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. 2018 Jul 18;10(1):65.
doi: 10.1186/s13195-018-0382-y.

The Toronto Cognitive Assessment (TorCA): normative data and validation to detect amnestic mild cognitive impairment

Morris Freedman  1   2   3   4   5 , Larry Leach  6   7 , M Carmela Tartaglia  8   6   9   10 , Kathryn A Stokes  11 , Yael Goldberg  11 , Robyn Spring  12 , Nima Nourhaghighi  6   13 , Tom Gee  12 , Stephen C Strother  12   6   14 , Mohammad O Alhaj  11   15 , Michael Borrie  16   17 , Sultan Darvesh  18 , Alita Fernandez  11 , Corinne E Fischer  6   19   20 , Jennifer Fogarty  16   17 , Barry D Greenberg  6   21 , Michelle Gyenes  11 , Nathan Herrmann  6   13   22   20 , Ron Keren  6   21   20 , Josh Kirstein  11 , Sanjeev Kumar  6   20   23 , Benjamin Lam  8   22   24 , Suvendrini Lena  8   6   23 , Mary Pat McAndrews  9   25   26 , Gary Naglie  11   12   6   27 , Robert Partridge  9 , Tarek K Rajji  6   20   23   28 , William Reichmann  11   6   20 , M Uri Wolf  11   6   20 , Nicolaas P L G Verhoeff  11   6   20 , Jordana L Waserman  11 , Sandra E Black  8   6   13   22   24   29 , David F Tang-Wai  8   6   9   23   25
Affiliations

The Toronto Cognitive Assessment (TorCA): normative data and validation to detect amnestic mild cognitive impairment

Morris Freedman et al. Alzheimers Res Ther. .

Erratum in

  • Correction to: The Toronto cognitive assessment (TorCA): normative data and validation to detect amnestic mild cognitive impairment.
    Freedman M, Leach L, Carmela Tartaglia M, Stokes KA, Goldberg Y, Spring R, Nourhaghighi N, Gee T, Strother SC, Alhaj MO, Borrie M, Darvesh S, Fernandez A, Fischer CE, Fogarty J, Greenberg BD, Gyenes M, Herrmann N, Keren R, Kirstein J, Kumar S, Lam B, Lena S, McAndrews MP, Naglie G, Partridge R, Rajji TK, Reichmann W, Uri Wolf M, Verhoeff NPLG, Waserman JL, Black SE, Tang-Wai DF. Freedman M, et al. Alzheimers Res Ther. 2018 Dec 7;10(1):120. doi: 10.1186/s13195-018-0446-z. Alzheimers Res Ther. 2018. PMID: 30526675 Free PMC article.

Abstract

Background: A need exists for easily administered assessment tools to detect mild cognitive changes that are more comprehensive than screening tests but shorter than a neuropsychological battery and that can be administered by physicians, as well as any health care professional or trained assistant in any medical setting. The Toronto Cognitive Assessment (TorCA) was developed to achieve these goals.

Methods: We obtained normative data on the TorCA (n = 303), determined test reliability, developed an iPad version, and validated the TorCA against neuropsychological assessment for detecting amnestic mild cognitive impairment (aMCI) (n = 50/57, aMCI/normal cognition). For the normative study, healthy volunteers were recruited from the Rotman Research Institute registry. For the validation study, the sample was comprised of participants with aMCI or normal cognition based on neuropsychological assessment. Cognitively normal participants were recruited from both healthy volunteers in the normative study sample and the community.

Results: The TorCA provides a stable assessment of multiple cognitive domains. The total score correctly classified 79% of participants (sensitivity 80%; specificity 79%). In an exploratory logistic regression analysis, indices of Immediate Verbal Recall, Delayed Verbal and Visual Recall, Visuospatial Function, and Working Memory/Attention/Executive Control, a subset of the domains assessed by the TorCA, correctly classified 92% of participants (sensitivity 92%; specificity 91%). Paper and iPad version scores were equivalent.

Conclusions: The TorCA can improve resource utilization by identifying patients with aMCI who may not require more resource-intensive neuropsychological assessment. Future studies will focus on cross-validating the TorCA for aMCI, and validation for disorders other than aMCI.

Keywords: Cognitive assessment; Diagnosis; Mild cognitive impairment; Normative study; TorCA; Toronto Cognitive Assessment; Validation.

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Conflict of interest statement

Authors' information

Tom Gee is now at Indoc Research, Toronto, ON, Canada. Barry D. Greenberg is now at Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Ethics approval and consent to participate

The study was approved by the Research Ethics Board at Baycrest Health Sciences. Written informed consent was obtained from all participants.

Competing interests

MF received financial support for a Behavioural Neurology fellow from Eli Lilly Canada, served on an advisory board for Eli Lilly Canada, receives royalties for a book on Clock Drawing from Oxford University Press, is listed on a provisional patent related to methods and kits for differential diagnosis of Alzheimer’s disease vs frontotemporal dementia using blood biomarkers, and may be listed on the planned patent application, and serves on the editorial board of Brain and Cognition. LL receives royalties from Pearson Assessment on sales of the Kaplan Baycrest Neurocognitive Assessment (KBNA). NH received research support from Axovant, Lundbeck and Roche, and consultation fees from Merck, Lilly, Mediti and Astellas. SEB reports institutional grants from Pfizer, GE Healthcare, Eli Lilly, Roche, Cognoptix, Biogen, and Novartis and personal honoraria from Pfizer, Eli Lilly, Boehringer Ingelheim, Novartis, Merck, and Medscape (Biogen Idec); SEB also reports salary support from Sunnybrook Research Institute, Brill Chair, Department of Medicine, Sunnybrook Health Sciences Centre. SCS is Chief Science Officer of ADMdx, LLC. MCT, KAS, YG, RS, NN, TG, MOA, MB, SD, AF, CEF, JF, BDG, MG, RK, JK, SK, BL, SL, MPM, GN, RP, TKR, WR, MUW, NPLGV, JLW, and DFT-W do not have any competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of participants for normative study
Fig. 2
Fig. 2
Flow chart of participants for validation study. TorCA Toronto Cognitive Assessment, aMCI amnestic mild cognitive impairment
Fig. 3
Fig. 3
Effect sizes on neuropsychological tests between aMCI and control groups. aMCI amnestic mild cognitive impairment, CI confidence interval, KWL1 KBNA Word List Learning immediate recall, KFC1 KBNA Complex Fig. 1 immediate recall, KWL2 KBNA Word List delayed recall, KFC2 KBNA Complex Figure delayed recall, KWLREC KBNA Word List delayed recognition, KCFREC KBNA Complex Figure delayed recognition, LMI WMS-III Logical Memory immediate recall, LMII WMS-III Logical Memory delayed recall, KSPLOC KBNA Spatial Location Memory, DSPAN WAIS-III Digit Span, KSEQ KBNA Sequencing, STROOPCW D-KEFS Color-Word Interference, STROOPSW D-KEFS Color-Word switching, TMTA Trail Making A, TMTB Trail Making B, KVISSP KBNA Complex Figure Copy + Clock Drawing, MR WAIS Matrix Reasoning, VOCAB WAIS Vocabulary, BNT Boston Naming Test, KPHF KBNA Phonemic Fluency, KSEM KBNA Semantic Fluency, KPREAS KBNA Practical Reasoning + Conceptual Shifting, KBNA Kaplan–Baycrest Neurocognitive Assessment, WMS-III Wechsler Memory Scale—IIII, WAIS-III Wechsler Adult Intelligence Scale—III, D-KEFS Delis–Kaplan Executive Function System
Fig. 4
Fig. 4
iPad summary score sheet showing domain scores and numerical and graphic percentile ratings. Probability of aMCI shown as 93.7%. aMCI amnestic mild cognitive impairment
See this image and copyright information in PMC

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