Neuropsychological assessments for dementia research in the COVID-19 era: comparing remote and face-to-face testing

Abstract

Objectives

We explored whether adapting traditional neuropsychological tests for online administration against the backdrop of COVID-19 was feasible for people with diverse forms of dementia and healthy older controls. We compared face-to-face and remote settings to ascertain whether remote administration affected performance.

Design

We used a longitudinal design for healthy older controls who completed face-to-face neuropsychological assessments between three and four years before taking part remotely. For patients, we used a cross-sectional design, contrasting a prospective remote cohort with a retrospective face-to-face cohort matched in age, education, and disease duration.

Setting

Remote assessments were performed using video-conferencing and online testing platforms, with participants using a personal computer or tablet and situated in a quiet room in their own home. Face-to-face assessments were carried out in dedicated testing rooms in our research centre.

Participants

The remote cohort comprised ten healthy older controls (also seen face-to-face 3-4 years previously) and 25 patients (n=8 Alzheimer’s disease (AD); n=3 behavioural variant frontotemporal dementia (bvFTD); n=4 semantic dementia (SD); n=5 progressive nonfluent aphasia (PNFA); n=5 logopenic aphasia (LPA)). The face-to-face patient cohort comprised 64 patients (n=25 AD; n=12 bvFTD; n=9 SD; n=12 PNFA; n=6 LPA).

Primary and secondary outcome measures

The outcome measures comprised the strength of evidence under a Bayesian analytic framework for differences in performances between face-to-face and remote testing environments on a general neuropsychological (primary outcomes) and neurolingustic battery (secondary outcomes).

Results

There was evidence to suggest comparable performance across testing environments for all participant groups, for a range of neuropsychological tasks across both batteries.

Conclusions

Our findings suggest that remote delivery of neuropsychological tests for dementia research is feasible.

Strengths and limitations of this study

Methodological strengths of this study include

Diverse patient cohorts representing rare dementias with specific communication difficulties
Sampling of diverse and relevant neuropsychological domains
Use of Bayesian statistics to quantify the strength of evidence for the putative null hypothesis (no effect between remote and face-to-face testing)

Limitations include

Relatively small cohort sizes
Lack of direct head-to-head comparisons of test environment in the same patients

SciScore for 10.1101/2022.04.28.22274370: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Ethics	Field Sample Permit: An initial telephone screen was conducted for each participant to establish they had access to the necessary equipment (tablet or desktop/laptop computer), a broadband internet connection, a quiet testing space to support the remote research assessment, and no preclusive hearing or visual impairments. Consent: All participants gave informed consent for their involvement in the study. IRB: Ethical approval was granted by the University College London and National Hospital for Neurology and Neurosurgery Joint Research Ethics Committees in accordance with the Declaration of Helsinki.
Sex as a biological variable	not detected.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Cell Line Authentication	Authentication: These sentences have previously been validated in hearing-impaired children.

Table 2: Resources

Software and Algorithms
Sentences	Resources
Statistical analysis: All statistical analyses were performed in JASP (version 0.16).	JASP suggested: (JASP, RRID:SCR_015823)

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

The current study presents several limitations which should inform future work. First, while most statistical comparisons indicated similar performance between testing environments for healthy and dementia participants, they were not all supported by strong evidence and certain comparisons even led to the opposite conclusion. Second, the present study was not ideally designed to compare the two testing environments, as the patient cohorts were different and the healthy control participants were not tested simultaneously in both environments within the same year. These findings would therefore need to be replicated in larger cohorts with the same patients in each test situation, to rule out the possibility of small differences observed in favour of face-to-face testing – and in particular, to assess the extent of individual variability in any differential effect of test environment.. Patients of equivalent disease severity would also need to be tested to compare the differential impact of diagnosis on remote performance over the course of the illness. Third, here we did not control for potential deficits in peripheral hearing as these are difficult to measure remotely without adequate equipment. Fourth, we manually adapted face-to-face tasks for remote administration, but there are now several established fully integrated online neuropsychological test batteries that have shown success in assessing patients with neurodegenerative disease remotely 56: future research could expl...

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
No protocol registration statement was detected.

Results from scite Reference Check: We found no unreliable references.

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