Validity of the T-MoCA for Screening MCI and Dementia and Its Equivalence to the K-MoCA-22

Background: With rapid population aging, the prevalence of cognitive impairment and dementia continues to rise, underscoring the need for accessible and reliable screening tools.The Telephone-Montreal Cognitive Assessment (T-MoCA) enables remote cognitive evaluation but has been rarely validated in non-Western populations or in patients with dementia.This study aimed to evaluate the diagnostic validity of the T-MoCA and its score equivalence to the corresponding face-to-face version, the Korean version of the MoCA (K-MoCA)-22, across the full cognitive spectrum in older Korean adults.Methods: The participants included 52 cognitively normal (CN) adults, 51 with mild cognitive impairment (MCI), and 50 with dementia.All participants completed the T-MoCA, the K-MoCA-30, and Korean-Mini Mental State Examination, 2nd Edition (K-MMSE-2).The K-MoCA-22 scores were derived from the K-MoCA-30 by excluding visuomotor items.The T-MoCA and K-MoCA-30 were administered approximately one month apart. Results:The T-MoCA showed moderate to strong correlations with the K-MoCA-30 and moderate correlations with the K-MMSE-2.T-MoCA scores declined progressively from CN to MCI to dementia, with significant between-group differences consistent with those observed for the K-MoCA-30.No significant differences in the areas under the curve were found between the T-MoCA and K-MoCA-30, or between the T-MoCA and K-MMSE-2, indicating comparable discriminability.Lin's concordance correlation coefficients showed good overall agreement, and Bradley-Blackwood tests revealed no significant differences in means or variances between the T-MoCA and K-MoCA-22.Bland-Altman plots showed no systematic bias, with differences symmetrically distributed around zero.Conclusion: These findings support the T-MoCA as a valid, reliable, and clinically equivalent alternative to in-person MoCA formats for older Korean adults, encompassing normal cognition, MCI and dementia.As a practical and accessible tool for remote cognitive screening, the T-MoCA is expected to facilitate early detection and longitudinal monitoring of cognitive decline, particularly in community and telehealth settings.