzheimer's disease and vascular dementia Kuslansky et al.
No information is provided concerning specific skills recommended for test applicants. The HVLT has as main advantages its appropriateness for serial testing as part of longitudinal studies, with the possibility for alternative forms to be used to circumvent practice effects test—retest. Also, the results were independent of the effects of demographic variables, and as such it may be more appropriate for identifying memory deficits associated with dementing processes than the MMSE.
As shortcomings of the instrument, the authors refer to its validation in samples of convenience patients referred to geriatric psychiatry and for neuropsychological evaluation ; therefore, the authors indicate for the necessity of further research in other community settings.
It is also noted that the HVLT performance is compromised in persons with low reading ability perhaps, as a proxy of education , as well as in individuals diagnosed with clinical depression. Further research is also recommended in order to develop shorter, efficient versions, or in combination with other tools to improve the sensitivity of the instrument. The T3MS is a modified version of the 3MS for the assessment of orientation to time and place, verbal memory, mental flexibility, abstract reasoning and language.
This instrument was used in the Cache County Study, designed to examine factors associated with the risk of Alzheimer's disease and other forms of dementia Norton et al. No information is provided regarding qualifications of the interviewers, and no comments are made regarding how it compares with other instruments.
The authors recognized that more studies are necessary to extrapolate the results to individuals with moderate to severe cognitive impairment, as well as studies with a more homogeneous population. The BSCI consists of a three-item test delayed verbal recall, frequency of help with planning everyday activities, and frequency of help remembering to take medications , which is also suitable to detect dementia Hill et al.
The target sample of the original study comprised demented patients and cognitively healthy individuals. Compared with other screening tests, the BSCI has the advantage of being very brief and presenting no difficulties in its administration and scoring. However, the authors recommend that an experienced interviewer should conduct the evaluation. In addition, it should not to be used in a stand-alone evaluation of MCI or dementia Fillit et al.
The main advantage of the instrument is that it was designed to be included in initiatives targeted to the elderly population, including comprehensive disease management and geriatric case management programs. Specifically, as described by the original authors, the BSCI can be incorporated into larger telephonic health risk assessments in the original study those conducted by Medicare-managed care plans.
Specifically, it assesses speed of processing, verbal working and long-term memory, executive function, and reasoning. Notably, the instrument can be paired with an optional computerized task-switching test, yielding further information on reaction time and executive function. The items are based on laboratory research and telephone versions of well-known psychometric testing instruments these were not, however, specified. One important feature of this test is its applicability in well-functioning younger and middle-aged individuals as well as older people, from a range of educational backgrounds, and also in face-to-face evaluations, providing versatility in aging studies that span different age intervals Tun and Lanchman, The authors recommend recording of the telephone interview and that, as hearing loss can compromise performance, a brief screening on hearing should be conducted at the beginning of the interview.
Developed and designed purposely by Rabin et al. The instrument was not modeled after the MMSE and excluded items known to lack sensitivity in preclinical groups e. It provides a key advantage over other instruments by including both objective and subjective memory assessments, and also by not showing a ceiling effect even in cognitively intact controls.
It is also reported that education, gender, and depressive symptoms did not significantly influence the results. Still, it is noted by the authors the relatively high education level of the participants in the validation sample, and that the instrument may be less sensitive to early cognitive impairment presented primarily in the form of nonamnestic deficits.
Sensitivity and specificity were not determined, which limits the interpretation and utility of the test. It is indicated that longitudinal follow-ups are necessary to confirm the instrument's diagnostic value, to monitor rates of cognitive progression, and to identify which test variables best predict clinical conversion. The COGTEL is a six components screening instrument that covers working, long-term verbal and prospective memory, verbal fluency and inductive reasoning Kliegel et al.
Its purpose is to assess cognitive-function domains across adulthood. The scores of the subtests can be analyzed one by one or be combined to a total score. In order to reduce missing data for patients that cannot be physically present in a clinical context, Pendlebury et al.
The T-MoCA includes items that do not require the use of a pencil and paper or a visual stimulus, with the exception of the sustained attention task where subjects have to tap the side of the telephone with a pencil, instead of tapping on the desk. This tool, combined with the TICSM, was tested in a sample of community-dwelling patients 1 year after they had a transient ischemic attack TIA or a mild stroke.
Screening for cognitive impairment is a relevant issue in clinical neuroscience and geriatrics. The use of cognitive assessments provides an important basis for diagnosing cognitive disorders and monitoring cognitive decline and, hence, disease progression. Here, culling from the available literature, we provide a compiled base of the available telephone-based instruments for neurocognitive screening, giving information on the instrument, its main characteristics, and validation measures Table 1.
Based only on published and peer-reviewed studies, a total of 19 validated instruments were identified, with A summary of the instruments is shown in Figure 2 , reporting on main advantages and limitations. Figure 2. Summary of the instruments for different screening goals. Key advantages and limitations of each set of instruments are identified. The choice of an appropriate screening measure depends on the question being asked and the sample studied.
From the literature review, the TICS was identified as the most widely translated and validated instrument, which may be considered as a possible indicator of the extent of its applicability. Regarding the validation sample, most studies In fact, regarding the former, only This may warrant some considerations. Despite the fact that the MMSE is the most commonly used instrument for global cognitive screening Molloy and Standish, , possessing good reliability indexes, some of its limitations have been identified particularly in detecting subtle memory losses Small, This is probably due to the fact that most instruments were at first developed to either detect dementia in normal samples Crooks et al.
This could be conducted in at least a percentage of the cohort, so to provide continued measures of internal validity. Interestingly, only for the MATS a longitudinal assessment was conducted in the validation study. This handicap should be addressed. The applicability of telephone assessment instruments should, after an initial assessment in a cross-sectional design, also be considered in a longitudinal approach if to better evaluate the sensitivity of the instrument for cognitive changes over time.
For example, a combined approach of a telephone-based cognitive-screening instrument with a questionnaire based on informant reports [such as the Informant Questionnaire on Cognitive Decline in the Elderly, IQCODE Jorm, ] could be applied.
Given their complementary characteristics, the combined use of telephone cognitive screening and informant reports, in cognitive evaluations, is expected to yield promising results in indicating for cognitive trajectories Knafelc et al. All studies considered reported on the statistical methodology used in the data analysis, with Still, as some of the samples were small, making meaningful conclusions regarding some of the tests is difficult.
The average time of administration for the instruments considered was Finally, common limitations were reported. Also, as tasks are instructed and solved verbally, those that involve visual, spatial, or sensorimotor skills cannot be evaluated.
It is also overall recommended that future studies should evaluate for the test—retest and parallel-test reliabilities of the instruments. As discussed, the current shift in population demographics has been accompanied by a need to develop brief and accurate cognitive screening instruments, with the potential to be applied in different research and clinical contexts for the cognitive assessment in medium to large-population samples Petersen et al. As face-to-face administration tools require individuals to be physically present, telephone instruments have been developed as an alternative.
If developed, used and validated properly, despite intrinsic limitations, telephone-based cognitive assessment can considerably contribute to increase sample sizes by reaching more individuals, and can also provide a mean for minimizing costs and participants' burden and accessibility.
Furthermore, several studies demonstrated that the outcome in cognitive assessments administered by telephone is similar to that conducted in face-to-face settings Wilson and Bennett, Furthermore, it is also noted that telephone-based tools can reduce selection bias in epidemiology studies by allowing covering large areas and facilitating follow-up Herr and Ankri, A final comment concerns the use of telephone cognitive assessment for clinical diagnosis.
Telephone-based cognitive instruments can be used as screening tools, but are inadequate tools for a diagnostic decision about the presence of MCI or dementia. Telephone tools can be used for provisional early diagnosis, with later evaluation by accurate clinical examination, neuropsychological assessment, sources of information based on informant reports, and laboratory and imaging methods.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Teresa C. Nadine C. Santos is a recipient of a postdoctoral fellowship by the Switchbox project. Alexopoulos, P. Progression to dementia in clinical subtypes of mild cognitive impairment. Ardila, A. Age-related cognitive decline during normal aging: the complex effect of education.
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