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.