Accuracy of Telephone-Based Cognitive Screening Tests: Systematic Review and Meta-Analysis.

ABSTRACT

BACKGROUND: Telephone-based cognitive assessments may be preferable to in-person testing in terms of test burden, economic and opportunity cost. OBJECTIVE: We sought to determine the accuracy of telephone-based screening for the identification of dementia or Mild Cognitive Impairment (MCI). METHODS: Five multidisciplinary databases were searched. Two researchers independently screened articles and extracted data. Eligible studies compared any multi-domain telephone-based assessment of cognition to the face-to-face diagnostic evaluation. Where data allowed, we pooled test accuracy metrics using the bivariate approach. RESULTS: From 11,732 titles, 34 papers were included, describing 15 different tests. There was variation in test scoring and quality of included studies. Pooled analyses of accuracy for dementia Telephone Interview for Cognitive Status (TICS) (<31/41) sensitivity 0.92, specificity 0.66 (6 studies); TICSmodified (<28/50) sensitivity 0.91, specificity 0.91 (3 studies). For MCI TICS-modified (<33/50) sensitivity 0.82, specificity 0.87 (3 studies); Telephone-Montreal Cognitive Assessment (<18/22) sensitivity 0.98, specificity 0.69 (2 studies). CONCLUSION: There is limited diagnostic accuracy evidence for the many telephonic cognitive screens that exist. The TICS and TICS-m have the greatest supporting evidence; their test accuracy profiles make them suitable as initial cognitive screens where face to face assessment is not possible.