Validity of the telephone interview for cognitive status (TICS) and modified TICS (TICSm) for mild cognitive imparment (MCI) and dementia screening
Introduction
Many cognitive screening instruments have been developed for the detection of dementia. Most of them including the mini-mental state examination (MMSE) (Folstein et al., 1975) requires face-to-face administration, which is not always feasible and cost a lot especially to screen geographically dispersed populations. These disadvantages of face-to-face administration instruments limit large-scale population-based cognitive screenings for clinical trials, epidemiological studies, or community-based dementia early detection program (Welsh et al., 1993). To overcome this limitation, several telephone interview-based cognitive screening instruments have been developed (Brandt et al., 1988, Roccaforte et al., 1992, Lanska et al., 1993, Gatz et al., 1995, Kawas et al., 1995, Go et al., 1997).
The telephone interview for cognitive status (TICS), developed by Brandt et al. (1988), is one of the most popular telephone interview-based screening instruments. The TICS consists of 11 items including word list memory, orientation, attention, repetition, conceptual knowledge, and nonverbal praxis. It has been used for epidemiological studies and clinical trials of dementia and known to have high reliability and validity (Brandt et al., 1988, Welsh et al., 1993). Although the TICS was modeled after the MMSE, it has less ceiling effects than the MMSE, and can be reliably used even for persons with visual or physical deficits (Welsh et al., 1993, Desmond et al., 1994).
A modified version of the TICS (TICSm) was also developed (Welsh et al., 1993). Compared with the TICS, a delayed verbal recall item, known as the most sensitive cognitive measure for mild cognitive impairment (MCI) and early Alzheimer's disease (AD) detection, is added in the TICSm, while most other TICS items are still maintained. A series of studies indicated that the TICSm is as valid as the TICS as a screening instrument for dementia (Welsh et al., 1993, Gallo and Breitner, 1995, Beeri et al., 2003). Some studies also reported that the TICSm was valid even for screening MCI (Graff-Radford et al., 2006, Cook et al., 2009, Duff et al., 2009). Any previous studies, however, have not directly compared the screening ability for MCI between the TICS and TICSm, although it is expected that the TICSm have better performance than the TICS in MCI screening given delayed verbal recall item.
Both the TICS (Ferrucci et al., 1998, Jarvenpaa et al., 2002, Dal Forno et al., 2006, Konagaya et al., 2007) and TICSm (Beeri et al., 2003) have been validated in several non-English language using populations, such as Spanish, Italian, Finnish, Hebrew, and Japanese ones. Both instruments or any other telephone interview-based cognitive screening instruments, however, were not validated for Korean population, although Korea is one of the most rapidly aging countries in the world (UN, 2008, Korea National Statistical Office, 2005) and dementia have already become a major health problem (Lee, 2007).
In this study, we first aimed to validate both the TICS and TICSm in Korean elderly population. We also directly compared MCI and dementia screening ability between the TICS and TICSm.
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Study population
Study subjects were recruited from the pool of elderly individuals registered in a nation-wide program for the early detection and management of dementia in Seoul and six provinces (Gyeonggi-do, Kangwon-do, Chungcheong-do, Gyeongsang-do, Chonra-do, and Jeju-do) of Korea from June 2007 to May 2008. Dementia, MCI, and cognitively normal (CN) individuals aged 60–90 were included. All subjects were examined by psychiatrists with advanced training in neuropsychiatry and dementia research according
Results
Seventy CN normal elderly, 75 with MCI and 85 individuals with dementia were included in the present study. Among the patients with dementia, 64 (75.3%) had probable or possible AD, and the other 21 (24.7%) patients had non-AD dementia. Among the participants with MCI, 65 (81.3%) individuals had amnestic MCI (aMCI). The demographic and clinical characteristics of subjects are summarized in Table 1. Internal consistency measured by Cronbach's alpha was 0.87 for both Korean versions of the TICS
Discussion
The present study was conducted to validate both the TICS and TICSm as cognitive screening instruments in Korean elderly people and to compare their ability for detecting MCI and dementia. Both the instruments showed high correlation not only with other representative cognitive scale (i.e., MMSE and SBT), but also with clinical severity scale (i.e., CDR-SOB) and functional scale (i.e., BDS-ADL). These results are globally in line with those from previous studies (Brandt et al., 1988, Beeri et
Conflict of interest statement
None.
Acknowledgements
This work was supported by a grant from the Seoul National University Hospital (Grant No.: 04-2007-027) and a grant of the Korea Healthcare technology R&D Project, Ministry for Health, Welfares & Family Affairs, Republic of Korea (Grant No.: A070001).
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