Tracking cognition with the T-MoCA in a racially/ethnically diverse older adult cohort.

Introduction: We investigated the utility of the Telephone-Montreal Cognitive Assessment (T-MoCA) to track cognition in a diverse sample from the Einstein Aging Study. Methods: Telephone and in-person MoCA data, collected annually, were used to evaluate longitudinal cognitive performance. Joint models of T-MoCA and in-person MoCA compared changes, variance, and test-retest reliability measured by intraclass correlation coefficient by racial/ethnic group. Results: There were no significant differences in baseline performance or longitudinal changes across three study waves for both MoCA formats. T-MoCA performance improved over waves 1-3 but declined afterward. Test-retest reliability was lower for the T-MoCA than for the in-person MoCA. In comparison with non-Hispanic Whites, non-Hispanic Blacks and Hispanics performed worse at baseline on both MoCA formats and showed lower correlations between T-MoCA and in-person versions. Conclusions: The T-MoCA provides valuable information on cognitive change, despite racial/ethnic disparities and practice effects. We discuss implications for health disparity populations. Highlights: We assessed the comparability of Telephone-Montreal Cognitive Assessment (T-MoCA) and in-person MoCA for tracking cognition.Changes within 3 years in T-MoCA were similar to that for the in-person MoCA.T-MoCA is subject to practice effects and shows difference in performance by race/ethnicity.Test-retest reliability of T-MoCA is lower than that for in-person MoCA.

T-MoCA: A valid phone screen for cognitive impairment in diverse community samples.

INTRODUCTION: There is an urgent need to validate telephone versions of widely used general cognitive measures, such as the Montreal Cognitive Assessment (T-MoCA), for remote assessments. METHODS: In the Einstein Aging Study, a diverse community cohort (n = 428; mean age = 78.1; 66% female; 54% non-White), equivalence testing was used to examine concordance between the T-MoCA and the corresponding in-person MoCA assessment. Receiver operating characteristic analyses examined the diagnostic ability to discriminate between mild cognitive impairment and normal cognition. Conversion methods from T-MoCA to the MoCA are presented. RESULTS: Education, race/ethnicity, gender, age, self-reported cognitive concerns, and telephone administration difficulties were associated with both modes of administration; however, when examining the difference between modalities, these factors were not significant. Sensitivity and specificity for the T-MoCA (using Youden's index optimal cut) were 72% and 59%, respectively. DISCUSSION: The T-MoCA demonstrated sufficient psychometric properties to be useful for screening of MCI, especially when clinic visits are not feasible.

Aging research in the time of COVID-19: A telephone screen for subjective cognitive concerns in community-dwelling ethnically diverse older adults

Background There is an urgent need for validation of remotely-administered cognitive screens to identify older adults at risk for dementia, to monitor disease progression, and to facilitate follow-up when in-person visits are not feasible. Restrictions on in-person cognitive assessments due to COVID-19 have spurred a growing literature on telephone-based cognitive screening. However, few studies have evaluated the value of telephone-administered screens of subjective cognitive concerns (SCC), an important early marker of dementia-risk. Method Einstein Aging Study participants (subsample, n=455;Mage=77.0;Myears education=15.0;64.1% women;46.4% White) completed the Telephone Screen for Subjective Cognitive Concerns (T-SSCC), a 16-item measure of self-reported memory, language, executive functioning, visuospatial/navigation, concentration, calculation, and mental clarity concerns, as well as the Telephone Montreal Cognitive Assessment (T-MoCA). In-person assessments included the paper-and-pencil Cognitive Change Index (CCI) and comprehensive neuropsychological evaluation. Classification as cognitively normal (CN;n=288) or mild cognitive impairment (MCI;n=153) was based on Jak/Bondi criteria. Primary analyses included correlations between the objective and subjective screening instruments, and logistic regression to evaluate the association between the T-SSCC and MCI status. Result Total endorsement of concerns on the T-SSCC (OR 1.095, CI 1.018-1.178, p=0.015) was significantly associated with MCI status. In particular, endorsement of ?Do any of these problems interfere with your daily life?? was strongly related to MCI (OR 2.296, CI 1.284-4.108, p=0.005). The T-SSCC was moderately correlated with the in-person CCI (r[114]=0.577, p<0.001). A small but significant relationship was observed between the T-SSCC and T-MoCA (r[258]=-0.206, p<0.001). Conclusion To our knowledge, this is the first study to validate a telephone SCC screen in response to the crucial need for such remotely administered measures. The T-SSCC was significantly associated MCI status;furthermore, specific items related to the impact of cognitive problems in daily life were particularly sensitive to MCI. Such SCC measures are brief, accessible, and well-tolerated and may provide additionally valuable information that enhances remotely-administered cognitive screens.