The goal of this paper is to investigate the sensitivity and specificity of a widely-used telephone interview for late-life cognitive assessment (the modified Telephone Interview for Cognitive Status; TICS-M 1
) in the detection of amnestic Mild Cognitive Impairment (aMCI). The present study seeks to extend previous research by adding to the small corpus of research 2
that suggests that the TICS-M may be a useful screening instrument not only for dementia (the original purpose of the TICS), but also for aMCI. The study also extends prior work by examining a community-dwelling population (i.e., not clinically referred), to examine the utility of the TICS-M as a screening tool in a community volunteer sample.
Most screening tools to detect cognitive impairment require in-person assessment (e.g., Mini-Mental Status Exam 3
, Mattis Dementia Rating Scale 4
, etc.). However, this method may not always be cost-effective or feasible for older adults who may be frail or have physical limitations. Furthermore, the need for in-person assessment can limit the ability of population-based studies to cognitively screen large numbers of adults. To overcome these barriers, the Telephone Interview for Cognitive Status (TICS) 5
was developed. The TICS has some similarities to the Mini-Mental Status Exam 3
, in that it includes questions regarding orientation, repetition, and naming; however, the measure has been subsequently modified (TICS-M) 1
to include a more comprehensive memory assessment, including both immediate and delayed recall of a 10-item non-semantically related word list, to increase the probability of identifying dementia. The TICS-M was included in the present study to determine how well this telephone approach detects aMCI in a non-clinically referred sample.
Individuals with MCI are at an increased risk for the development of Alzheimer’s Disease (AD), with an annual conversion rate to AD of 6 to 25% compared to less than 4% of the general population 6
, which has led to investigations of early identification and pharmacological and behavioral interventions to help delay the progression of MCI to AD. There are multiple presentations of MCI (e.g., single impairment in a cognitive domain other than memory, multiple domains impaired 7
). The present study focused solely on the amnestic type (aMCI). aMCI patients show a mild memory deficit beyond what is expected for their age (e.g., perform ≥ 1.5 SD below age and education corrected norms) while other cognitive domains (e.g., working memory or language abilities) are within normal limits. In this study, we also examined the Clinical Dementia Rating Scale 8
(CDR), to ascertain whether individuals and their proxy informants verified cognitive impairments and declining function in everyday contexts. Criteria for aMCI also require the individual express a subjective memory complaint, exhibit intact activities of daily living (ADLs; i.e., bathing, dressing; operationalized with Personal Care subscale of the CDR 8
in this study), and to not meet the criteria for dementia 6
Preliminary research of the use of the TICS-M in detecting MCI 9
has shown that in the course of recruitment for a population-based study, approximately 50% of individuals with TICS-M scores between 19–38 who were later assessed in the clinic met criteria for aMCI. However, the authors did not specify what score or range of scores was most indicative of aMCI. A study by Graff-Radford and colleagues 2
used a cutoff for MCI of 29 on the TICS-M; while this cutoff showed 86% sensitivity, it only had 63% specificity of detecting MCI, with only 12 of the 20 cognitively impaired participants below this cutoff score. Furthermore, the sample used in the Graff-Radford et al. study was lower educated and older than most studies of cognitive aging and thus may not be representative of the greater older population.
Therefore, the present study sought to determine the sensitivity and specificity (and positive and negative predictive value) for detecting aMCI with the TICS-M within a non-clinically referred community-based volunteer sample. Given the selective nature of the sample, the current data set does not meet the standards of a normative sample (i.e., to provide TICS-M cutoff scores for various age/sex/education groups). Finally, we investigated the utility of using receiver operating characteristics (ROC) analysis to identify cutoffs for this sample.