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

Morris Freedman, Larry Leach, M. Carmela Tartaglia, Kathryn A. Stokes, Yael Goldberg, Robyn Spring, Nima Nourhaghighi, Tom Gee, Stephen C. Strother, Mohammad O. Alhaj, Michael Borrie, Sultan Darvesh, Alita Fernandez, Corinne E. Fischer, Jennifer Fogarty, Barry D. Greenberg, Michelle Gyenes, Nathan Herrmann, Ron Keren, Josh Kirstein, Sanjeev Kumar, Benjamin Lam, Suvendrini Lena, Mary Pat McAndrews, Gary Naglie, Robert Partridge, Tarek K. Rajji, William Reichmann, M. Uri Wolf, Nicolaas P. L. G. Verhoeff, Jordana L. Waserman, Sandra E. Black, David F. Tang-Wai

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. 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. 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. 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.