Remote versus face-to-face neuropsychological testing for dementia research: a comparative study in people with Alzheimer’s disease, frontotemporal dementia and healthy older individuals

Abstract

ObjectivesWe explored whether adapting neuropsychological tests for online administration during the COVID-19 pandemic was feasible for dementia research.DesignWe used a longitudinal design for healthy controls, who completed face-to-face assessments 3–4 years before remote assessments. For patients, we used a cross-sectional design, contrasting a prospective remote cohort with a retrospective face-to-face cohort matched for age/education/severity.SettingRemote assessments were conducted using video-conferencing/online testing platforms, with participants using a personal computer/tablet at home. Face-to-face assessments were conducted in testing rooms at our research centre.ParticipantsThe remote cohort comprised 25 patients (n=8 Alzheimer’s disease (AD); n=3 behavioural variant frontotemporal dementia (bvFTD); n=4 semantic dementia (SD); n=5 progressive non-fluent 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). Ten controls who previously participated in face-to-face research also took part remotely.Outcome measuresThe outcome measures comprised the strength of evidence under a Bayesian framework for differences in performances between testing environments on general neuropsychological and neurolinguistic measures.ResultsThere was substantial evidence suggesting no difference across environments in both the healthy control and combined patient cohorts (including measures of working memory, single-word comprehension, arithmetic and naming; Bayes Factors (BF)01>3), in the healthy control group alone (including measures of letter/category fluency, semantic knowledge and bisyllabic word repetition; all BF01>3), and in the combined patient cohort alone (including measures of working memory, episodic memory, short-term verbal memory, visual perception, non-word reading, sentence comprehension and bisyllabic/trisyllabic word repetition; all BF01>3). In the control cohort alone, there was substantial evidence in support of a difference across environments for tests of visual perception (BF01=0.0404) and monosyllabic word repetition (BF01=0.0487).ConclusionsOur findings suggest that remote delivery of neuropsychological tests for dementia research is feasible.

Symptom-led staging for primary progressive aphasia

“…By contrast, in nfvPPA the sequence of multidimensional symptoms suggests relatively early involvement of motor control and basal ganglia networks, consistent with neuroanatomical studies of this syndrome 18,50 ; while in lvPPA, the symptom sequence tracks disease evolution through parietal cortices 66,67 and highlights the substantial phenotypic overlap between lvPPA and PCA 2,22,36,58 . The varying 'confidence' in symptom staging between PPA syndromes is also informative (Figures 2 to 4; Tables S1 to S3): across stages, consensus was higher for svPPA than other variants, endorsing the view from previous neuropsychological, neuroanatomical and neuropathological studies that this is a highly coherent syndrome, whereas nfvPPA and lvPPA are intrinsically heterogeneous and likely to encompass various sub-syndromes 3,8,58,[68][69][70] While our symptom-led survey methodology builds on recent initiatives toward online collection of large clinical and neuropsychological datasets 71,72 , its advantages are offset by several limitations. Most obviously, caregiver reports (and indeed the individual diagnoses provided) were retrospective and generally not objectively verifiable.…”

“…While our symptom-led survey methodology builds on recent initiatives toward online collection of large clinical and neuropsychological datasets 71, 72 , its advantages are offset by several limitations. Most obviously, caregiver reports (and indeed the individual diagnoses provided) were retrospective and generally not objectively verifiable.…”

Web-based cognitive assessment in older adults: Where do we stand?

“…Finally, a limited number of studies have examined the user-experience, which report good acceptability of remote testing through videoconferencing, even among a diverse population and patients with dementia [13 ▪ ,14,15]. However, challenges have been reported, specifically for certain linguistic tasks (e.g.…”

“…monosyllabic repetition) or visual items (e.g. Visual Object and Space Perception Battery (VOSP) object decision task) [14].…”

Comprehension of acoustically degraded speech in Alzheimer’s disease and primary progressive aphasia

“…We have described the design and implementation of our remote neuropsychological assessment protocol elsewhere. 44 All participants gave informed consent to take part in the study. Ethical approval was granted by the UCL-NHNN Joint Research Ethics Committees, in accordance with Declaration of Helsinki guidelines.…”