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Sperling SA, Acheson SK, Fox-Fuller J, Colvin MK, Harder L, Cullum CM, Randolph JJ, Carter KR, Espe-Pfeifer P, Lacritz LH, Arnett PA, Gillaspy SR. Tele-Neuropsychology: From Science to Policy to Practice. Arch Clin Neuropsychol 2024; 39:227-248. [PMID: 37715508 DOI: 10.1093/arclin/acad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). METHOD We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. RESULTS The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. CONCLUSIONS More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.
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Affiliation(s)
- Scott A Sperling
- Department of Neurology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joshua Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lana Harder
- Children's Health, Children's Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John J Randolph
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Randolph Neuropsychology Associates, PLLC, Lebanon, NH, USA
| | | | - Patricia Espe-Pfeifer
- Department of Psychiatry and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Laura H Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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Viñas-Guasch N, Chia PSQ, Yap MLM, Wu CY, Chen SHA. Cognitive pediatric tele-assessment: a scoping review. Front Psychol 2023; 14:1288021. [PMID: 38162979 PMCID: PMC10754967 DOI: 10.3389/fpsyg.2023.1288021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Cognitive tele-assessment (CTA) adoption has increased considerably recently, in parallel with the maturation of the digital technologies that enable it, and the push to move assessment to the online format during the COVID-19 pandemic in 2019. This mode of assessment stems from remote assessment applications that originated in general tele-medicine, where it was typically used for patient screening as part of an intervention. The development of remote tele-medicine was later adapted for CTA in adult populations in tele-neuropsychiatry and tele-psychology and is increasingly applied in experimental research in cognitive science research with adult and pediatric populations, and for remote academic assessment. Compared to in-person assessment, CTA offers advantages such as decreasing time and logistic costs and facilitating the assessment of remote or special needs populations. However, given the novelty of CTA, its technical, methodological, and ethical issues remain poorly understood, especially in cases where methods for assessment of adults are used in pediatric populations. In the current paper, we provide a scoping review on the evolution of remote tele-assessment from the years 2000 to 2021, to identify its main themes, methodologies, and applications, and then focus on the issues of assessment in pediatric populations. Finally, we present recommendations on how to address the challenges previously mentioned.
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Affiliation(s)
- Nestor Viñas-Guasch
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Phoebe Si Qi Chia
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Michelle Li-Mei Yap
- Centre for Research in Child Development, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Chiao-Yi Wu
- Centre for Research in Child Development, National Institute of Education, Nanyang Technological University, Singapore, Singapore
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
| | - S. H. Annabel Chen
- Psychology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Centre for Research and Development in Learning (CRADLE), Nanyang Technological University, Singapore, Singapore
- Lee Kong Chian School of Medicine (LKCMedicine), Nanyang Technological University, Singapore, Singapore
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Kann MR, Zeiger PJ, Rizer SJ, Cosentino S, Azar M. Virtual Assessment as a Way to Reduce Help-seeking Barriers in Older Adults With Subjective Cognitive Decline. Alzheimer Dis Assoc Disord 2023; 37:373-378. [PMID: 37738277 PMCID: PMC10719961 DOI: 10.1097/wad.0000000000000582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/04/2023] [Indexed: 09/24/2023]
Abstract
Subjective cognitive decline (SCD), a potential early marker for neurodegenerative disease such as Alzheimer's disease, is common among older adults. Although it is often regarded as a personal health concern, most individuals with SCD do not seek help from a health care professional. Help-seeking (HS) is a complex, individualized process with significant life-course implications, and older adults often face several barriers to HS across personal, socioeconomic, and cultural domains. The pandemic exacerbated these barriers by imposing additional limitations on in-person care. In response, virtual assessment became a popular method to conduct remote care. We provide a narrative review of the challenges and triumphs that came with the transition from in-person, pen-paper cognitive assessments to virtual cognitive assessments. In addition, we address the impact virtual assessment had in tackling barriers that previously limited individuals with SCD from formal HS. We argue that virtual cognitive assessment helps alleviate health access barriers to HS (e.g., cost, transportation, and physician availability) and allows individuals with different coping styles to undergo assessment within more convenient environments. We hope the findings presented in this review inform health care practice, public education, and future research targeted towards the use of virtual assessment to facilitate HS in older adults with SCD.
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Affiliation(s)
- Michael R Kann
- Cognitive Neuroscience Division, Department of Neurology, G.H. Sergievsky Center, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center
| | - Peter J Zeiger
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY
| | - Sandra J Rizer
- Cognitive Neuroscience Division, Department of Neurology, G.H. Sergievsky Center, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center
| | - Stephanie Cosentino
- Cognitive Neuroscience Division, Department of Neurology, G.H. Sergievsky Center, and Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Medical Center
| | - Martina Azar
- Psychology Department, VA Boston Health Care System, Boston, MA
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Montemurro S, Mondini S, Pucci V, Durante G, Riccardi A, Maffezzini S, Scialpi G, Signorini M, Arcara G. Tele-Global Examination of Mental State (Tele-GEMS): an open tool for the remote neuropsychological screening. Neurol Sci 2023; 44:3499-3508. [PMID: 37248426 PMCID: PMC10226870 DOI: 10.1007/s10072-023-06862-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
Tele-neuropsychology, i.e., the application of remote audio-visual technologies to neuropsychological evaluation or rehabilitation, has become increasingly popular and widespread during and after the COVID-19 pandemic. New tools with updated normative data and appropriate methodological developments are necessary. We present Tele-GEMS, a telephone-based cognitive screening developed on N = 601 Italian participants. It yields a global score tapping on orientation, memory, spatial representation, language, and pragmatic abilities. Its administration lasts about 10 min. Clinical cut-offs are provided, accounting for demographic variables (age, education, and sex) and also for a comprehensive index taking into account cognitively stimulating life experiences that can build up a cognitive reserve. Tele-GEMS shows good internal consistency and a good inter-rater agreement. The test includes the thresholds for estimating a significant change after repeated measurements. Tele-GEMS has a good construct validity as assessed with MoCA and a suitable criterion validity assessed with its in-person version (GEMS). All the materials and the instructions, including scripts and an online Application for the automatic calculation of cut-offs, are accessible on OSF at https://osf.io/t3bma/ under a Creative Commons license.
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Affiliation(s)
| | - Sara Mondini
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), Università di Padova, Padova, Italy
- Centro di Ateneo Servizi Clinici Universitari Psicologici (SCUP), Università di Padova, Padova, Italy
- Human Inspired Technology Research Centre HIT, University of Padova, Padova, Italy
| | - Veronica Pucci
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), Università di Padova, Padova, Italy
- Human Inspired Technology Research Centre HIT, University of Padova, Padova, Italy
| | - Giorgia Durante
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), Università di Padova, Padova, Italy
| | - Alice Riccardi
- Multiple Sclerosis Centre, Department of Neurosciences-DNS, Università di Padova, Padova, Italy
| | - Sabrina Maffezzini
- Multiple Sclerosis Centre, Department of Neurosciences-DNS, Università di Padova, Padova, Italy
| | - Graziana Scialpi
- Multiple Sclerosis Centre, Department of Neurosciences-DNS, Università di Padova, Padova, Italy
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Saini G, Malhotra S, Rajan R, Vishnu VY, Mani K, Bhatia R, Bhushan M, Srivastava MVP, Gupta A. Video Teleconference Administration of the Addenbrooke's Cognitive Examination-III for the Assessment of Neuropsychological Status: An Experience in Indian Subjects with Cognitive Dysfunction. Ann Indian Acad Neurol 2023; 26:447-452. [PMID: 37970289 PMCID: PMC10645197 DOI: 10.4103/aian.aian_97_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 11/17/2023] Open
Abstract
Objective To determine the feasibility, reliability, and acceptability of video teleconference (VTC)-based neuropsychological assessment using Addenbrooke's cognitive examination-III (ACE-III). Methods This study was performed from January 2022 to April 2022, during the third wave of the COVID-19 pandemic in India. We administered ACE-III using video-teleconferencing and compared the scores to face-to-face (FTF) testing for the eligible participants. We also conducted a participant's satisfaction survey of VTC-administered ACE-III compared to FTF-administered ACE-III, using a 7-point Likert scale. Results We screened 37 participants and 24 (64.9%) successfully underwent ACE-III testing through VTC. We included 20 patients (mean age: 62.7 ± 10 years, mean education: 12.0 ± 4.6 years, 85% men) for final analysis, (who completed both VTC and FTF-administered ACE-III). Nine patients had major neurocognitive disorder (dementia), eight had mild neurocognitive disorder (MCI), and three had subjective cognitive decline (SCD). The two tests were administered at a median gap of 36 (18,74.5) days. The Intraclass correlation coefficients (ICC) of ACE-3 total scores (0.97) and the subdomain scores was high (>0.8). There was "very low" to "no" bias on the Bland-Altman plots, across all domains. The mean overall satisfaction score was 4.1, indicating that VTC is "as good as" FTF. Conclusions Results support the feasibility and acceptability of remote administration of ACE-III via VTC. There is a good agreement between the ACE-III scores across VTC and in-person conditions.
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Affiliation(s)
- Garima Saini
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Simran Malhotra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Sumpter R, Camsey E, Meldrum S, Alford M, Campbell I, Bois C, O'Connell S, Flood J. Remote neuropsychological assessment: Acceptability and feasibility of direct-to-home teleneuropsychology methodology during the COVID-19 pandemic. Clin Neuropsychol 2023; 37:432-447. [PMID: 35505636 DOI: 10.1080/13854046.2022.2056922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the acceptability and feasibility of telephone and video-conference calls to complete cognitive assessments during the COVID-19 pandemic. METHOD In rapid response to the pandemic, evidence-based adaptations were made to routine face-to-face (FTF) practice, delivering teleneuropsychology (TNP) within a National Health Service (NHS) Scotland neuropsychology service. Caldicott guardian approval was obtained to complete a six month study (April to October 2020) from the early stages of the first United Kingdom (UK) lockdown. Assessments were completed with patients in their own homes (direct-to-home) via remote connections. Neuropsychology clinicians, service-users and referring agents were approached for structured feedback and qualitative comment. RESULTS Data was captured for 212 referrals assessed by seven clinical psychologists; with responses from 70 (33%) service-users and 14 (58%) referring agents. 94% of referrals were assessed remotely and discharged. TNP reduced defaulted appointment discharge rates. Gender, socioeconomic deprivation and age did not affect access to information technology (IT) equipment.Clinicians agreed that remote assessment allowed them to complete initial interview (96%) and formulate (77%) cases appropriately. Service-users agreed they were comfortable with equipment (84%), the process was straightforward (74%), and would recommend TNP to others (68%). Referring agents were satisfied with the service provided (100%). Limitations included evidence-based remote test availability, technical issues and home distractions. CONCLUSIONS Study findings evidence the acceptability and efficiency of TNP; increasing service accessibility, while reducing infection risk, defaulted appointments and travel. The results advocate for a post-pandemic mixed model of service delivery encompassing both FTF and TNP approaches.
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Affiliation(s)
| | | | | | - Max Alford
- NHS Greater Glasgow & Clyde, Glasgow, UK
| | | | | | | | - John Flood
- NHS Greater Glasgow & Clyde, Glasgow, UK
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Asensio D, Duñabeitia JA. The necessary, albeit belated, transition to computerized cognitive assessment. Front Psychol 2023; 14:1160554. [PMID: 37168430 PMCID: PMC10165007 DOI: 10.3389/fpsyg.2023.1160554] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/06/2023] [Indexed: 05/13/2023] Open
Abstract
Cognitive assessment is a common and daily process in educational, clinical, or research settings, among others. Currently, most professionals use classic pencil-and-paper screenings, tests, and assessment batteries. However, as the SARS-CoV-2 health crisis has shown, the pencil-and-paper format is becoming increasingly outdated and it is necessary to transition to new technologies, using computerized cognitive assessments (CCA). This article discusses the advantages, disadvantages, and implications of this necessary transition that professionals should face in the immediate future, and encourages careful adoption of this change to ensure a smooth transition.
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Affiliation(s)
- David Asensio
- Facultad de Lenguas y Educación, Universidad Nebrija, Madrid, Spain
| | - Jon Andoni Duñabeitia
- Facultad de Lenguas y Educación, Universidad Nebrija, Madrid, Spain
- AcqVA Aurora Center, UiT The Arctic University of Norway, Tromsø, Norway
- *Correspondence: Jon Andoni Duñabeitia,
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Zhao X, Hu R, Wen H, Xu G, Pang T, He X, Zhang Y, Zhang J, Chen C, Wu X, Xu X. A voice recognition-based digital cognitive screener for dementia detection in the community: Development and validation study. Front Psychiatry 2022; 13:899729. [PMID: 35935417 PMCID: PMC9354045 DOI: 10.3389/fpsyt.2022.899729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION To facilitate community-based dementia screening, we developed a voice recognition-based digital cognitive screener (digital cognitive screener, DCS). This proof-of-concept study aimed to investigate the reliability, validity as well as the feasibility of the DCS among community-dwelling older adults in China. METHODS Eligible participants completed demographic, clinical, and the DCS. Diagnosis of mild cognitive impairment (MCI) and dementia was made based on the Montreal Cognitive Assessment (MoCA) (MCI: MoCA < 23, dementia: MoCA < 14). Time and venue for test administration were recorded and reported. Internal consistency, test-retest reliability and inter-rater reliability were examined. Receiver operating characteristic (ROC) analyses were conducted to examine the discriminate validity of the DCS in detecting MCI and dementia. RESULTS A total of 103 participants completed all investigations and were included in the analysis. Administration time of the DCS was between 5.1-7.3 min. No significant difference (p > 0.05) in test scores or administration time was found between 2 assessment settings (polyclinic or community center). The DCS showed good internal consistency (Cronbach's alpha = 0.73), test-retest reliability (Pearson r = 0.69, p < 0.001) and inter-rater reliability (ICC = 0.84). Area under the curves (AUCs) of the DCS were 0.95 (0.90, 0.99) and 0.77 (0.67, 086) for dementia and MCI detection, respectively. At the optimal cut-off (7/8), the DCS showed excellent sensitivity (100%) and good specificity (80%) for dementia detection. CONCLUSION The DCS is a feasible, reliable and valid digital dementia screening tool for older adults. The applicability of the DCS in a larger-scale community-based screening stratified by age and education levels warrants further investigation.
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Affiliation(s)
- Xuhao Zhao
- School of Public Health and The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Ruofei Hu
- Life Support Technologies Group, Technical University of Madrid, Madrid, Spain.,DAMO Academy, Alibaba Group, Hangzhou, China
| | - Haoxuan Wen
- School of Public Health and The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Guohai Xu
- DAMO Academy, Alibaba Group, Hangzhou, China
| | - Ting Pang
- School of Public Health and The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Xindi He
- School of Public Health and The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Yaping Zhang
- School of Public Health and The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Ji Zhang
- DAMO Academy, Alibaba Group, Hangzhou, China
| | - Christopher Chen
- Memory, Ageing, and Cognition Centre (MACC), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xifeng Wu
- School of Public Health and The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Xu
- School of Public Health and The Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, China.,Memory, Ageing, and Cognition Centre (MACC), Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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