Telephone Interview for Cognitive Status: Creating a crosswalk with the Mini‐Mental State Examination

Fong, Tamara G.; Fearing, Michael A.; Jones, Richard N.; Shi, Peilin; Marcantonio, Edward R.; Rudolph, James L.; Yang, Frances M.; Kiely, K. Dan; Inouye, Sharon K. · 2009 · OpenAlex-citations

DOI: 10.1016/j.jalz.2009.02.007

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Summary

This study addresses the need for a standardized method to compare scores between the Mini-Mental State Examination (MMSE) and the Telephone Interview for Cognitive Status (TICS). While the MMSE is the most widely used instrument for screening cognitive impairment, it requires face-to-face administration, relies on visual and motor skills, and is subject to copyright restrictions. The TICS offers a valid alternative that can be administered via telephone and is suitable for individuals with visual or motor impairments. However, previous studies had not established a direct statistical linkage between the scores of these two instruments, limiting the ability to apply established MMSE cut points to TICS results. To create this crosswalk, the researchers conducted a cross-sectional analysis of baseline data from 746 community-dwelling elders aged 70 and older who participated in the Aging, Demographics, and Memory Study (ADAMS). Participants underwent comprehensive in-person evaluations, including the MMSE and a neuropsychological battery from which TICS-30 and TICS-40 scores were derived. The TICS-30 consists of eight items with a maximum score of 30, while the TICS-40 includes an additional delayed recall item for a maximum score of 40. The study employed equipercentile equating, a statistical method that determines comparable scores based on percentile equivalents, to link the scores of the MMSE with those of the TICS-30 and TICS-40. Log-linear smoothing was used to regularize score distributions, and respondent-level sampling weights were applied to ensure national representativeness. The results demonstrated a high correlation between the instruments, with intra-class correlation coefficients of 0.80 for both MMSE versus TICS-30 and MMSE versus TICS-40. The study established specific equivalent cut points; for instance, an MMSE score of 23 corresponds to a TICS-30 score of 17 and a TICS-40 score of 20. Weighted kappa values of 0.69 indicated substantial agreement between the instruments at these cut points. The correct classification rates were 87.6% for TICS-30 and 88.1% for TICS-40. The authors provided a nomogram illustrating these equivalencies across the full range of scores, showing that higher MMSE scores (e.g., 30) correspond to broader ranges on the TICS scales, while lower scores align more closely. The significance of this work lies in providing clinicians and researchers with a validated metric to translate MMSE cut points to TICS scores. This facilitates the widespread use of the TICS in both clinical practice and large-scale epidemiological studies, particularly where telephone administration is more feasible or cost-effective than face-to-face assessment. Although the study notes limitations—specifically that TICS scores were derived from face-to-face neuropsychological tests rather than actual telephone interviews—the findings confirm that the TICS is a robust alternative to the MMSE. By linking these scores, the study enables the application of widely recognized MMSE thresholds to TICS data, enhancing the utility of cognitive screening in diverse populations, including those with sensory or motor deficits.

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• cognitive impairment