InterOrganizational practice committee recommendations/guidance for teleneuropsychology (TeleNP) in response to the COVID-19 pandemic

Remote Neuropscyhological Assessment: Teleneuropsychology

Introduction

Teleneuropsychology, which includes the remote application of neuropsychological tests to patients via telephone or videoconferencing, can expand access to health services for patients who reside in distant areas or have mobility restrictions. With the emergence of the COVID-19 pandemic, there has been a significant increase in the use of teleneuropsychology in cognitive assessment. In this review, the aim was to critically review the results of studies conducted in the field of teleneuropsychology and the fundamental principles related to tele-neuropsychological assessment. Additionally, the "guideline for home-based teleneuropsychology" developed for Türkiye's practices is outlined in this review.

Method

A literature search was conducted using the Web of Science and PubMed databases to include all types of articles related to the subject.

Results

The results of studies on in-clinic and home-based teleneuropsychological assessment indicate that tests that assess cognitive functions such as attention, memory, executive functions, and language, particularly those based on verbal administration, can be reliably applied through teleneuropsychological assessment. However, there are factors to consider when referring patients for teleneuropsychological assessment, selecting tests for assessment, and making ethical considerations. Additionally, it is important to follow recommended steps for both the clinician and the patient and/or their caregiver before and during the interview in order for the assessment to be carried out effectively.

Conclusion

Although direct contact with the patient is an essential element in clinical neuropsychology practice, when necessary, teleneuropsychological assessment performed by trained experts following appropriate application procedures can be a good alternative to face-to-face evaluations.

Computerized assessment of executive functioning: Validation of the CNS Vital Signs executive functioning scores in a sample of community-dwelling older adults

Objective: Computerized assessment of cognitive functioning has gained significant popularity over recent years, yet options for clinical assessment of executive functioning (EF) are lacking. One computerized testing platform, CNS Vital Signs (CNS-VS), offers tests designed to measure EF but requires further validation. The goal of the present study was to validate CNS-VS executive scores against standard clinical measures of EF. We also sought to determine whether a modified CNS-VS composite score that included variables purported to measure inhibition, switching, and working memory would outperform the currently available CNS-VS Executive Function Index. Method: A sample of 73 cognitively healthy older adults completed four tests from the Delis-Kaplan Executive Function System, the Digit Span subtest from the Wechsler Adult Intelligence Scale-fourth edition, and three CNS-VS tasks purported to measure inhibition, switching, and working memory. Results: Performances on the CNS-VS tests were predicted by performances on standard paper-and-pencil measures. Although the currently available CNS-VS Executive Function Index predicted unique variance in a well-validated paper-and-pencil EF composite score, our Modified CNS-VS EF composite accounted for unique variance above and beyond the original CNS-VS Executive Function Index, while the reverse was not true. Conclusions: The present results support the construct validity of CNS-VS EF tests but also suggest that modifications to their current composite scores would improve the prediction of EF performance.

Diagnostic certainty during in-person and telehealth autism evaluations

Background

Many diagnostic evaluations abruptly shifted to telehealth during the COVID-19 pandemic; however, little is known about the impact on diagnosis patterns for children evaluated for autism spectrum disorder (ASD). The purpose of this clinical research study was to examine (1) the frequency of diagnoses evaluated beyond ASD; (2) the frequency of diagnoses made, including ASD; and (3) clinician diagnostic certainty for all diagnoses evaluated for children who received an evaluation due to primary concerns about ASD via telehealth during the pandemic compared to those evaluated in person before the pandemic at an ASD specialty clinic.

Methods

The sample included 2192 children, 1-17 years (M = 6.5 years; SD = 3.9), evaluated by a physician/psychologist at an ASD specialty center. A total of 649 children were evaluated in-person September 1, 2019-March 13, 2020 (pre-pandemic) and 1543 were evaluated via telehealth March 14, 2020-July 26, 2021 (during pandemic). Upon completion of each evaluation, clinicians provided a final diagnostic determination (i.e., "Yes," "No," "Possible," or "Not Assessed") for the following DSM-5 conditions: ASD, attention-deficit/hyperactivity disorder (ADHD), intellectual developmental disorder (IDD), anxiety (ANX), depression (DEP), and behavioral disorder (BD). "Possible" indicated lower certainty and the diagnosis was not provided. "Not Assessed" indicated the disorder was not evaluated.

Results

Diagnostic certainty for ASD and ADHD was lower and clinicians evaluated for and made diagnoses of IDD less often during evaluations that occurred via telehealth during the pandemic versus in person before the pandemic. DEP and BD were diagnosed more frequently, diagnostic certainty of DEP was lower, and no differences in the frequency of ANX diagnoses emerged during evaluations conducted via telehealth during the pandemic compared to those conducted in person before the pandemic.

Conclusions

Differences emerged in the frequency of diagnoses evaluated and made and diagnostic certainty for evaluations conducted via telehealth during the pandemic compared to in person before the pandemic, which likely impacted patients and reflect real-word challenges. Future work should examine whether these patterns are generalizable and the mechanisms that contribute to these differences.

Evaluation of the Uniform Data Set version 3 teleneuropsychological measures

OBJECTIVE

Few studies have evaluated in-home teleneuropsychological (teleNP) assessment and none, to our knowledge, has evaluated the National Alzheimer's Coordinating Center's (NACC) Uniform Data Set version 3 tele-adapted test battery (UDS v3.0 t-cog). The current study evaluates the reliability of the in-home UDS v3.0 t-cog with a prior in-person UDS v3.0 evaluation.

METHOD

One hundred and eighty-one cognitively unimpaired or cognitively impaired participants from a longitudinal study of memory and aging completed an in-person UDS v3.0 and a subsequent UDS v3.0 t-cog evaluation (∼16 months apart) administered either via video conference (n = 122) or telephone (n = 59).

RESULTS

We calculated intraclass correlation coefficients (ICCs) between each time point for the entire sample. ICCs ranged widely (0.01-0.79) but were generally indicative of "moderate" (i.e., ICCs ranging from 0.5-0.75) to "good" (i.e., ICCs ranging from 0.75-0.90) agreement. Comparable ICCs were evident when looking only at those with stable diagnoses. However, relatively stronger ICCs (Range: 0.35-0.87) were found between similarly timed in-person UDS v3.0 evaluations.

CONCLUSIONS

Our findings suggest that most tests on the UDS v3.0 t-cog battery may serve as a viable alternative to its in-person counterpart, though reliability may be attenuated relative to the traditional in-person format. More tightly controlled studies are needed to better establish the reliability of these measures.

Lessons From the Coronavirus Disease Experience: Research Participant and Staff Satisfaction With Remote Cognitive Evaluations

OBJECTIVE

In New York City in 2020 the pandemic shut down in-person research. Icahn School of Medicine's Alzheimer's Disease Research Center transitioned longitudinal evaluations from in-person to telephone to enhance equity of access. We assessed diverse research participants' and clinical research coordinators' (CRC) satisfaction with remote evaluation and examined sociodemographic, cognitive, and behavioral factors that might impact satisfaction.

METHODS

Data collected: 241 participants with Clinical Dementia Rating (CDR) = 0/0.5 (3/2020 to 6/2021). A Telehealth Satisfaction Questionnaire for CRCs and participants was administered at the end of remote evaluations. We compared Telehealth Satisfaction Questionnaire items by CDR and Geriatric Depression Scale.

RESULTS

Participants' mean age was 78.4, 61.4% were females, 16.2% were Hispanic, 17.1% Asian, 15.8% were non-Hispanic black, and 72.6% CDR = 0. Participant satisfaction was high [14.1 ± 1.4 (out of 15)] but was lower among those with depression. CRC satisfaction was high [16.9 ± 1.8 (out of 18)] but was lower concerning the ability to explain the test battery and interact with participants with CDR = 0.5.

CONCLUSION

Telephone research assessments provide flexibility in a hybrid model. They offer equitable access to research participation for those who do not use computer technology and may promote the retention of diverse elderly research participants.

Assessing the Impact of Evidence-Based Mental Health Guidance During the COVID-19 Pandemic: Systematic Review and Qualitative Evaluation

BACKGROUND

During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, and vaccine hesitancy and prioritization in the context of mental illness, to inform timely clinical decision-making.

OBJECTIVE

This study aimed to evaluate the practice of creating evidence-based health guidelines during health emergencies using the OxPPL guidance as an example. An international network of clinical sites and colleagues (in Australia, New Zealand, and the United Kingdom) including clinicians, researchers, and experts by experience aimed to (1) evaluate the clinical impact of the OxPPL guidance, as an example of an evidence-based summary of guidelines; (2) review the literature for other evidence-based summaries of COVID-19 guidelines regarding mental health care; and (3) produce a framework for response to future global health emergencies.

METHODS

The impact and clinical utility of the OxPPL guidance were assessed using clinicians' feedback via an international survey and focus groups. A systematic review (protocol registered on Open Science Framework) identified summaries or syntheses of guidelines for mental health care during and after the COVID-19 pandemic and assessed the accuracy of the methods used in the OxPPL guidance by identifying any resources that the guidance had not included.

RESULTS

Overall, 80.2% (146/182) of the clinicians agreed or strongly agreed that the OxPPL guidance answered important clinical questions, 73.1% (133/182) stated that the guidance was relevant to their service, 59.3% (108/182) said that the guidelines had or would have a positive impact on their clinical practice, 42.9% (78/182) that they had shared or would share the guidance, and 80.2% (146/182) stated that the methodology could be used during future health crises. The focus groups found that the combination of evidence-based knowledge, clinical viewpoint, and visibility was crucial for clinical implementation. The systematic review identified 2543 records, of which 2 syntheses of guidelines met all the inclusion criteria, but only 1 (the OxPPL guidance) used evidence-based methodology. The review showed that the OxPPL guidance had included the majority of eligible guidelines, but 6 were identified that had not been included.

CONCLUSIONS

The study identified an unmet need for web-based, evidence-based mental health care guidance during the COVID-19 pandemic. The OxPPL guidance was evaluated by clinicians as having a real-world clinical impact. Robust evidence-based methodology and expertise in mental health are necessary, but easy accessibility is also needed, and digital technology can materially help. Further health emergencies are inevitable and now is the ideal time to prepare, including addressing the training needs of clinicians, patients, and carers, especially in areas such as telepsychiatry and digital mental health. For future planning, guidance should be widely disseminated on an international platform, with allocated resources to support adaptive updates.

Telemedicine-Based Cognitive Examinations During COVID-19 and Beyond: Perspective of the Massachusetts General Hospital Behavioral Neurology & Neuropsychiatry Group

Telehealth and telemedicine have encountered explosive growth since the beginning of the COVID-19 pandemic, resulting in increased access to care for patients located far from medical centers and clinics. Subspecialty clinicians in behavioral neurology & neuropsychiatry (BNNP) have implemented the use of telemedicine platforms to perform cognitive examinations that were previously office based. In this perspective article, BNNP clinicians at Massachusetts General Hospital (MGH) describe their experience performing cognitive examinations via telemedicine. The article reviews the goals, prerequisites, advantages, and potential limitations of performing a video- or telephone-based telemedicine cognitive examination. The article shares the approaches used by MGH BNNP clinicians to examine cognitive and behavioral areas, such as orientation, attention and executive functions, language, verbal learning and memory, visual learning and memory, visuospatial function, praxis, and abstract abilities, as well as to survey for neuropsychiatric symptoms and assess activities of daily living. Limitations of telemedicine-based cognitive examinations include limited access to and familiarity with telecommunication technologies on the patient side, limitations of the technology itself on the clinician side, and the limited psychometric validation of virtual assessments. Therefore, an in-person examination with a BNNP clinician or a formal in-person neuropsychological examination with a neuropsychologist may be recommended. Overall, this article emphasizes the use of standardized cognitive and behavioral assessment instruments that are either in the public domain or, if copyrighted, are nonproprietary and do not require a fee to be used by the practicing BNNP clinician.

It's complicated: Executive functioning moderates impacts of daily busyness on everyday functioning in community-dwelling older adults

OBJECTIVE

Research shows that cognitively healthy older adults with mild executive function (EF) weaknesses are vulnerable to the negative impacts of life complexity (or daily busyness) when performing instrumental activities of daily living (IADLs). However, past research assessed life complexity only at one timepoint, not capturing daily fluctuations. Importantly, fluctuations in busyness can themselves have deleterious impacts on functioning. This study extended past research by examining whether (1) variability in daily busyness would be more detrimental than level of busyness to performance of IADLs, and (2) EF assessed at home would moderate deleterious impact of busyness on IADLs.

METHOD

Fifty-two community-dwelling older adults aged 60 to 95 completed daily IADL tasks and daily measures of EF and busyness via ecological momentary assessment, independently at home for 18 days.

RESULTS

(1) In a subset of participants with mild EF weaknesses, high variability in busyness across days was associated with fewer tasks completed correctly; and (2) across all participants (regardless of EF), high levels of daily busyness were associated with fewer tasks completed on time.

CONCLUSIONS

Findings indicate that high variability in daily busyness, potentially reflecting a lack of daily routine, was associated with IADL errors among cognitively healthy older adults with mild EF weaknesses. Additionally, consistently high levels of busyness were associated with failures to complete tasks, or failures to complete them on time, regardless of EF. These results further support the Contextually Valid Executive Assessment (ConVExA) model, which posits that EF and contextual factors interact to predict functional outcomes.

The effects of cognitive rehabilitation combined with aerobic exercise or stretching-and-toning on new learning and memory in persons with moderate-to-severe TBI: Protocol for a randomized controlled trial

This paper describes the protocol for a Phase I/II, parallel-group, blinded randomized controlled trial that compares the effects of 12-weeks of combined learning and memory rehabilitation with either aerobic cycling exercise or stretching on cognitive, neuroimaging, and everyday life outcomes in 60 persons with moderate-to-severe traumatic brain injury (TBI) who demonstrate impairments in new learning. Briefly, participants will undergo baseline testing consisting of neuropsychological testing, neuroimaging, daily life measures, and cardiorespiratory fitness. Following baseline testing, participants will be randomized to one of 2 conditions (30 participants per condition) using concealed allocation. Participants will be masked as to the intent of the conditions. The conditions will both involve supervised administration of an enhanced, 8-week version of the Kessler Foundation modified Story Memory Technique, embedded within either 12-weeks of supervised and progressive aerobic cycling exercise training (experimental condition) or 12-weeks of supervised stretching-and-toning (active control condition). Following the 12-week intervention period, participants will complete the same measures as at baseline that will be administered by treatment-blinded assessors. The primary study outcome is new learning and memory impairment based on California Verbal Learning Test (CVLT)-III slope, the secondary outcomes include neuroimaging measures of hippocampal volume, activation, and connectivity, and the tertiary outcomes involve measures of daily living along with other cognitive outcomes. We further will collect baseline sociodemographic data for examining predictors of response heterogeneity. If successful, this trial will provide the first Class I evidence supporting combined memory rehabilitation and aerobic cycling exercise training for treating TBI-related new learning and memory impairment.

Telehealth competencies for allied health professionals: A scoping review

INTRODUCTION

Telehealth has become one of the main methods of delivering allied health professional services world-wide, yet many professionals do not have sufficient training to deliver high-quality telehealth services. This review aims to identify what competencies allied health professionals require for effective telehealth service delivery.

METHODS

This scoping review used the Population Concept Context framework and searched the following databases: MEDLINE, CINAHL, PsychInfo, Cochrane, EMBASE, Web of Science, PEDro, United Kingdom Health Forum, WHO, Health Education England, and all UK and Australian AHP professional bodies.

RESULTS

A total of 37 articles were included out of 92,525 identified by the literature search. Competencies were related to two areas: (1) delivery of the telehealth consultation and (2) service management of telehealth consultations. The first area included the following competency themes: clinical reasoning, communication, effectively using technology, person-centred care, practice-based assessment and intervention knowledge/behaviour/skills, privacy, security, and patient safety, professionalism, and setting up the technical environment. The second area included the following competency themes: digital infrastructure, informing practice, and management. Although findings emphasised the importance of telehealth competencies, none have been implemented within education. One-third of the articles were from the discipline of psychology.

CONCLUSION

This is the first scoping review to combine telehealth competencies reported across allied health disciplines. Although there were a vast range of competencies, they need implementation into teaching and learning to be practically useful. Most competencies were from psychology, but potentially applicable for other allied health professionals. A shared and adaptable standard for telehealth competencies would be useful to ensure high-quality practice across all allied health professionals.

Improved parent self-efficacy following pediatric evaluation: Evidence for value of a telemedicine approach in psychological and neuropsychological assessment

Objective: While considerable inquiry is currently underway into the comparability of psychological test results obtained in onsite/in-person settings versus telemedicine settings, there has been less attention given to the comparability of the impact/outcome of the assessment process across settings. The current quality improvement study conceptualized impact/outcome according to the model of Austin et al. and sought to determine whether the prior finding of increased parent self-efficacy following onsite neuropsychological assessment was also observed when psychological and neuropsychological assessment was conducted via a telemedicine modality. Method: In the course of standard care delivery, ratings from Austin et al.'s four parent self-efficacy items were obtained at time 1 prior to patients' assessment visits and then again at time 2 either (1) following their last assessment/feedback visit (the Complete Assessment group; n = 157) or (2) in the middle of the assessment process prior to the last planned visit (the Incomplete Assessment group; n = 117). Results: Analyses revealed significant findings for time and time × group. Parent self-efficacy ratings improved over time in both groups, with significantly higher ratings in the Complete Assessment group at time 2. When compared to reference means from the in-person/onsite Austin et al. study, ratings from the current study found comparable improvement in parent self-efficacy achieved via telemedicine assessment in the Complete Assessment group. Conclusions: These data support the use of telemedicine based psychological and neuropsychological evaluation and provide preliminary evidence that the impact/outcome is comparable with in-person/onsite assessment.

The development of the Cognitive Assessment for Tagalog Speakers (CATS): A culturally and linguistically tailored test battery for Filipino Americans

INTRODUCTION

Filipino Americans are one of the largest Asian American and Pacific Islander (AAPI) populations in the United States (US). Previous studies suggest that Filipino Americans have one of the highest incidence rates of Alzheimer's disease and related dementias (ADRD) among AAPI subgroups. Despite the expected increase in Filipino Americans with ADRD, no studies to-date have validated neuropsychological measures in the United States for speakers of Tagalog, a major language spoken by Filipino Americans. A significant barrier to dementia care and diagnosis is the lack of linguistically and socioculturally appropriate cognitive tasks for Tagalog speakers. To address this need, we developed and piloted the Cognitive Assessment for Tagalog Speakers (CATS), the first neuropsychological battery for the detection of ADRD in Filipino American Tagalog speakers.

METHODS

Based on evidence-based neuropsychological batteries, we adapted and constructed de novo tasks to measure performance across 4 main cognitive domains: visual/verbal memory, visuospatial functioning, speech and language, and frontal/executive functioning. Tasks were developed with a team of bilingual English/Tagalog, bicultural Filipino American/Canadian experts, including a neurologist, speech-language pathologist, linguist, and neuropsychologist. We recruited Tagalog-speaking participants of age 50+ through social media advertisements and recruitment registries for this cross-sectional study. We present the CATS design and protocol.

RESULTS

To-date, the CATS battery has been administered to 26 healthy control participants (age 64.5 ± 7.8 years, 18F/8 M) at an academic institution in Northern California, United States. The development and administration of the CATS battery demonstrated its feasibility but also highlighted the need to consider the effects of bilingualism, language typology, and cultural factors in result interpretation.

DISCUSSION

The CATS battery provides a mechanism for cognitive assessment of Filipino Americans, a population that has been underrepresented in ADRD research. As we move toward the treatment and cure of ADRD, linguistically and socioculturally appropriate cognitive tests become even more important for equitable care.

Tele-neuropsychological Assessment of Children and Young People: A Systematic Review

The coronavirus pandemic identified a clinical need for pediatric tele-neuropsychology (TeleNP) assessment. However, due to limited research, clinicians have had little information to develop, adapt, or select reliable pediatric assessments for TeleNP. This preliminary systematic review aimed to examine the feasibility of pediatric TeleNP assessment alongside (1) patient/family acceptability, (2) reliability, and (3) the quality of the literature. Between May 2021 and November 2022, manual searches of PubMed, PsycINFO, and Google Scholar were conducted using terms related to "pediatric" and "tele-neuropsychology." After extracting relevant papers with samples aged 0-22 years, predefined exclusion criteria were applied. Quality assessment was completed using the AXIS appraisal tool (91% rater-agreement). Twenty-one studies were included in the review, with reported qualitative and quantitative data on the feasibility, reliability, and acceptability extracted. Across included studies, TeleNP was completed via telephone/video conference with participants either at home, in a local setting accompanied by an assistant, or in a different room but in the same building as the assessor. Pediatric TeleNP was generally reported to be feasible (e.g., minimal behavioral differences) and acceptable (e.g., positive feedback). Nineteen studies conducted some statistical analyses to assess reliability. Most observed no significant difference between in-person and TeleNP for most cognitive domains (i.e., IQ), with a minority finding variable reliability for some tests (e.g., attention, speech, visuo-spatial). Limited reporting of sex-assigned birth, racialized identity, and ethnicity reduced the quality and generalizability of the literature. To aid clinical interpretations, studies should assess underexamined cognitive domains (e.g., processing speed) with larger, more inclusive samples.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40817-023-00144-6.

Feasibility of remotely delivered and supported aerobic walking exercise training for cognitive processing speed impairment in fully-ambulatory persons with multiple sclerosis

PURPOSE

The current pilot, single-blind, randomized controlled trial (RCT) examined the feasibility of remotely-delivered and supported aerobic walking exercise training compared with an active control condition on cognitive processing speed (CPS) in 19 fully-ambulatory persons with multiple sclerosis (pwMS) who were pre-screened for impaired CPS.

METHODS

Feasibility was assessed in the domains of process (e.g., recruitment), resource (e.g., monetary costs), management (e.g., time requirements), and scientific outcomes (i.e., treatment effect). Fully-ambulatory, but CPS-impaired pwMS were randomly assigned into either 16-weeks of home-based aerobic walking exercise or home-based stretching and range-of-motion activities. Both conditions involved delivery of informational newsletters and one-on-one, online video chats with a behavior coach. Participants across both conditions tracked their activity using highly accurate wearable motion sensors. Treatment-blinded assessors administered the Symbol Digit Modalities Test (SDMT) remotely before and after the 16-week study period.

RESULTS

The study was cost-effective, accessible, and acceptable. The intervention further was safe. Adherence and compliance rates across both conditions exceeded 80%. There was an overall moderate effect for change in SDMT score between the conditions (d = 0.42). The intervention was associated with a 4.8-point improvement in SDMT scores (d = 0.70; 10% increase) compared with a 1-point improvement for the control condition (d = 0.09; 2% increase).

CONCLUSIONS

This remotely-delivered and supported aerobic walking exercise training intervention was safe and feasible for fully-ambulatory, CPS-impaired pwMS. The pattern of results, including the promising effects on CPS, support the design and implementation of an appropriately-powered RCT on this approach for managing CPS impairment in a large MS sample.

Teleneuropsychology during the COVID-19 pandemic in Mexico: the perspective from a middle-income country

INTRODUCTION

The use of teleneuropsychology (TeleNP) increased as a result of the COVID-19 pandemic; however, there have been no studies of the benefits and difficulties with this modality in middle-income countries. This study aimed to assess the current use of TeleNP in Mexico.

METHOD

Mexican neuropsychologists were invited to participate in an online survey regarding the use of TeleNP during the COVID-19 pandemic. The survey was based on issues from a literature review and consisted of 36 questions requiring yes/no, multiple choice, or ordinal answers. The survey was created using Google Forms and asked respondents to provide informed consent. A total of 107 clinical neuropsychologists completed the survey.

RESULTS

82% of participants currently use TeleNP, and most reported learning about TeleNP through personal experience, literature research, and colleagues. Brief evaluations, delivery of results, and intervention were the principal services provided, most frequently on a home-to-home basis. Almost 30% of clinicians reported not requiring informed consent for use of the modality. Consultations included children, adolescents, and adults in similar numbers; older adults were less frequent. Technological limitations were the most frequent reason for ruling out the modality with particular patients. Perceived benefits included the ability to continue consultations despite social distancing measures, lesser risk of COVID-19 infection, and the possibility of seeing patients with limited access to neuropsychological services. Reasons for not using TeleNP included a lack of standardized instruments, not feeling comfortable with the modality, and lack of technological resources and skills.

CONCLUSIONS

Despite the socioeconomic differences between Mexico and high-income countries, most of our findings were similar to reports from those countries. However, technological limitations were common, and smartphones were commonly used, contrary to recommendations in the literature. The future use of TeleNP in Mexico should include formal training and ethical guidelines.

Remote testing in Abbiategrasso (RTA): results from a counterbalanced cross-over study on direct-to-home neuropsychology with older adults

BACKGROUND

The SARS-CoV-2 pandemic forced to rethink teleneuropsychology, since neuropsychological assessments started to be performed by phone or videoconference, with personal devices and without direct assistance from the clinician, a practice called "Direct-To-Home NeuroPsychology" (DTH-NP).

AIMS

The present study, employing a counterbalanced cross-over design, was aimed at evaluating (1) the feasibility and (2) the acceptability of DTH-NP in Italian older adults without previously diagnosed neurocognitive disorder, (3) the comparability between remote and face-to-face administration of selected neuropsychological tests.

METHODS

Fifty-eight community-dwelling older adults (65-85 years) were randomly assigned to one of two groups performing a complete neuropsychological assessment remotely (via phone call and videoconference) and face-to-face, in a counterbalance order, 8 weeks apart. The study recruitment rate was calculated, and the number of uncompleted tests and acceptability questionnaire responses were compared between the two administration modalities. Comparability was defined as good reliability of DTH-NP (intraclass correlation coefficient) and agreement between remote and face-to-face scores (Bland-Altman plots).

RESULTS

Recruitment rate was 81%, with a preference for telephonic contact (79%). The acceptability analysis did not reveal any issues related to the DTH-NP assessment, even if most participants would rather repeat it face-to-face. Tests assessing short-term memory, language, and reasoning showed good comparability.

DISCUSSION AND CONCLUSION

Our results point out to a good recruitment rate in a DTH-NP study in an Italian population of older adults (mean age = 80), satisfying acceptability of DTH-NP and remote-face-to-face comparability of certain verbally mediated tests. Further studies including larger samples in videoconference modality, and outpatients, could better clarify its strengths and limits.

Remote neuropsychological assessment: Acceptability and feasibility of direct-to-home teleneuropsychology methodology during the COVID-19 pandemic

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.

Teleneuropsychology: normative data for the assessment of memory in online settings

INTRODUCTION

The COVID-19 pandemic has forced significant changes in clinical practice. Psychologists and neuropsychologists had to modify their settings to assess patients' abilities, switching from an in-person modality to a remote setting by using video calling platforms. Consequently, this change brought about the need for new normative data tailored to remote settings.

AIM AND METHODS

The study aimed to develop normative data for the online assessment of neuropsychological memory tests and to compare it with the published norms obtained in standard settings. Two hundred and four healthy Italian volunteers performed three verbal memory tests through the Google Meet platform: the Digit Span (Backward and Forward), the Rey Auditory Verbal Learning, and the Verbal Paired Associated Learning Test.

RESULTS

This research provides specific norms that consider the influence of demographic characteristics. Their comparison with published norms shows a medium to high agreement between systems. The present study provides a reference for the clinical use of neuropsychological instruments to assess verbal memory in a remote setting and offers specific recommendations.

Does Assessment Format Matter? A Comparison of In-Person Versus Teletesting Scores for Youth with ADHD

OBJECTIVE

This study examined test score equivalency between traditional in-person assessment and teletesting among youth diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD).

METHOD

In all, 896 youth with ADHD, ages 5-21 years, were administered cognitive, academic achievement, and verbal fluency measures via either teletesting (n = 448) or traditional in-person assessment (n = 448). The teletesting and in-person groups were matched on age, sex, and insurance type (as a proxy for income).

RESULTS

Results indicated no significant differences in test scores obtained via in-person and teletesting evaluations across all examined measures.

CONCLUSION

Clinically referred youth with ADHD perform similarly on measures of cognitive functioning, academic achievement, and verbal fluency, regardless of whether these measures are administered in-person or via teletesting. While additional evidence for equivalent psychometric properties of neuropsychological instruments administered remotely is needed, this study offers support for the validity of remote administration among youth with ADHD.

Cognitive and emotional impairments associated with COVID-19 (literature review)

Background. Currently, there are two main areas of study of the impact of a new coronavirus infection on mental processes: the first is in connection with the regime of self-isolation and restrictions in a pandemic; the second – with the impact of the pathological process itself and the post-covid syndrome on the central nervous system. The results of the studies indicate the relationship of this infection with local lesions of the brain and the corresponding disturbances in the functioning of mental processes.The aim of the research. To systematize and analyze the results of studies on the main routes of penetration of the SARS-CoV-2 virus into the central nervous system, cognitive and emotional disorders in people who have recovered from COVID-19, and to discuss the areas of psychological rehabilitation for this group of patients.Materials and methods. Information search was carried out using Internet resources (PubMed, Web of Science, Scopus, bmj.com, eLibrary.ru, frontiersin.org, sciencedirect. com, ncbi.nlm.nih.gov), literature sources were analyzed for the period from May of 2020 to November of 2021 for the following keywords: COVID-19, SARS-CoV-2, cognitive functions, cognitions, cognitive impairments, emotional dysfunction, affective dysfunction.Results. According to the analysis of the literature, most researchers identify the neurogenic pathway of SARS-CoV-2 penetration into the CNS, as well as penetration through the bloodstream or through cerebral lymphatic drainage, which are a possible cause of mental disorders of a neurological nature. Correction of these violations involves the creation of a comprehensive system of rehabilitation with the inclusion of psychotherapeutic methods.Conclusions. Despite the lack of a single picture describing the specifics of cognitive and affective symptoms in COVID-19, in the most general terms, there is a certain consensus. So, quite often, post-COVID cognitive symptoms are characterized by impaired memory and attention, and post-COVID affective symptoms are characterized by increased levels of anxiety, depression, and fatigue. The issues of diagnosis and correction of disorders in post-COVID syndrome and the admissibility of the existence of this diagnosis are still relevant.

Preliminary Validity of a Telephone-Based Neuropsychological Battery in a Consecutive Series of Persons with HIV Disease Referred for Clinical Evaluation

OBJECTIVE

The COVID-19 pandemic necessitated use of remote assessments by clinical neuropsychologists. Telehealth was particularly important for vulnerable groups, including persons living with HIV (PLWH); however, limited internet access can be a serious barrier to care. This study examined the preliminary validity of a telephone-based neuropsychological assessment in a clinical sample of PLWH.

METHOD

A consecutive series of 59 PLWH were assessed via telephone at an HIV clinic in the southern U.S. between April 2020 and July 2022. The battery included auditory-verbal neuropsychological tests of memory, attention, and executive functions, and questionnaires assessing self-reported mood and activities of daily living (ADL).

RESULTS

Study measures demonstrated acceptable internal consistency. PLWH demonstrated worse neuropsychological performance compared with expectations derived from the normal curve and an HIV-seronegative adult sample (N = 44). PLWH assessed via telephone demonstrated similar impairment rates to that of a consecutive series of PLWH (N = 41) assessed in-person immediately prior to the pandemic. Higher telephone-based global neuropsychological scores were related to younger age, more education, better fund of knowledge, White race/ethnicity, fewer medical conditions, and fewer depression symptoms. Global neuropsychological impairment was strongly and independently associated with greater dependence in ADL domains, particularly for instrumental activities.

CONCLUSIONS

Although telephone-based approaches to neuropsychological assessment are not ideal, these data provide support for the feasibility, internal consistency, and preliminary validity of this method in a consecutive clinical series of PLWH. The direct comparability of telephone-based and in-person neuropsychological assessments remains to be determined by prospective, counterbalanced study designs examining both PLWH and seronegative individuals.

Reliability, Validity, and User-Experience of Remote Unsupervised Computerized Neuropsychological Assessments in Community-Living 55- to 75-Year-Olds

BACKGROUND

Self-administered computerized neuropsychological assessments (CNAs) provide lower cost, more accessible alternatives to traditional in-person assessments but lack critical information on psychometrics and subjective experience of older adults in remote testing environments.

OBJECTIVE

We used an online brief battery of computerized tasks selected from the Cogstate Brief Battery (CBB) and Cambridge Brain Sciences (CBS) to 1) determine test-retest reliability in an unsupervised setting; 2) examine convergent validity with a comprehensive 'gold standard' paper-and-pencil neuropsychological test battery administered in-person; and 3) explore user-experience of remote computerized testing and individual tests.

METHODS

Fifty-two participants (mean age 65.8±5.7 years) completed CBB and CBS tests on their own computer, unsupervised from home, on three occasions, and visited a research center for an in-person paper-and-pencil assessment. They also completed a user-experience questionnaire.

RESULTS

Test-retest reliabilities varied for individual measures (ICCs = 0.20 to 0.83). Global cognition composites showed excellent reliability (ICCs > 0.8 over 1-month follow-up). A strong relationship between a combination of CNA measures and paper-and-pencil battery was found (canonical correlation R = 0.87, p = 0.04). Most tests were rated as enjoyable with easy-to-understand instructions. Ratings of general experience with online testing were mostly favorable; few had difficulty concentrating (17%) or using the computer for tasks (10%), although over one-third experienced performance anxiety (38%).

CONCLUSION

A combined brief online battery selected from two CNAs demonstrated robust psychometric standards for reliability (global composite), and convergent validity with a gold standard battery, and mostly good usability and acceptability in the remote testing environment.

Remote cognitive assessment in severe mental illness: a scoping review

Many individuals living with severe mental illness, such as schizophrenia, present cognitive deficits and reasoning biases negatively impacting clinical and functional trajectories. Remote cognitive assessment presents many opportunities for advancing research and treatment but has yet to be widely used in psychiatric populations. We conducted a scoping review of remote cognitive assessment in severe mental illness to provide an overview of available measures and guide best practices. Overall, 34 studies (n = 20,813 clinical participants) were reviewed and remote measures, psychometrics, facilitators, barriers, and future directions were synthesized using a logic model. We identified 82 measures assessing cognition in severe mental illness across 11 cognitive domains and four device platforms. Remote measures were generally comparable to traditional versions, though psychometric properties were infrequently reported. Facilitators included standardized procedures and wider recruitment, whereas barriers included imprecise measure adaptations, technology inaccessibility, low patient engagement, and poor digital literacy. Our review identified several remote cognitive measures in psychiatry across all cognitive domains. However, there is a need for more rigorous validation of these measures and consideration of potentially influential factors, such as sex and gender. We provide recommendations for conducting remote cognitive assessment in psychiatry and fostering high-quality research using digital technologies.

Culturally Responsive Telepsychology & mHealth Interventions for Racial-Ethnic Minoritized Youth: Research Gaps and Future Directions

Telepsychology and mHealth (TPmH) services for youth and their families have become increasingly prevalent in recent years. However, significant limitations in theory, research, and policy introduce questions about the effectiveness of such interventions, particularly for racial-ethnic minoritized youth and their families, who already contend with inequities in mental health treatment access and outcomes. Although TPmH have the potential to reduce barriers to mental health services in ways that may benefit racial-ethnic minoritized youth and their families, the mental health field must first grapple with limitations in culturally responsive TPmH work to avoid perpetuating existing mental health inequities. As such, this article begins by briefly reviewing extant literature on (1) TPmH for youth, (2) culturally adapted or culturally responsive evidence-based interventions for racial-ethnic minoritized youth and families, and (3) the intersection of TPmH and culturally responsive interventions. Informed by the gaps identified by this review, we provide recommendations for future directions in culturally responsive TPmH for racial-ethnic minoritized youth and families. These recommendations have been organized into four overarching categories: (1) conceptual and theoretical recommendations, (2) research priorities, (3) practice and policy recommendations, and (4) engagement and access recommendations. These recommendations offer novel ideas for researchers, clinicians, funding agencies, policy-makers, and other key stakeholders and are intended to facilitate equity in TPmH for racial-ethnic minoritized youth and their families.

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.

Teleneuropsycological adaptation of the NEUROPSI Breve screening test

OBJECTIVE

Teleneuropsychology refers to the application of neuropsychology using video teleconferencing (VTC) techniques, whose methodology facilitates access to remote populations, a need that has increased due to the COVID-19 pandemic. Numerous investigations have documented the equivalence of different screening assessments (Mini Mental State Examination, Montreal Cognitive Assessment (MoCA) test and the Repeatable Battery for the Assessment for Neuropsychological Status) when applied via teleneuropsychology. The goal of the present work is to test the equivalence of the Brief Neuropsychological Battery in Spanish (NEUROPSI Breve), a neuropsychological screening instrument standardized for Spanish-speaking population that has reported a high sensitivity (91.6%) for identifying dementia, when applied in the VTC modality.

METHOD

In total, 32 Mexicans between 16 and 70 years were assessed, both in traditional (face-to-face) and VTC format with a 20 min wait between each application. Each participant was randomly assigned into one of four groups that were generated from the established conditions: the first application could be face-to-face or by VTC modality and an adapted or original version of NEUROPSI Breve would be applied; for the second application, the remaining modality and instrument would be used. Statistical analysis was carried out using the IBM Statistical Package for the Social Sciences (SPSS) software (v. 25).

RESULTS

The Wilcoxon signed-rank test presented statistically significant differences (Z = -2.79, P = .005). However, when applied to each one of the four evaluation groups, the Wilcoxon signed-rank test showed no statistically significant differences; the same results were found when starting with the original or adapted instrument, and when starting with the face-to-face modality (P < .005). However, differences are shown when starting with the online (VTC) modality (groups B and C) (P = .028).

CONCLUSIONS

The NEUROPSI Breve is applicable in both modalities, satisfying the needs of the population and the evaluation guidelines.

The cumulative effect of fibromyalgia symptoms on cognitive performance: The mediating role of pain

Fibromyalgia (FMS) is a chronic condition that encompasses widespread pain associated with cognitive impairment and significant emotional distress related to functional disability. This study aimed to obtain evidence of the role of pain in the effect of time since FMS diagnosis and cognitive performance using a novel online protocol of neuropsychological evaluation since the COVID-19 pandemic has challenged traditional neuropsychology testing leading to the need for novel procedures transitioning to tele-neuropsychology. A sample of 70 adult women was evaluated (50 with FMS and 19 controls) using online questionnaires that evaluated pain and executive functioning (impulsivity, inhibition control, monitoring, and planning). Afterward, participants were evaluated by trained neuropsychologists in a 30 min online session using virtually adapted cognitive tests: the Hopkins Verbal Learning Test (memory), the Symbol-Digit Modalities Test (attention and speed processing), the F-A-S test (verbal fluency), and Digit Span tests (working memory). We found that the time of FMS diagnosis has an effect on cognitive functioning predominantly mediated by pain. Our results point out the role of pain as a mediator on cognitive performance, specifically in executive functions which are directly affected by the cumulative effect of the time of diagnosis. Furthermore, the importance of considering a broader perspective for assessment and treatment including novel procedures via tele-neuropsychology.

Evidence for the reliability and validity of a Spanish translation of the Medication Management Ability Assessment administered via tele-assessment

We translated the Medication Management Ability Assessment (MMAA) from English to Spanish for use via tele-assessment and examined its reliability and validity. Following International Test Commission Guidelines for Translating and Adapting Tests, we used translation/back-translation and a small focus group (n = 6) to adapt a Spanish version of the MMAA. Eighty-six Spanish-speaking adults completed the adapted MMAA via tele-assessment at baseline and at a two-week follow-up visit. Participants also completed several self-report and performance-based cognitive and functional measures. The internal consistency of the MMAA was excellent (standardized Cronbach's α = 0.90). Performance-based functional assessments (PBFAs) and objective cognition were positively associated with the MMAA at small to medium effect sizes. Self-report measures of daily function and cognition, measures of health literacy, and estimates of premorbid intellectual functioning were not significantly associated with MMAA performance. The test-retest reliability of the MMAA was good (CCC = 0.73, 95% CI [0.62, 0.81]; rs = 0.37, p < 0.001) and demonstrated a small practice effect (Cohen's d = 0.36, p = 0.001). Preliminary evidence for the construct validity of a Spanish-language MMAA administered via tele-assessment further expands the potential clinical utility of PBFAs in culturally diverse, Spanish-speaking populations.

Relationship of psychological/mild traumatic brain injury (mTBI) history and invalid reporting to self-reported executive function

Individuals with mild traumatic brain injury (mTBI) often complain of executive functioning (EF) difficulties. There is a discrepancy between self-reported EF impairment and EF deficits on neuropsychological tests, with some arguing that self-report EF is more related to real-world functioning than EF tests. However, research suggests that self-reported EF may be related more to emotional distress and is vulnerable to invalid reporting. We examined the vulnerability of the short form Barkley Deficits in Executive Functioning Scale (BDEFS) to invalid reporting, using a simulated mTBI paradigm. We included four groups: individuals simulating mTBI with (N = 24) and without (N = 21) histories of mTBI/other psychological conditions and controls with (N = 21) and without (N = 25) histories of mTBI/other psychological conditions. As hypothesized, simulators performed worse on the BDEFS Total Score and EF Symptom Count relative to controls; however, this effect was larger within those who had no self-reported history of mTBI/other psychological conditions. We identified a preliminary cutoff on the EF Symptom Count that detected 42.8% of simulators, with 95% specificity relative to the controls with histories of mTBI/other psychological conditions. The present study emphasizes the need for validity scales on self-report EF measures such as the BDEFS.

Telehealth diagnosis of autism spectrum disorder through clinical cases

A diagnosis of autism spectrum disorder (ASD) provides access to interventions that are important for fostering development and improving quality of life. Thus, the timeliness of a diagnosis should not be limited by social-distancing limitations whenever possible. Despite this, clear guidance for transitioning autism diagnostic services to a telehealth model of care in the era of the COVID-19 pandemic is lacking. At our Institute, we have adapted our approach to ASD evaluation to promote continued access to evaluation services during this unprecedented time. The purpose of this case series is to provide examples of three different approaches to ASD differential diagnostic services via telehealth that we have taken at our Institute.

We illustrate our methods and clinical decision-making, based on patient characteristics and referral aims, in providing telehealth diagnostic services and discuss the advantages and limitations of telehealth utilization in the differential diagnosis of ASD.

At our Institute, telehealth services have provided an invaluable opportunity to continue to confirm (or rule out) an ASD diagnosis when appropriate to facilitate access to services during this time. Future research examining the utility of telehealth in the differential diagnosis of ASD is imperative given the potential advantages of telehealth services beyond the COVID-19 pandemic for some patients.

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults

The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access.

Objective

This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic.

Methods

We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile.

Results

To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm.

Conclusions

The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.

Implementation of a Hybrid Teleneuropsychology Method to Assess Middle Aged and Older Adults During the COVID-19 Pandemic

Objective

Hybrid teleneuropsychology has emerged as a useful assessment method to manage physical distancing requirements during the COVID-19 pandemic. We describe the development of a hybrid teleneuropsychology clinic and compare results of six neuropsychological tasks across testing modalities, as well as a participant experience survey.

Method

Healthy middle-aged and older adults completed a face-to-face assessment two years previously. Participants either completed reassessment face-to-face or via the hybrid setup. Results were compared across time points and delivery modality.

Results

There were no significant differences in scores at reassessment between face-to-face and a hybrid setup on nonverbal fluid intelligence, verbal memory, visual memory, language, working memory or verbal initiation. Retest reliability was moderate to excellent for verbal and visual memory, attention and naming. Results of an anonymous survey indicated that participants felt comfortable and established good rapport with the examiner.

Conclusions

This hybrid method of teleneuropsychology can be used to obtain high quality and reliable results including on tasks yet to be evaluated for teleneuropsychology, including the Graded Naming Test and the Topographical Recognition Memory Test.

Feasibility and Acceptance of Direct-to-Home Tele-neuropsychology Services during the COVID-19 Pandemic

OBJECTIVE

Neuropsychological assessment via video conferencing has been proposed during the COVID-19 pandemic. Existing literature has demonstrated feasibility and acceptance of neuropsychological measures administered by videoconference, although few studies have examined feasibility and patient acceptance of TNP visits directly to patients' homes (DTH-TNP).

METHODS

We modified a previously published patient satisfaction survey for DTH-TNP and developed a clinician feasibility survey to examine experiences during DTH-TNP.

RESULTS

Seventy-two patients (age range: preschool-geriatric) evaluated by DTH-TNP for cognitive problems at an academic medical center responded to voluntary surveys between April 20, 2020, and August 19, 2020, and 100% indicated satisfaction. Fifty-nine percent of patients reported limitations (e.g., technological concern) during the appointment. 134 clinician surveys were collected and indicated that clinicians achieved the goal of their appointment in 90% of encounters.

CONCLUSIONS

These qualitative data suggest that patients and clinicians found DTH-TNP to be satisfactory during the COVID-19 pandemic, while also recognizing limitations of the practice. These results are limited in that voluntary surveys are subject to bias. They support the growing body of literature suggesting that DTH-TNP provides a valuable service, though additional research to establish reliability and validity is needed.

Rationale and Design of the National Neuropsychology Network

OBJECTIVE

The National Neuropsychology Network (NNN) is a multicenter clinical research initiative funded by the National Institute of Mental Health (NIMH; R01 MH118514) to facilitate neuropsychology's transition to contemporary psychometric assessment methods with resultant improvement in test validation and assessment efficiency.

METHOD

The NNN includes four clinical research sites (Emory University; Medical College of Wisconsin; University of California, Los Angeles (UCLA); University of Florida) and Pearson Clinical Assessment. Pearson Q-interactive (Q-i) is used for data capture for Pearson published tests; web-based data capture tools programmed by UCLA, which serves as the Coordinating Center, are employed for remaining measures.

RESULTS

NNN is acquiring item-level data from 500-10,000 patients across 47 widely used Neuropsychology (NP) tests and sharing these data via the NIMH Data Archive. Modern psychometric methods (e.g., item response theory) will specify the constructs measured by different tests and determine their positive/negative predictive power regarding diagnostic outcomes and relationships to other clinical, historical, and demographic factors. The Structured History Protocol for NP (SHiP-NP) helps standardize acquisition of relevant history and self-report data.

CONCLUSIONS

NNN is a proof-of-principle collaboration: by addressing logistical challenges, NNN aims to engage other clinics to create a national and ultimately an international network. The mature NNN will provide mechanisms for data aggregation enabling shared analysis and collaborative research. NNN promises ultimately to enable robust diagnostic inferences about neuropsychological test patterns and to promote the validation of novel adaptive assessment strategies that will be more efficient, more precise, and more sensitive to clinical contexts and individual/cultural differences.

Suspend or amend? Randomized controlled trial on neuropsychological rehabilitation for epilepsy: A COVID-19 impact

COVID-19 caused devastating effects of human loss and suffering along with disruption in clinical research, forcing reconceptualization and modification of studies. This paper attempts to outline the steps followed and detail the modifications undertaken to deal with the impacts of the pandemic on the first ongoing randomized controlled trial on effectiveness of neuropsychological rehabilitation in adult patients with drug-resistant epilepsy in India. All modifications were based on evolving guidelines and circumstantial context and were planned, reviewed and approved by important stakeholders. Results obtained from the trial need to be interpreted and analysed within this context. These modifications have implications for wider outreach of neuropsychology services in India.

Working Group Recommendations for the Practice of Teleneuropsychology in Latin America

OBJECTIVE

Teleneuropsychology (teleNP) could potentially expand access to services for patients who are confined, have limited personal access to healthcare, or live in remote areas. The emergence of the COVID-19 pandemic has significantly increased the use of teleNP for cognitive assessments. The main objective of these recommendations is to identify which procedures can be potentially best adapted to the practice of teleNP in Latin America, and thereby facilitate professional decision-making in the region.

METHOD

Steps taken to develop these recommendations included (1) formation of an international working group with representatives from 12 Latin American countries; (2) assessment of rationale, scope, and objectives; (3) formulation of clinical questions; (4) evidence search and selection; (5) evaluation of existing evidence and summary; and (6) formulation of recommendations. Levels of evidence were graded following the Oxford Centre for Evidence-Based Medicine system. Databases examined included PubMed, WHO-IRIS, WHO and PAHO-IRIS, Índice Bibliográfico Español en Ciencias de la Salud (IBCS), and LILACS.

RESULTS

Working group members reviewed 18,400 titles and 422 abstracts and identified 19 articles meeting the criteria for level of evidence, categorization, and elaboration of recommendations. The vast majority of the literature included teleNP tests in the English language. The working group proposed a series of recommendations that can be potentially best adapted to the practice of teleNP in Latin America.

CONCLUSIONS

There is currently sufficient evidence to support the use of videoconferencing technology for remote neuropsychological assessments. These recommendations will likely contribute to the advancement of teleNP research and practice in the region.

Feasibility of administering the WAIS-IV using a home-based telehealth videoconferencing model

Use of telehealth to deliver neuropsychological services has proven to be a feasible approach, however, there is limited research which has examined the reliability of home-based assessment models using a comprehensive intelligence test. The aim of this study was to examine the reliability and feasibility of a home-based videoconferencing administration of the Wechsler Adult Intelligence Scales-4^th Edition (WAIS-IV).

Thirty healthy participants (aged 18-40 years) completed the WAIS-IV both in-person and via home-based videoconferencing utilizing a randomized counter-balanced methodology to attempt to control for an order effect. Paper record forms for Coding/Symbol Search and Blocks were sent and returned via tamper proof courier packs. Participants completed an online survey of their experiences of TNP following completion of their assessments. Group mean comparisons, intra class correlation coefficients (ICCs) and Bland-Altman measures of bias were calculated.

Findings from both modalities were highly concordant across all WAIS-IV subtests and indices, with all ICCs rated as "excellent," (≥0.9). There were no significant mean group differences and no evidence of proportional bias. The majority of participants were very satisfied with the use of videoconferencing as an application for cognitive assessment and high levels of participant compliance were observed.

In this non-clinical cohort home-based videoconference administration of the WAIS-IV was feasible, reliable and acceptable. TNP may offer an alternative for those consumers where there are challenges in accessing a face-to-face service delivery model, thereby improving equity, and enabling continuation of service delivery. Future research is needed with a larger and more ethnically diverse clinical population.

Conducting Clinical Research Remotely for Individuals with Traumatic Brain Injury (TBI) and Depression during the COVID-19 Pandemic: Transitioning from In-Person to Remote Implementation

Background

Telehealth has provided many researchers, especially those conducting psychosocial research, with the tools necessary to transition from in-person to remote clinical trials during the COVID-19 pandemic. A growing body of research supports the effectiveness of telemental health for a variety of psychiatric conditions, but few studies have examined telemental health for individuals with comorbid medical diagnoses. Furthermore, little is known about the remote implementation of clinical trials examining telemental health interventions.

Objective

This paper outlines the procedural modifications used to facilitate conversion of an in-person randomized controlled trial of cognitive behavioral therapy (CBT) for depression in individuals with traumatic brain injury (TBI; CBT-TBI) to a telemental health study administered remotely.

Methods

Given the nature of remote implementation and specific challenges experienced by individuals with TBI, considerations related to treatment delivery, remote consent, data management, neuropsychological assessment, safety monitoring, and delivery of supportive material have been discussed. Feasibility, acceptability, and safety were evaluated by examining attendance and participant responses on self-report measures of treatment satisfaction and suicidal behavior.

Results

High rates of treatment attendance, assessment completion, study retention, and satisfaction with the intervention and modality were reported by participants who completed at least one telemental health CBT-TBI session.

Conclusions

Study modifications are necessary when conducting a study remotely, and special attention should be paid to comorbidities and population-specific challenges (eg, cognitive impairment). Preliminary data support the feasibility, acceptability, and safety of remotely conducting a randomized controlled trial of CBT-TBI.

Trial Registration

ClinicalTrials.gov NCT03307070; https://clinicaltrials.gov/ct2/show/NCT03307070

Update on Third Party Observers in Neuropsychological Evaluation: An Interorganizational Position Paper

OBJECTIVE

The National Academy of Neuropsychology (NAN), the American Academy of Clinical Neuropsychology (AACN), and the American College of Professional Neuropsychology (ACPN) collaborated to publish an update to their original position statements, confirming the organizations' opposition to third party observer (TPO).

METHOD

A review of literature addressing TPO effects, ethical standards, professional organization position statements, test publisher policies and new telemedicine developments was completed to obtain consensus on relevant issues in TPO and recording of neuropsychological evaluations.

RESULTS

TPO has been shown to impact the cognitive functions most often assessed in forensic or medicolegal settings. Third party observation, whether in person, recorded or electronic, remains a potential threat to the validity and reliability of evaluation results, and violates test security guidelines, ethical principles and standards of conduct in the field. Demands for TPO in the context of medicolegal or forensic settings have become a tactic designed to limit the ability of the consulting neuropsychologist to perform assessment and provide information to the trier of fact.

CONCLUSION

The field of neuropsychology opposes the presence of TPO in the setting of medicolegal or forensic neuropsychological evaluations.

Cross-cultural considerations for teleneuropsychology with Asian patients

OBJECTIVE

Recent teleneuropsychology (TeleNP) models provide some degree of guidance in the application of telecommunication technologies toward the practice of neuropsychology. However, there remains a paucity of peer-reviewed data on TeleNP practices with culturally diverse patients, including Asian patients. This manuscript describes the challenges related to TeleNP practices with Asian patients and offers practical recommendations to complement existing TeleNP guidelines.

METHOD

Based on extant literature on multicultural applications of neuropsychology, weprovide recommendations for TeleNP services with Asian patients that pertain to specific components of a TeleNP evaluation, such as a) pre-evaluation preparation, b) determining the appropriateness of the referral, c) determining language proficiency, d) working with interpreters, e) informed consent and confidentiality issues, f) conducting a culturally sensitive clinical interview, g) behavioral observations and communication, h) test selection, and i) interpreting data and writing reports.

CONCLUSIONS

Our recommendations for TeleNP services with Asian patients highlight the need for flexibility to accommodate cultural differences and commitment to the complex nature of working with patients requiring interpretation services, while also recognizing the importance of preserving the validity of neuropsychological methods. Moving forward, it is imperative that the field of neuropsychology increases the training and accessibility of neuropsychologists who are knowledgeable in providing TeleNP services to Asian patients, and promotes research on the validation of TeleNP for Asian and other ethnic minority groups.

Cognitive Stabilization Intervention during the Era of COVID-19

As COVID-19 halted traditional neuropsychological assessment due to infection risk, neuropsychologists considered alternative practice models. Cognitive stabilization intervention (CSI) via telehealth, was developed to stabilize cognition in advance of neuropsychological assessment. It incorporates elements of evidence-based treatments, including cognitive training, sleep training, and medication adherence training within a motivational interview framework. Two case vignettes are described. One vignette describes an elder man who received CSI to manage sleep difficulties, forgetfulness, and mood symptoms. Another vignette describes a woman who completed CSI following an autoimmune disorder episode to improve sleep, organization, and attention. The benefits and limitations of CSI are discussed.

Clinical neuropsychology in Canada: results from the 2020 AACN, NAN, SCN professional practice and "salary survey"

Objective: The current study summarizes the results of a 2020 survey that solicited information regarding backgrounds, beliefs, practices, and incomes of clinical neuropsychologists who practice in Canada. Methods: Clinical neuropsychologists who practice in Canada were invited to participate in an online survey that was available from 1/17/20 to 4/02/20. Available survey findings were obtained from 111 respondents, which reflects a response rate of 51.3% of the 216 doctoral-level Canadian neuropsychologists identified in at least one major North American or international professional organization membership list (AACN, INS, NAN, or SCN). Results: Most of the current respondents were White/Caucasian women who identified as adult providers and worked full-time in urban institutional settings. Four Canadian provinces (Alberta, British Columbia, Ontario, Quebec) accounted for more than 91% of the current respondent sample. Incomes and career satisfactions were largely encouraging, though some important variations were noted by province, work setting, and professional identity. Incomes were significantly associated with forensic practices and years of clinical experience. Most respondents made use of technician support in their practices, largely to increase productivity and patient volume. Only a small minority of respondents were board-certified and there was generally limited interest in future board certification. Conclusions: While important similarities were observed in the current Canadian sample relative to recent survey findings obtained in a U.S. sample, results also reveal a number of important differences that serve as important areas of future consideration.

Technology meets tradition: a hybrid model for implementing digital tools in neuropsychology

The COVID-19 pandemic has significantly impacted the provision of mental health care services and the ability to provide neuropsychological evaluations. The inability to conduct traditional evaluations has left neuropsychologists with the unprecedented task of determining how to modify existing paradigms while balancing the need to provide services and adhere to safety parameters. The COVID-19 literature suggests clinicians are modifying their evaluations based on the following models: (1) continuing to administer in-person evaluations; (2) discontinuing all evaluations due to issues related to standardization, test security, and patient-specific characteristics; (3) conducting virtual evaluations; and/or (4) adopting a hybrid model incorporating both traditional and technology-based modalities. Given the challenges with models 1-3, along with the modifications in telehealth guidelines and insurance reimbursement rates, neuropsychologists are more poised than ever to solidify the implementation of a hybrid model that lasts beyond COVID-19. We introduce the term Hybrid Neuropsychology, a model for the future of neuropsychological evaluations that includes three Action Items: (1) building a technology-based practice; (2) integrating data science; and (3) engaging with innovators in other fields. Hybrid Neuropsychology will enable clinicians to effectively modernize their practice, improve health care equity, and ensure neuropsychology secures its place in a technology-based world.

Update on Third Party Observers in Neuropsychological Evaluation: An Interorganizational Position Paper

OBJECTIVE

The National Academy of Neuropsychology (NAN), the American Academy of Clinical Neuropsychology (AACN), and the American College of Professional Neuropsychology (ACPN) collaborated to publish an update to their original position statements, confirming the organizations' opposition to third party observers (TPO).

METHOD

A review of literature addressing TPO effects, ethical standards, professional organization position statements, test publisher policies and new telemedicine developments was completed to obtain consensus on relevant issues in TPO and recording of neuropsychological evaluations.

RESULTS

TPO has been shown to impact the cognitive functions most often assessed in forensic or medicolegal settings. Third party observation, whether in person, recorded or electronically, remains a potential threat to the validity and reliability of evaluation results, and violates test security guidelines, ethical principles and standards of conduct in the field. Demands for TPO in the context of medicolegal or forensic settings have become a tactic designed to limit the ability of the consulting neuropsychologist to perform assessment and provide information to the trier of fact.

CONCLUSIONS

The field of neuropsychology opposes the presence of TPO in the setting of medicolegal or forensic neuropsychological evaluations.

How, when, and for whom: decisions regarding remote neuropsychological assessment during the 2020 COVID-19 pandemic

Neuropsychological assessment provides crucial information about cognitive, behavioral, and socioemotional functioning in medical, educational, legal, and social contexts. During the 2020 COVID-19 pandemic, the Israeli Ministry of Health initially mandated that all psychological assessments be postponed. However, as referrals to time-sensitive, high-need, and high-stakes assessments began to accumulate, it became necessary to consider remote solutions. In the current paper, we describe the considerations that affected the transition to remote activity in a prominent Israeli provider of neuropsychological assessment and rehabilitation services, referring to technological and environmental conditions, cognitive requirements, and tasks, as well as to legal, regulatory, and funding issues. After discussing how assessments should be conducted to maximize feasibility and validity while minimizing risks to clients and clinicians, we propose a preliminary model for deciding whether specific referrals warrant remote administration. The model delineates key factors in decisions regarding remote assessment, emphasizing the distinct roles of the referring clinician and the neuropsychologist who conducts the assessment, and highlighting the need for collaboration between them. The abrupt need for remote assessments during the pandemic required a quick response with little preparation. The lessons learned from this process can be applied in the future, so that the need for remote services can be met with greater certainty and uniformity.

Teleneuropsychology practice survey during COVID-19 within the United States

OBJECTIVE

Identify factors influencing service delivery changes during COVID-19 and examine barriers and provider satisfaction with teleneuropsychology (teleNP).

METHOD

Licensed clinical neuropsychologists within the United States recruited via neuropsychology-specific listservs (July-August 2020) to complete an online survey.

RESULTS

A total of 261 individuals completed the survey. Most (76%) reported delivering in-person testing in some capacity at the time of our survey. Relatively more private practitioners identified concerns with privacy/confidentiality (45.2% vs. 17.9%; χ²(2) = 6.99, p < 0.05), legal issues (47.6% vs. 17.9%; χ²(2) = 8.06, p < 0.05), and an undesirable precedent for legal/forensic cases (59.5% vs. 15.4%; χ²(2) = 17.54, p < 0.001) compared to hospital or other medical (non-VA) practitioners. Multiple resources informed teleNP protocols, such as organization guidelines (87.6%), literature review (75.9%), webinars (72.4%), and consultation (68%). Several factors influenced test selection, including availability of normative data (70.1%), test familiarity (66.4%), administration time (63.5%), and evidence base (60.6%). Reported barriers to continuing teleNP after COVID-19 included need for improved teleNP norms (85.9%), domain coverage (84.7%), improved patient access to technology (74.1%) and further validation studies (84.1%).

CONCLUSION

TeleNP may not be feasible in all settings and/or referrals. Respondents employed multiple resources in aggregating teleNP protocols and considered several factors when selecting tests. Results highlight the complex and varied decision-making processes utilized by respondents to adapt to service delivery changes. Considering the many benefits of teleNP, future research addressing some of the potentially modifiable factors (e.g., technology access, attitudes regarding teleNP) and significant development needs for teleNP itself (i.e., improved teleNP norms, further validation studies, etc.) is warranted.