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The Telephone Interview for Cognitive Status.

T Telephone Interview for Cognitive Status (TICS) was first described in this journal in 1988 (Brandt et al, 1988). According to a Clarivate Analytics/Web of Science cited reference search, the TICS article has been cited 784 times so far (Carrie Price, written communication, August 14, 2018). It is not clear how many of those citations represent actual use of the TICS, but it is likely that it is the most widely used telephonic cognitive assessment tool in academic research. Although the TICS was subsequently modified, the basic idea of the telephonic examination was a novel one that transformed a face-to-face evaluation into one that could be administered remotely. The TICS or TICS-modified has found applications in many different clinical and research areas (Plassman et al, 1994). In epidemiology, telephonic cognitive assessments are particularly helpful when the study population is geographically dispersed. But even when the study involves a defined geographic area, the opportunity to perform a cognitive assessment on someone who otherwise would not or could not travel to the research clinic enables far more people to participate. Generally speaking, greater levels of participation mean better representativeness of the data. There are now cognitive tests that can be administered on tablets or laptops, but it is not clear whether they are superior to cognitive assessments performed by a live human at one end of the phone and the participant at the other. Telephonic instruments are not without their problems, but the limitations are really no different from those of any other brief cognitive assessment, whether conducted in person, by telephone, or electronically. There are always concerns that the participant might be distracted by features of their immediate environment, such as extraneous noises, conversations, television, and so on. There is not a foolproof way to prevent such distractions, but experienced interviewers can minimize them by anticipating them. There are also potential problems with administering a telephonic instrument to people with very poor hearing, but because telephone communication has a high signal-to-noise ratio, reduced hearing is not a major impediment to telephonic cognitive assessments. Some cognitive domains such as spatial cognition obviously cannot be assessed over the telephone. However, orientation, verbal memory, certain aspects of mental agility such as arithmetic, and other tasks requiring concentration and verbal responses are feasible. Many tasks can be administered telephonically in a manner that is virtually identical to face-to-face administration. Any brief instrument, whether administered telephonically or in person, will have limited effectiveness in differentiating mild cognitive impairment from mild dementia or mild cognitive impairment from normal cognition (Knopman et al, 2010). This is not a fault of the technology, but rather reflects challenges in making diagnoses of cognitive syndromes at the boundary zones between categories. Tests like the TICS or TICS-modified are best used as screening instruments to either rule in or exclude cognitive impairment (Graff-Radford et al, 2006), rather than to assign more granular diagnoses. The TICS may not have had a revolutionary impact on epidemiology, but it added an important tool that is widely used and has contributed to improved understanding of population cognitive health.