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Feasibility of the Modified Telephone Interview for Cognitive Status (M-TICS) in the peri-operative environment
Kelly J Atkins1,2,3, Lis Evered1,2,3, Brendan Silbert2,3
1Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
Introduction:
Peri-operative neurocognitive disorders are common among older adults presenting for surgery and anaesthesia. Cognitive screening is recommended to identify patients at risk for adverse neurocognitive outcomes, though the most appropriate peri-operative tool remains debated. Remote assessment methods may be advantageous, but they need robust validation. We aimed to examine the feasibility and validity of the Modified Telephone Interview for Cognitive Status (TICS-M) among older adults and provide recommended TICS-M scores to identify those most at risk of poor postoperative cognitive outcomes.
Methods:
As part of a prospective longitudinal study with 215 older adults living in the community or scheduled for elective surgery, we conducted the modified, 22-item, 50-point version of the TICS remotely, followed by in-person assessments using two common cognitive screening tools: the Mini-Mental State Examination (MMSE); Alzheimer's Disease Assessment Scale Cognition Subscale (ADAS-Cog); and a comprehensive neuropsychological and functional assessment.
Results:
The TICS-M was feasible and acceptable, with a completion rate of 86%. TICS-M scores correlated with scores on the MMSE (r = 0.61, p < 0.001) and ADAS-Cog (r = -0.55, p < 0.001) at baseline, and associations remained consistent at 12- and 24-month follow-up. After controlling for age, sex and education, baseline performance on the TICS-M was independently associated with subsequent cognitive impairment at 12 months (OR 0.84, 95% CI 0.77-0.92, p < 0.001) and 24 months (OR 0.84, 95% CI 0.76-0.94, p = 0.001). A TICS-M score of 32.5 was the optimal threshold to identify people with cognitive impairment (0.76, 95% CI 0.70-0.82, p < 0.001).
Discussion:
The TICS-M is a feasible, valid and reliable remotely administered tool that shows utility in the peri-operative environment. We recommend its implementation into routine clinical practice for remote pre-operative assessment in patients aged ≥ 65 y scheduled for surgery and anaesthesia.
