Cognitive assessment using face-to-face and videoconferencing methods

Comparing the Reliability of Virtual and In-Person Post-Stroke Neuropsychological Assessment with Language Tasks

OBJECTIVE

Neuropsychological testing is essential for both clinical and basic stroke research; however, the in-person nature of this testing is a limitation. Virtual testing overcomes the hurdles of geographic location, mobility issues and permits social distancing, yet its validity has received relatively little investigation, particularly in comparison with in-person testing.

METHOD

We expand on our prior findings of virtual testing feasibility by assessing virtual versus in-person administration of language and communication tasks with 48 left-hemisphere stroke patients (21 F, 27 M; mean age = 63.4 ± 12; mean years of education = 15.3 ± 3.5) in a quasi-test-retest paradigm. Each participant completed two testing sessions: one in their home and one in the research lab. Participants were assigned to one of the eight groups, with the testing condition (fully in-person, partially virtual), order of home session (first, second) and technology (iPad, Windows tablet) varied across groups.

RESULTS

Across six speech-language tasks that utilized varying response modalities and interfaces, we found no significant difference in performance between virtual and in-person testing. However, our results reveal key considerations for successful virtual administration of neuropsychological tests, including technology complications and disparities in internet access.

CONCLUSIONS

Virtual administration of neuropsychological assessments demonstrates comparable reliability with in-person data collection involving stroke survivors, though technology issues must be taken into account.

A Systematic Review and a Latin American Clinical Model for Teleneuropsychological Assessment

OBJECTIVE

The objective of this study is to propose a TeleNP model for remote assessment and offer practical recommendations for clinical practice with patients in Mexico and Latin America, based on a systematic literature review and clinical experience.

METHOD

A systematic review of studies from 2011 to 2021 in English and Spanish used TeleNP, teleneuropsychology, telepsychology, online, assessment, teleneuropsicología, and evaluación for the search; the databases examined included PubMed, BiDi UNAM, ScienceDirect, Google Scholar, and Wiley One Library; the Oxford Centre for Evidence-Based Medicine system was used to grade the levels of evidence. The experience of the last two years of students and faculty in the Master's and Doctoral Programs in Psychology, Clinical Neuropsychology Residency Program, was also used as a basis for this guide.

RESULTS

We propose a clinical model for TeleNP assessment in Mexico and Latin America based on the review of 31 articles and the practice of professors and students of clinical neuropsychology.

CONCLUSION

The proposed model describes a procedure and adaptations for home-to-home clinical practice in the neuropsychological assessment of Mexican patients that could also be used in other Latin American countries. Its reliability remains to be assessed, but this model and the suggestions proposed could be used in future studies and clinical trials for Mexican and Latin American populations.

The Cognitive Sequelae of Transient Ischemic Attacks-Recent Insights and Future Directions

There is now considerable evidence that Transient Ischemic Attack (TIA) carries important sequelae beyond the risk of recurrent stroke, particularly with respect to peri-event and post-event cognitive dysfunction and subsequent cognitive decline. The occurrence of a TIA could provide an important window in understanding the relationship of early mixed vascular-neurodegenerative cognitive decline, and by virtue of their clinical relevance as a "warning" event, TIAs could also furnish the opportunity to act preventatively not only for stroke prevention but also for dementia prevention. In this review, we discuss the current state of the literature regarding the cognitive sequelae associated with TIA, reviewing important challenges in the field. In particular, we discuss definitional and methodological challenges in the study of TIA-related cognitive impairment, confounding factors in the cognitive evaluation of these patients, and provide an overview of the evidence on both transient and long-term cognitive impairment after TIA. We compile recent insights from clinical studies regarding the predictors and mediators of cognitive decline in these patients and highlight important future directions for work in this area.

Tele-Assessments in Rural and Remote Schools – Perspectives of Support Teachers

Tele-assessments may enable specialist evaluation of students in schools and their progress following intervention. The aim of this project was to evaluate the feasibility of using videoconferencing technology to assess students with reading difficulties in the school setting and obtain the perspectives of teachers supporting the students during the assessment. Teachers ( n = 57) of 71 primary school age students participated in the study. Teachers provided feedback on the tele-assessment by completing questionnaires about students’ behaviours and the quality of the technology and assessment process. Randomly selected teachers ( n = 24) were invited to participate in a semi-structured interview to provide qualitative feedback. Tele-assessments were completed in 93.4% of the sample. Support teachers reported satisfaction with the audio and visual quality as well as the assessment process. The majority of students completed the tele-assessment with good compliance, engagement and attention. Feedback from support teachers also reflected the strengths of tele-assessments, such as better access to service, cost saving and convenience. Barriers to tele-assessments included technical difficulties, assessment limitations and equipment issues at schools. Tele-assessment is a feasible method of objectively measuring outcomes of students following an intervention. Tele-assessment at school is largely accepted by teachers who supported students in this study. Feedback obtained from this research may be used to offer guidance on undertaking tele-assessments with students in the school setting.

Scoping review: the empowerment of Alzheimer's Disease caregivers with mHealth applications

Alzheimer's Disease (AD) is one of the most prevalent neurodegenerative chronic diseases. As it progresses, patients become increasingly dependent, and their caregivers are burdened with the increasing demand for managing their care. Mobile health (mHealth) technology, such as smartphone applications, can support the need of these caregivers. This paper examines the published academic literature of mHealth applications that support the caregivers of AD patients. Following the PRISMA for scoping reviews, we searched published literature in five electronic databases between January 2014 and January 2021. Twelve articles were included in the final review. Six themes emerged based on the functionalities provided by the reviewed applications for caregivers. They are tracking, task management, monitoring, caregiver mental support, education, and caregiver communication platform. The review revealed that mHealth applications for AD patients' caregivers are inadequate. There is an opportunity for industry, government, and academia to fill the unmet need of these caregiver.

Effects of restraining measures due to COVID-19: Pre- and post-lockdown cognitive status and mental health

The COVID-19 pandemic has prompted all countries to adopt restraining measures to mitigate the spread of the disease. Usually, large-scale disasters tend to be accompanied by significant increases of psychological distress, depression and anxiety. Confinement measures imposed during the COVID-19 pandemic are likely to have similar consequences. In the present study we aim to evaluate how COVID-19 affected the overall psychological functioning of Portuguese individuals by providing a comparison of current data with status prior to the COVID-19 pandemic. The study sample was composed of 150 cognitively healthy participants. Results show an overall maintenance of cognitive capacities, although subjective cognitive decline complaints significantly increased during the pandemic. Regarding mental health, restraining measures culminated in an aggravation of depressive and decrease of the perceived quality of life, associated with feelings of loneliness and perceived social isolation. Finally, higher levels of pre-COVID-19 quality of life seem to play a protective role against depression and anxiety and predict less difficulties in emotion regulation, feelings of solitude and cognitive complaints. In sum, confinement due to COVID-19 implied an aggravation of the mental health of the Portuguese population, which appears to have been attenuated in those with higher pre-pandemic levels of perceived quality of life.

Are videoconferenced mental and behavioral health services just as good as in-person? A meta-analysis of a fast-growing practice

The use of videoconferencing technologies (VCT) is on the rise given its potential to close the gap between mental health care need and availability. Yet, little is known about the effectiveness of these services compared to those delivered in-person. A series of meta-analyses were conducted using 57 empirical studies (43 examining intervention outcomes; 14 examining assessment reliability) published over the past two decades that included a variety of populations and clinical settings. Using conventional and HLM3 meta-analytical approaches, VCT consistently produced treatment effects that were largely equivalent to in-person delivered interventions across 281 individual outcomes and 4336 clients, with female clients and those treated in medical facilities tending to respond more favorably to VCT than in-person. Results of an HLM3 model suggested assessments conducted using VCT did not appear to lead to differential decisions compared to those conducted in-person across 83 individual outcomes and 332 clients/examinees. Although aggregate findings support the use of VCT as a viable alternative to in-person service delivery of mental healthcare, several limitations in the current literature base were revealed. Most concerning was the relatively limited number of randomized controlled trials and the inconsistent (and often incomplete) reporting of methodological features and results. Recommendations for reporting the findings of telemental health research are provided.

Teleneuropsychology in the time of COVID-19: The experience of The Australian Epilepsy Project

PURPOSE

Traditional neuropsychological testing carries elevated COVID-19 risk for both examinee and examiner. Here we describe how the pilot study of the Australian Epilepsy Project (AEP) has transitioned to tele-neuropsychology (teleNP), enabling continued safe operations during the pandemic.

METHODS

The AEP includes adults (age 18-60) with a first unprovoked seizure, new diagnosis of epilepsy or drug resistant focal epilepsy. Shortly after launching the study, COVID-related restrictions necessitated adaptation to teleNP, including delivery of verbal tasks via videoconference; visual stimulus delivery via document camera; use of web-hosted, computerised assessment; substitution of oral versions for written tests; online delivery of questionnaires; and discontinuation of telehealth incompatible tasks.

RESULTS

To date, we have completed 24 teleNP assessments: 18 remotely (participant in own home) and six on-site (participant using equipment at research facility). Five face-to-face assessments were conducted prior to the transition to teleNP. Eight of 408 tests administered via teleNP (1.9 %) have been invalidated, for a variety of reasons (technical, procedural, environmental). Data confirm typical patterns of epilepsy-related deficits (p < .05) affecting processing speed, executive function, language and memory. Questionnaire responses indicate elevated rates of patients at high risk of mood (34 %) and anxiety disorder (38 %).

CONCLUSION

Research teleNP assessments reveal a typical pattern of impairments in epilepsy. A range of issues must be considered when introducing teleNP, such as technical and administrative set up, test selection and delivery, and cohort suitability. TeleNP enables large-scale neuropsychological research during periods of social distancing (and beyond), and offers an opportunity to expand the reach and breadth of neuropsychological services.