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Vol. 34, No. 1, 2010
Issue release date: January 2010
Free Access
Neuroepidemiology 2010;34:34–42
(DOI:10.1159/000255464)

Validation of the Telephone Interview for Cognitive Status-modified in Subjects with Normal Cognition, Mild Cognitive Impairment, or Dementia

Knopman D.S.a, b · Roberts R.O.b, c · Geda Y.E.b–d · Pankratz V.S.b, e · Christianson T.J.H.b, e · Petersen R.C.a, b · Rocca W.A.a, c
aDepartment of Neurology, bMayo Clinic Alzheimer’s Disease Research Center, cDivision of Epidemiology, Department of Health Sciences Research, dDepartment of Psychiatry and Psychology, eDivision of Biomedical Statistics and Informatics, Department of Health Sciences Research, College of Medicine, Mayo Clinic, Rochester, Minn., USA
email Corresponding Author

Abstract

Background: The telephone assessment of cognitive functions may reduce the cost and burden of epidemiological studies. Methods: We validated the Telephone Interview for Cognitive Status-modified (TICS-m) using an extensive in-person assessment as the standard for comparison. Clinical diagnoses of normal cognition, mild cognitive impairment (MCI), or dementia were established by consensus of physician, nurse, and neuropsychological assessments. Results: The extensive in-person assessment classified 83 persons with normal cognition, 42 persons with MCI, and 42 persons with dementia. There was considerable overlap in TICS-m scores among the three groups. Receiver operating characteristic curves identified ≤31 as the optimal cutoff score to separate subjects with MCI from subjects with normal cognition (sensitivity = 71.4%; subjects with dementia excluded), and ≤27 to separate subjects with dementia from subjects with MCI (sensitivity = 69.0%; subjects with normal cognition excluded). The TICS-m performed well when subjects with MCI were pooled either with subjects with dementia (sensitivity = 83.3%) or with subjects with normal cognition (sensitivity = 83.3%). Conclusions: Although the TICS-m performed well when using a dichotomous classification of cognitive status, it performed only fairly in separating MCI from either normal cognition or dementia. The TICS-m should not be used as a free-standing tool to identify subjects with MCI, and it should be used with caution as a tool to detect dementia.


 goto top of outline Key Words

  • Dementia
  • Mild cognitive impairment
  • Telephone Interview for Cognitive Status-modified

 goto top of outline Abstract

Background: The telephone assessment of cognitive functions may reduce the cost and burden of epidemiological studies. Methods: We validated the Telephone Interview for Cognitive Status-modified (TICS-m) using an extensive in-person assessment as the standard for comparison. Clinical diagnoses of normal cognition, mild cognitive impairment (MCI), or dementia were established by consensus of physician, nurse, and neuropsychological assessments. Results: The extensive in-person assessment classified 83 persons with normal cognition, 42 persons with MCI, and 42 persons with dementia. There was considerable overlap in TICS-m scores among the three groups. Receiver operating characteristic curves identified ≤31 as the optimal cutoff score to separate subjects with MCI from subjects with normal cognition (sensitivity = 71.4%; subjects with dementia excluded), and ≤27 to separate subjects with dementia from subjects with MCI (sensitivity = 69.0%; subjects with normal cognition excluded). The TICS-m performed well when subjects with MCI were pooled either with subjects with dementia (sensitivity = 83.3%) or with subjects with normal cognition (sensitivity = 83.3%). Conclusions: Although the TICS-m performed well when using a dichotomous classification of cognitive status, it performed only fairly in separating MCI from either normal cognition or dementia. The TICS-m should not be used as a free-standing tool to identify subjects with MCI, and it should be used with caution as a tool to detect dementia.

Copyright © 2009 S. Karger AG, Basel


 goto top of outline References
  1. Welsh KA, Breitner JCS, Magruder-Habib KM: Detection of dementia in the elderly using telephone screening of cognitive status. Neuropsychiatry Neuropsychol Behav Neurol 1993;6:103–110.

    External Resources

  2. Brandt J, Spencer M, Folstein M: The telephone interview for cognitive status. Neuropsychiatry Neuropsychol Behav Neurol 1988;1:111–117.
  3. Plassman BL, Newman TT, Welsh KA, Helms M, Breitner JCS: Properties of the telephone interview for cognitive status. Application in epidemiological and longitudinal studies. Neuropsychiatry Neuropsychol Behav Neurol 1994;7:235–241.

    External Resources

  4. De Jager CA, Budge MM, Clarke R: Utility of TICS-m for the assessment of cognitive function in older adults. Int J Geriatr Psychiatry 2003;18:318–324.
  5. Crooks V, Clark L, Petitti D, Chui H, Chiu V: Validation of multi-stage telephone-based identification of cognitive impairment and dementia. BMC Neurol 2005;5:8.
  6. Beeri MS, Werner P, Davidson M, Schmidler J, Silverman J: Validation of the modified telephone interview for cognitive status (TICS-m) in Hebrew. Int J Geriatr Psychiatry 2003;18:381–386.
  7. Gallo JJ, Breitner JC: Alzheimer’s disease in the NAS-NRC Registry of aging twin veterans. 4. Performance characteristics of a two-stage telephone screening procedure for Alzheimer’s dementia. Psychol Med 1995;25:1211–1219.
  8. Roberts RO, Geda YE, Knopman DS, Cha RH, Pankratz VS, Boeve BF, Ivnik RJ, Tangalos EG, Petersen RC, Rocca WA: The Mayo Clinic Study of Aging: design and sampling, participation, baseline measures and sample characteristics. Neuroepidemiology 2008;30:58–69.
  9. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E: Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303–308.
  10. Wechsler DA: Wechsler Adult Intelligence Scale-Revised. New York, Psychological Corporation, 1987.
  11. Wechsler DA: Wechsler Memory Scale-Revised. New York, Psychological Corporation, 1987.
  12. Reitan RM: Validity of the Trail Making Test as an indicator of organic brain damage. Percept Motor Skills 1958;8:271–276.

    External Resources

  13. Kaplan EF, Goodglass H, Weintraub S: The Boston Naming Test, ed 2. Philadelphia, Lea & Febiger, 1982.
  14. Lucas JA, Ivnik RJ, Smith GE, Bohac DL, Tangalos EG, Graff-Radford NR, Petersen RC: Mayo’s Older Americans Normative Studies: category fluency norms. J Clin Exp Neuropsychol 1998;20:194–200.
  15. Ivnik RJ, Malec JF, Smith GE: WAIS-R, WMS-R and AVLT norms for ages 56 through 97. Clin Neuropsychol 1992;6:1–104.

    External Resources

  16. Kokmen E, Naessens JM, Offord KP: A short test of mental status: description and preliminary results. Mayo Clin Proc 1987;62:281–288.
  17. Kokmen E, Smith GE, Petersen RC, Tangalos E, Ivnik RC: The Short Test of Mental Status. Correlations with standardized psychometric testing. Arch Neurol 1991;48:725–728.
  18. Tang-Wai DF, Knopman DS, Geda YE, Edland SD, Smith GE, Ivnik RJ, Tangalos EG, Boeve BF, Petersen RC: Comparison of the Short Test of Mental Status and the Mini-Mental State Examination in mild cognitive impairment. Arch Neurol 2003;60:1777–1781.
  19. Ivnik RJ, Malec JF, Smith GE, Tangalos EG, Petersen RC, Kokmen E, Kurland LT: Mayo’s Older Americans Normative Studies: WAIS-R norms for ages 56 to 97. Clin Neuropsychol 1992;65:1–30.

    External Resources

  20. Petersen RC: Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183–194.
  21. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
  22. Morris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412–2414.
  23. Graff-Radford NR, Ferman TJ, Lucas JA, Johnson HK, Parfitt FC, Heckman MG, Todd M, Sadowsky C, Epstein DE, Crook JE: A cost effective method of identifying and recruiting persons over 80 free of dementia or mild cognitive impairment. Alzheimer Dis Assoc Disord 2006;20:101–104.
  24. Rocca WA, Bower JH, Maraganore DM, Ahlskog JE, Grossardt BR, de Andrade M, Melton LJ 3rd: Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology 2007;69:1074–1083.
  25. Rocca WA, Bower JH, Ahlskog JE, Elbaz A, Grossardt BR, McDonnell SK, Schaid DJ, Maraganore DM: Risk of cognitive impairment or dementia in relatives of patients with Parkinson disease. Arch Neurol 2007;64:1458–1464.
  26. Lines CR, McCarroll KA, Lipton RB, Block GA: Telephone screening for amnestic mild cognitive impairment. Neurology 2003;60:261–266.
  27. Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  28. Knopman DS, Knudson D, Yoes ME, Weiss DJ: Development and standardization of a new telephonic cognitive screening test: the Minnesota Cognitive Acuity Screen (MCAS). Neuropsychiatry Neuropsychol Behav Neurol 2000;13:286–296.

 goto top of outline Author Contacts

Dr. David S. Knopman
Department of Neurology, College of Medicine
Mayo Clinic, 200 First Street SW
Rochester, MN 55905 (USA)
Tel. +1 507 538 1038, Fax +1 507 538 6012, E Mail knopman@mayo.edu


 goto top of outline Article Information

Conflict of Interest: Dr. Knopman has served on a Data Safety Monitoring Board for Sanofi-Aventis and serves on a Data Safety Monitoring Board for Lilly. He served as a consultant to GlaxoSmithKline. He is also an investigator in a clinical trial sponsored by Elan Pharmaceuticals. Dr. Petersen has been a consultant to GE HealthCare, Servier, and Elan Pharmaceuticals.

Received: June 17, 2009
Accepted: September 7, 2009
Published online: November 5, 2009
Number of Print Pages : 9
Number of Figures : 4, Number of Tables : 5, Number of References : 28


 goto top of outline Publication Details

Neuroepidemiology

Vol. 34, No. 1, Year 2010 (Cover Date: January 2010)

Journal Editor: Feigin V.L. (Auckland)
ISSN: 0251-5350 (Print), eISSN: 1423-0208 (Online)

For additional information: http://www.karger.com/NED


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Background: The telephone assessment of cognitive functions may reduce the cost and burden of epidemiological studies. Methods: We validated the Telephone Interview for Cognitive Status-modified (TICS-m) using an extensive in-person assessment as the standard for comparison. Clinical diagnoses of normal cognition, mild cognitive impairment (MCI), or dementia were established by consensus of physician, nurse, and neuropsychological assessments. Results: The extensive in-person assessment classified 83 persons with normal cognition, 42 persons with MCI, and 42 persons with dementia. There was considerable overlap in TICS-m scores among the three groups. Receiver operating characteristic curves identified ≤31 as the optimal cutoff score to separate subjects with MCI from subjects with normal cognition (sensitivity = 71.4%; subjects with dementia excluded), and ≤27 to separate subjects with dementia from subjects with MCI (sensitivity = 69.0%; subjects with normal cognition excluded). The TICS-m performed well when subjects with MCI were pooled either with subjects with dementia (sensitivity = 83.3%) or with subjects with normal cognition (sensitivity = 83.3%). Conclusions: Although the TICS-m performed well when using a dichotomous classification of cognitive status, it performed only fairly in separating MCI from either normal cognition or dementia. The TICS-m should not be used as a free-standing tool to identify subjects with MCI, and it should be used with caution as a tool to detect dementia.



 goto top of outline Author Contacts

Dr. David S. Knopman
Department of Neurology, College of Medicine
Mayo Clinic, 200 First Street SW
Rochester, MN 55905 (USA)
Tel. +1 507 538 1038, Fax +1 507 538 6012, E Mail knopman@mayo.edu


 goto top of outline Article Information

Conflict of Interest: Dr. Knopman has served on a Data Safety Monitoring Board for Sanofi-Aventis and serves on a Data Safety Monitoring Board for Lilly. He served as a consultant to GlaxoSmithKline. He is also an investigator in a clinical trial sponsored by Elan Pharmaceuticals. Dr. Petersen has been a consultant to GE HealthCare, Servier, and Elan Pharmaceuticals.

Received: June 17, 2009
Accepted: September 7, 2009
Published online: November 5, 2009
Number of Print Pages : 9
Number of Figures : 4, Number of Tables : 5, Number of References : 28


 goto top of outline Publication Details

Neuroepidemiology

Vol. 34, No. 1, Year 2010 (Cover Date: January 2010)

Journal Editor: Feigin V.L. (Auckland)
ISSN: 0251-5350 (Print), eISSN: 1423-0208 (Online)

For additional information: http://www.karger.com/NED


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Welsh KA, Breitner JCS, Magruder-Habib KM: Detection of dementia in the elderly using telephone screening of cognitive status. Neuropsychiatry Neuropsychol Behav Neurol 1993;6:103–110.

    External Resources

  2. Brandt J, Spencer M, Folstein M: The telephone interview for cognitive status. Neuropsychiatry Neuropsychol Behav Neurol 1988;1:111–117.
  3. Plassman BL, Newman TT, Welsh KA, Helms M, Breitner JCS: Properties of the telephone interview for cognitive status. Application in epidemiological and longitudinal studies. Neuropsychiatry Neuropsychol Behav Neurol 1994;7:235–241.

    External Resources

  4. De Jager CA, Budge MM, Clarke R: Utility of TICS-m for the assessment of cognitive function in older adults. Int J Geriatr Psychiatry 2003;18:318–324.
  5. Crooks V, Clark L, Petitti D, Chui H, Chiu V: Validation of multi-stage telephone-based identification of cognitive impairment and dementia. BMC Neurol 2005;5:8.
  6. Beeri MS, Werner P, Davidson M, Schmidler J, Silverman J: Validation of the modified telephone interview for cognitive status (TICS-m) in Hebrew. Int J Geriatr Psychiatry 2003;18:381–386.
  7. Gallo JJ, Breitner JC: Alzheimer’s disease in the NAS-NRC Registry of aging twin veterans. 4. Performance characteristics of a two-stage telephone screening procedure for Alzheimer’s dementia. Psychol Med 1995;25:1211–1219.
  8. Roberts RO, Geda YE, Knopman DS, Cha RH, Pankratz VS, Boeve BF, Ivnik RJ, Tangalos EG, Petersen RC, Rocca WA: The Mayo Clinic Study of Aging: design and sampling, participation, baseline measures and sample characteristics. Neuroepidemiology 2008;30:58–69.
  9. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E: Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303–308.
  10. Wechsler DA: Wechsler Adult Intelligence Scale-Revised. New York, Psychological Corporation, 1987.
  11. Wechsler DA: Wechsler Memory Scale-Revised. New York, Psychological Corporation, 1987.
  12. Reitan RM: Validity of the Trail Making Test as an indicator of organic brain damage. Percept Motor Skills 1958;8:271–276.

    External Resources

  13. Kaplan EF, Goodglass H, Weintraub S: The Boston Naming Test, ed 2. Philadelphia, Lea & Febiger, 1982.
  14. Lucas JA, Ivnik RJ, Smith GE, Bohac DL, Tangalos EG, Graff-Radford NR, Petersen RC: Mayo’s Older Americans Normative Studies: category fluency norms. J Clin Exp Neuropsychol 1998;20:194–200.
  15. Ivnik RJ, Malec JF, Smith GE: WAIS-R, WMS-R and AVLT norms for ages 56 through 97. Clin Neuropsychol 1992;6:1–104.

    External Resources

  16. Kokmen E, Naessens JM, Offord KP: A short test of mental status: description and preliminary results. Mayo Clin Proc 1987;62:281–288.
  17. Kokmen E, Smith GE, Petersen RC, Tangalos E, Ivnik RC: The Short Test of Mental Status. Correlations with standardized psychometric testing. Arch Neurol 1991;48:725–728.
  18. Tang-Wai DF, Knopman DS, Geda YE, Edland SD, Smith GE, Ivnik RJ, Tangalos EG, Boeve BF, Petersen RC: Comparison of the Short Test of Mental Status and the Mini-Mental State Examination in mild cognitive impairment. Arch Neurol 2003;60:1777–1781.
  19. Ivnik RJ, Malec JF, Smith GE, Tangalos EG, Petersen RC, Kokmen E, Kurland LT: Mayo’s Older Americans Normative Studies: WAIS-R norms for ages 56 to 97. Clin Neuropsychol 1992;65:1–30.

    External Resources

  20. Petersen RC: Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183–194.
  21. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4. Washington, American Psychiatric Association, 1994.
  22. Morris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology 1993;43:2412–2414.
  23. Graff-Radford NR, Ferman TJ, Lucas JA, Johnson HK, Parfitt FC, Heckman MG, Todd M, Sadowsky C, Epstein DE, Crook JE: A cost effective method of identifying and recruiting persons over 80 free of dementia or mild cognitive impairment. Alzheimer Dis Assoc Disord 2006;20:101–104.
  24. Rocca WA, Bower JH, Maraganore DM, Ahlskog JE, Grossardt BR, de Andrade M, Melton LJ 3rd: Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology 2007;69:1074–1083.
  25. Rocca WA, Bower JH, Ahlskog JE, Elbaz A, Grossardt BR, McDonnell SK, Schaid DJ, Maraganore DM: Risk of cognitive impairment or dementia in relatives of patients with Parkinson disease. Arch Neurol 2007;64:1458–1464.
  26. Lines CR, McCarroll KA, Lipton RB, Block GA: Telephone screening for amnestic mild cognitive impairment. Neurology 2003;60:261–266.
  27. Folstein MF, Folstein SE, McHugh PR: ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  28. Knopman DS, Knudson D, Yoes ME, Weiss DJ: Development and standardization of a new telephonic cognitive screening test: the Minnesota Cognitive Acuity Screen (MCAS). Neuropsychiatry Neuropsychol Behav Neurol 2000;13:286–296.