Assessing the Equivalence of Telephone-MoCA and MoCA-22 in Healthy Adults

The Telephone-Montreal Cognitive Assessment (T-MoCA) is a remote cognitive screening tool increasingly used in clinical and research contexts. However, its applicability in Korean populations remains underexplored. This study examined the equivalence between the T-MoCA and the face-to-face Korean MoCA-22 (K-MoCA-22) in a community-based sample of 113 cognitively normal adults aged 21-91 years. The sample was stratified into 2 age groups (<60 and ≥60 years) for subgroup analyses. All participants completed both the T-MoCA and K-MoCA-22 in a counterbalanced order, with a one-month interval between assessments. Both T-MoCA and K-MoCA-22 scores were significantly associated with age and education, but not with sex in either age group. However, none of these variables significantly influenced the score differences between the 2 tests. Lin's concordance correlation coefficient indicated strong agreement between the 2 tests in the overall sample and in participants aged ≥60, with minimal systematic bias. Equivalence testing using the two one-sided tests procedure supported statistical equivalence in the total sample and the <60 group, but not in the ≥60 group. Subtest-level differences were observed in the ≥60 group, with higher repetition scores on the K-MoCA-22 and higher delayed recall scores on the T-MoCA, possibly reflecting absence of visual cues, reduced supervision, and lower anxiety during remote testing. These findings support the T-MoCA as an equivalent and reliable alternative to the K-MoCA-22 for remote cognitive screening in Korean adults. Nonetheless, age-related and modality-specific factors should be considered when interpreting scores, particularly in older individuals.