Telehealth‐based assessment of cognition in older adults during COVID‐19 and beyond

Abstract

BackgroundEvidence supporting the use of telehealth techniques in the assessment and diagnosis of dementia has been growing steadily. This began with the use of telephone‐based cognitive screening in the 1980s and televideoconference‐based assessments in the 2000s. The COVID19 pandemic brought telehealth suddenly to the forefront of healthcare, particularly for aging and at‐risk populations, as well as for clinical providers and researchers. While clinicians have been challenged to continue to provide patient care in a safe manner, researchers have been faced with the challenge of maintaining study protocols and continuing to advance the science of dementia. Fortunately, a growing body of research has demonstrated the feasibility, reliability, validity, and consumer acceptability of telehealth‐based assessment procedures, including teleneuropsychological (teleNP) techniques.MethodWe first reported results from a study of 202 adults age 50‐85 using a brief battery of common neuropsychological tests administered via teleNP vs in‐person in counterbalanced fashion which showed generally strong intraclass correlations (Cullum et al., 2014). Additional studies have since examined the validity and consumer acceptability of teleNP assessment in older adults, including recent reviews and findings from surveys and observations using teleNP during the COVID19 pandemic.ResultOur initial investigation revealed essentially equivalent results across teleNP vs traditional in‐person test conditions, with intraclass correlations around .80 and high levels of satisfaction with the procedures. Additional findings revealed validity by the discrimination of impaired and non‐impaired older adults with and without cognitive impairment similar to traditional in‐person assessment. Subsequent studies and reviews have added to this growing body of literature supporting the use of teleNP in older adults.ConclusionIn this presentation, the literature supporting the evidence for telehealth applications in the assessment and diagnosis of dementia will be reviewed, along with commonly used assessment instruments. A critical review of the strengths and limitations of remote clinical/cognitive evaluations as applied to aging individuals with and without cognitive impairment will be provided, along with practical recommendations for application of these procedures, including in‐home and computerized evaluations. Last, needs, opportunities, and future directions for remote cognitive assessment in clinical and research settings, including large‐scale surveillance and treatment studies, will be discussed.