Remote assessment of cognition in Parkinson’s disease and Cerebellar Ataxia: the MoCA test in English and Hebrew

Abstract

There is a critical need for accessible neuropsychological testing for basic research and translational studies worldwide. Traditional in-person neuropsychological studies are inherently difficult to conduct because testing requires the recruitment and participation of individuals with neurological conditions. Consequently, studies are often based on small sample sizes, are highly time-consuming, and lack diversity. To address these challenges, in the last decade, the utilization of remote testing platforms has demonstrated promising results regarding the feasibility and efficiency of collecting patient data online. Herein, we tested the validity and generalizability of remote administration of the Montreal Cognitive Assessment (MoCA) test. We administered the MoCA to English and Hebrew speakers from three different populations: Parkinson’s disease, Cerebellar Ataxia, and healthy controls via video conferencing. First, we found that the online MoCA scores do not differ from traditional in-person studies, demonstrating convergent validity. Second, the MoCA scores of both our online patient groups were lower than controls, demonstrating construct validity. Third, we did not find differences between the two language versions of the remote MoCA, supporting its generalizability to different languages and the efficiency of collecting binational data (USA and Israel). Given these results, future studies can utilize the remote MoCA, and potentially other remote neuropsychological tests to collect data more efficiently across multiple different patient populations, language versions, and nations.

Online cognitive testing in Parkinson’s disease: advantages and challenges

“…Online methods allow efficient recruitment necessary for large-scale studies ( 45 , 46 ). Methods for improving scalability in recruitment include using social media platforms (e.g., Facebook) and support groups ( 27 ), which may be leveraged for extensive exposure and distribution ( 31 ). Online advertisements, such as sponsored ads, can also attract a diverse pool of participants.…”

“…Online testing facilitates the collection of data across different languages and cultures, providing an opportunity to efficiently expand research participation across geographic and language barriers. International studies using in-person testing methods require extensive collaboration and bureaucracy in order to collect PD patient data from multiple testing sites, while online testing can be conducted from the comfort of the participant’s and researcher’s home ( 31 ). In addition, by including more than one language, especially non-English speakers, researchers can better capture the cognitive abilities of speakers of different languages and more accurately characterize cognitive dysfunction on a global scale ( 56 ).…”

“…Since PD has a multifactorial effect on nonmotor domains, ranging from emotional well-being to cognition ( 75–79 ), online studies can measure multiple domains, allowing for better characterization of PD and the disease progression over time. Online cognitive testing also facilitates between-group comparison ( 28 , 31 ), which can improve sensitivity and specificity of assessment tools. However, although online protocols may be adapted for several domains of study, it may not be suitable for all domains.…”

“…Therefore, developing a standardized protocol that adapts traditional cognitive (and motor) in-person assessments to online settings is crucial. For instance, multiple online VC protocols have been developed to assess cognitive symptoms in PD using the MoCA ( 14 , 29 , 31 ).…”

“…A study on telerehabilitation of PD compared F2F and online assessment of the dysarthric speech disorder associated with PD, determining that the online method is valid and reliable ( 30 ). Another study tested the validity and generalizability of remote administration of the MoCA test ( 31 ). The MoCA-VC was administered to English and Hebrew speakers from three different populations: PD, Cerebellar Ataxia, and healthy controls via VC.…”