Remote Cognitive Assessment Research Articles

USEFULNESS OF REVISED SIMPLIFIED SHORT-TERM COGNITIVE SCREENING TEST (STMT-R) IN ACUTELY ILL GERIATRIC PATIENTS

Abstract Background Dementia can be a major cause of mortality and morbidity in geriatric patients. So, it would be essential to assess their mental state.Aims: We aim to appraise the impact of cognitive dysfunction on the long-term prognosis on STMT-R as a quicker and sensitive cognitive identification in acutely ill geriatric patients. Methods The inclusion criteria were to measure geriatric patients by STMT-R at admission, age≧50yo and being non-critical ill. Between October 2014 and September 2015, 836 were enrolled (52.4% female, mean age: 78.9 years). STMT-R≦4 was considered as cognitive dysfunction. Following the collection of clinical data, survival was subsequently measured for 7-8 years until January 2022. Cox’s proportional hazards regression models were used to evaluate the hazard of death according to the dementia severity, with adjustment for potential covariates. Survival was estimated using Kaplan-Meier method. Results Among enrolled subjects, 144 were unable to complete the test due to severe dementia (ITG). 433 had cognitive dysfunction (STMT-R≦4; CDG) and 259 didn’t have cognitive dysfunction (STMT-R>4; NCDG). The survival curves for death among three groups were significantly decreased in the CDG and ITG compared with the NCDG. The risks for mortality in the ITG and CDG are 3.92 (hazard ratio; 95% confidence interval:2.74-5.61, p< 0.001) and 1.82(1.33-2.51, p< 0.001) compared with the NCDG as reference. Conclusion 1) It was suggested that severity of cognitive dysfunction at admission has independently an impact on survival rate in acutely ill geriatric patients.2) STMT-R may also be useful for the future bedside or remote cognitive assessment.

Convergent and criterion validity of a computer adaptive self‐administered word list memory test and the Mayo Test Drive composite: correlations with traditional measures and group difference by PET imaging biomarker status in persons without dementia.

AbstractBackgroundMayo Test Drive (MTD): Test Development through Rapid Iteration, Validation and Expansion, is a web‐based platform optimized for remote self‐administered assessment that includes a computer adaptive word list memory test (Stricker Learning Span; SLS) and a measure of processing speed (Symbols Test). Study aims were to determine 1) convergent validity of MTD through correlations with in‐person neuropsychological measures and 2) criterion validity of MTD by qualitatively comparing the ability of Mayo Test Drive and in‐person administered neuropsychological measures to differentiate biomarker‐defined groups, independent of clinical diagnosis.MethodsMayo Clinic Study of Aging participants (N = 282) completed a brief remote cognitive assessment (mean age = 74, SD = 12; 262 CU and 20 MCI per consensus conference diagnosis; see Table 1). A subset of participants had brain amyloid and/or brain tau PET scans available within 3 years; overlapping groups were formed for 1) those on the Alzheimer’s disease (AD) continuum (A+, n = 31) or not (A‐, n = 57) and for 2) those with biological AD (A+T+, n = 19) or without any AD biomarkers (A‐T‐, n = 47). Primary outcome variables were SLS sum of trials, AVLT sum of trials, SYM Correct Trials response time, Digit Symbol Coding, MTD composite and Mayo‐PACC (AVLT sum of trials, Trails B, animals). Bivariate correlations were performed across all participants. Linear model ANOVAs were used to investigate biomarker subgroup differences; Hedge’s g effect sizes are reported.ResultsConvergent validity was supported through significant correlation (p’s < .001) of SLS and AVLT (r = .63), SYM and Coding (r = ‐.64), and MTD composite with Mayo‐PACC (r = .67); see Table 2. MTD subtests showed expected relationships with age and education (p’s < .05; Table 3). All MTD performances were significantly lower for A+ and A+T+ participants relative to A‐ or A‐T‐ (p’s<.001; Table 4). All MTD outcome measures showed a similar or greater group difference effect size relative to traditional in‐person administered neuropsychological measures for separating A+ vs. A‐ and A+T+ vs. A‐T‐ groups. See Figure 1 and Table 4.ConclusionsMTD subtests show evidence of convergent validity through strong correlations with traditional in‐person cognitive measures. Preliminary analyses suggest MTD has promise for differentiating PET biomarker groups.

An examination of the usability of the Mayo Test Drive remote cognitive testing platform in older adults with and without cognitive impairment

AbstractBackgroundMayo Test Drive (MTD): Test Development through Rapid Iteration, Validation and Expansion, is a web‐based platform for self‐administered assessment for novel (Stricker Learning Span) and open access (Symbols Test) cognitive measures with previously demonstrated validity and reliability. Our study aim was to examine the usability of MTD, defined as the extent to which MTD was used to achieve the desired study goal of completing a testing session among participants willing to engage in an all‐remote study.Methods248 Mayo Clinic Study of Aging and Mayo Alzheimer’s Disease Research Center participants were invited to participate in this ancillary, uncompensated remote pilot study via email. To examine 1) willingness to participate in a remote cognitive assessment study and 2) usability of MTD, the initiation and completion rates of MTD were examined by cognitively unimpaired (CU; n = 142) and cognitively impaired (CI; n = 106) groups (see Figure 1). These rates and other factors associated with MTD feasibility were further explored across age in CU (i.e., 50–69, 70–79, and 80+ years) and specific diagnostic groups in CI (i.e., individuals with dementia, mild cognitive impairment (MCI), and possible MCI).ResultsSession completion rate (usability) was 98% across all participants who chose to participate, and, surprisingly, completion rates did not vary by age or diagnostic groups (p = .69; see Table 1). As expected, more individuals chose to participate in the CU (77%) versus CI (52%) group (p < .001). In terms of feasibility, individuals over 80 and with CI were more likely to have some contact with the study coordinator. Use of smartphones decreased with age, with most CU individuals over 70 using a personal computer (69‐73%; Table 2).ConclusionsThough the CI group was less likely to choose to participate than the CU group, out of those that did choose to participate the rate of completion was 98%. This demonstrates high usability of MTD. Study coordinator support and a flexible testing platform is critical for facilitating participation in remote testing across the aging population, and more supports and incentives may be needed for individuals with cognitive impairment to improve participation rates.

An examination of the usability of the Mayo Test Drive remote cognitive testing platform in older adults with and without cognitive impairment.

Mayo Test Drive (MTD): Test Development through Rapid Iteration, Validation and Expansion, is a web-based platform for self-administered assessment for novel (Stricker Learning Span) and open access (Symbols Test) cognitive measures with previously demonstrated validity and reliability. Our study aim was to examine the usability of MTD, defined as the extent to which MTD was used to achieve the desired study goal of completing a testing session among participants willing to engage in an all-remote study. 248 Mayo Clinic Study of Aging and Mayo Alzheimer's Disease Research Center participants were invited to participate in this ancillary, uncompensated remote pilot study via email. To examine 1) willingness to participate in a remote cognitive assessment study and 2) usability of MTD, the initiation and completion rates of MTD were examined by cognitively unimpaired (CU; n = 142) and cognitively impaired (CI; n = 106) groups (see Figure 1). These rates and other factors associated with MTD feasibility were further explored across age in CU (i.e., 50-69, 70-79, and 80+ years) and specific diagnostic groups in CI (i.e., individuals with dementia, mild cognitive impairment (MCI), and possible MCI). Session completion rate (usability) was 98% across all participants who chose to participate, and, surprisingly, completion rates did not vary by age or diagnostic groups (p =.69; see Table 1). As expected, more individuals chose to participate in the CU (77%) versus CI (52%) group (p < .001). In terms of feasibility, individuals over 80 and with CI were more likely to have some contact with the study coordinator. Use of smartphones decreased with age, with most CU individuals over 70 using a personal computer (69-73%; Table 2). Though the CI group was less likely to choose to participate than the CU group, out of those that did choose to participate the rate of completion was 98%. This demonstrates high usability of MTD. Study coordinator support and a flexible testing platform is critical for facilitating participation in remote testing across the aging population, and more supports and incentives may be needed for individuals with cognitive impairment to improve participation rates.

Diagnostic accuracy of the Stricker Learning Span and Mayo Test Drive Composite for amnestic Mild Cognitive Impairment.

AbstractBackgroundRemote assessment tools offer significant promise for aiding early detection of cognitive impairment. Mayo Test Drive (MTD): Test Development through Rapid Iteration, Validation and Expansion, is a web‐based platform for remote self‐administered assessment that includes a computer adaptive word list memory test (Stricker Learning Span; SLS) and a measure of processing speed (Symbols Test). We examined the diagnostic accuracy of the SLS and a MTD composite (SLS max span, SLS trials 1–5 total correct, SLS delay correct, [Symbols correct item response time*‐1]) for amnestic mild cognitive impairment (aMCI). We also explored diagnostic accuracy for a broader group that included individuals with possible MCI (pMCI; see Figure 1).MethodsParticipants were recruited from the Mayo Clinic Study of Aging for this ancillary remote study. 226 were cognitively unimpaired (CU; concordant CU diagnosis by 3 independent raters). Fifty‐six participants had possible MCI (at least 1 of 3 raters indicated MCI) and 16 had a consensus diagnosis of aMCI. Primary outcome variables were SLS sum of trials, AVLT sum of trials, Symbols correct items response time, and MTD composite. Mean difference analyses used linear model ANOVAs (alpha = .05). Receiver operating characteristic (ROC) curves were applied; we derived optimal cutoff scores based on the Youden index method.ResultsBoth aMCI and possible MCI groups showed significantly lower performance than the CU group on SLS (Hedge’s g aMCI = ‐1.72, pMCI = ‐1.04), Symbols (Hedge’s g aMCI = 1.38, pMCI = 0.64), and MTD composite (Hedge’s g aMCI = ‐1.89, pMCI = ‐1.09); see Tables 1 and 2 (all p‘s&lt;.01 even when additionally covarying age, education, sex). Total area under the curve was high for differentiating of CU vs. aMCI (MTD Composite = 0.91, SLS = 0.91) and acceptable for CU vs. pMCI (MTD Composite = 0.77, SLS = 0.77); see Table 2. Consistent with our flexible platform, a variety of device types were used to complete remote testing (32% smartphone, 12% tablet, 56% PC).ConclusionsMTD and the SLS show high diagnostic accuracy for aMCI. MTD is a flexible, brief, and easy‐to‐use remote cognitive assessment tool with great potential for scalable use in future studies seeking to maximize inclusion of individuals with aMCI in clinical trials or for cognitive screening in clinical settings.

Remote self-administration of digital cognitive tests using the Brief Assessment of Cognition: Feasibility, reliability, and sensitivity to subjective cognitive decline.

Cognitive impairment is a common and pervasive feature of etiologically diverse disorders of the central nervous system, and a target indication for a growing number of symptomatic and disease modifying drugs. Remotely acquired digital endpoints have been recognized for their potential in providing frequent, real-time monitoring of cognition, but their ultimate value will be determined by the reliability and sensitivity of measurement in the populations of interest. To this end, we describe initial validation of remote self-administration of cognitive tests within a regulatorily compliant tablet-based platform. Participants were 61 older adults (age 55+), including 20 individuals with subjective cognitive decline (SCD). To allow comparison between remote (in-home) and site-based testing, participants completed 2 testing sessions 1 week apart. Results for three of four cognitive domains assessed demonstrated equivalence between remote and site-based tests, with high cross-modality ICCs (absolute agreement) for Symbol Coding (ICC = 0.75), Visuospatial Working Memory (ICC = 0.70) and Verbal Fluency (ICC > 0.73). Group differences in these domains were significant and reflected sensitivity to objective cognitive impairment in the SCD group for both remote and site-based testing (p < 0.05). In contrast, performance on tests of verbal episodic memory suggested inflated performance during unmonitored testing and indicate reliable use of remote cognitive assessments may depend on the construct, as well as the population being tested.

A-303 Preliminary Analysis of the Influence of Age and Education on the Boston Cognitive Assessment (BoCA)

Abstract Objective: Remote cognitive assessment is increasingly common for efficient screening of patients' cognitive status. The Boston Cognitive Assessment (BoCA), is a brief, digital, global screening instrument that can be administered in-person or remotely. To evaluate the psychometric properties of the BoCA, the present study explored the effect of age and education on performance. Method: A sample of 61 cognitively healthy adults (19-82 years old) with 12-20 years of education completed the BoCA in-person. BoCA performance is rated along eight subscales (Immediate Recall, Delayed Recall, Visuospatial, Executive Functioning, Mental Rotation, Attention, Language, Mental Math, and Orientation) with a total score of 30. A regression analysis assessed if age or education predicted BoCA scores. BoCA performance was evaluated based on age with and without adjusting for educational attainment. Results: The regression analysis yielded a significant model with age being a significant predictor of total BoCA scores. Education did not contribute significantly. An ANOVA based on age revealed a significant effect on the Total BoCA score and specific subscales (Immediate and Delayed Memory). When adjusting for educational attainment, an ANCOVA identified significant differences within the total BoCA score and subscales of Delayed Memory and Language. Conclusions: After correcting for level of education, results from the present study suggest that participants' age does affect the total BoCA score of cognitively healthy users. This has implications for future BoCA users, as age-adjusted scores may be necessary to prevent false positive identification of cognitive impairment using the BoCA. Potential explanations for discrepancies among age groups are discussed.

Diagnostic test accuracy of remote, multidomain cognitive assessment (telephone and video call) for dementia.

Remote cognitive assessments are increasingly needed to assist in the detection of cognitive disorders, but the diagnostic accuracy of telephone- and video-based cognitive screening remains unclear. To assess the test accuracy of any multidomain cognitive test delivered remotely for the diagnosis of any form of dementia. To assess for potential differences in cognitive test scoring when using a remote platform, and where a remote screener was compared to the equivalent face-to-face test. We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, LILACS, and ClinicalTrials.gov (www. gov/) databases on 2 June 2021. We performed forward and backward searching of included citations. We included cross-sectional studies, where a remote, multidomain assessment was administered alongside a clinical diagnosis of dementia or equivalent face-to-face test. Two review authors independently assessed risk of bias and extracted data; a third review author moderated disagreements. Our primary analysis was the accuracy of remote assessments against a clinical diagnosis of dementia. Where data were available, we reported test accuracy as sensitivity and specificity. We did not perform quantitative meta-analysis as there were too few studies at individual test level. For those studies comparing remote versus in-person use of an equivalent screening test, if data allowed, we described correlations, reliability, differences in scores and the proportion classified as having cognitive impairment for each test. The review contains 31 studies (19 differing tests, 3075 participants), of which seven studies (six telephone, one video call, 756 participants) were relevant to our primary objective of describing test accuracy against a clinical diagnosis of dementia. All studies were at unclear or high risk of bias in at least one domain, but were low risk in applicability to the review question. Overall, sensitivity of remote tools varied with values between 26% and 100%, and specificity between 65% and 100%, with no clearly superior test. Across the 24 papers comparing equivalent remote and in-person tests (14 telephone, 10 video call), agreement between tests was good, but rarely perfect (correlation coefficient range: 0.48 to 0.98). Despite the common and increasing use of remote cognitive assessment, supporting evidence on test accuracy is limited. Available data do not allow us to suggest a preferred test. Remote testing is complex, and this is reflected in the heterogeneity seen in tests used, their application, and their analysis. More research is needed to describe accuracy of contemporary approaches to remote cognitive assessment. While data comparing remote and in-person use of a test were reassuring, thresholds and scoring rules derived from in-person testing may not be applicable when the equivalent test is adapted for remote use.

Asynchronous Remote Assessment for Cognitive Impairment: Reliability Verification of the Neurotrack Cognitive Battery.

BackgroundAs evidenced by the further reduction in access to testing during the COVID-19 pandemic, there is an urgent, growing need for remote cognitive assessment for individuals with cognitive impairment. The Neurotrack Cognitive Battery (NCB), our response to this need, was evaluated for its temporal reliability and stability as part of ongoing validation testing.ObjectiveThe aim of this study is to assess the temporal reliability of the NCB tests (5 total) across a 1-week period and to determine the temporal stability of these measures across 3 consecutive administrations in a single day.MethodsFor test-retest reliability, a range of 29-66 cognitively healthy participants (ages 18-68 years) completed each cognitive assessment twice, 1 week apart. In a separate study, temporal stability was assessed using data collected from 31 different cognitively healthy participants at 3 consecutive timepoints in a single day.ResultsCorrelations for the assessments were between 0.72 and 0.83, exceeding the standard acceptable threshold of 0.70 for temporal reliability. Intraclass correlations ranged from 0.60 to 0.84, indicating moderate to good temporal stability.ConclusionsThese results highlight the NCB as a brief, easy-to-administer, and reliable assessment for remote cognitive testing. Additional validation research is underway to determine the full magnitude of the clinical utility of the NCB.

User Perceptions &amp; Subjective Memory Concerns are Associated With Brief, Remote Cognitive Assessment Performance

Online cognitive tests offer a cost-effective, accessible means of cognitive screening and may prove especially important for individuals with memory complaints, a risk factor for cognitive impairment (Kaup et al., 2015). Although older adults’ perceptions of everyday technologies impact their uptake and adoption, there is limited understanding about how perceptions of online cognitive screening tests impact test performance. The purpose of the current study was to examine relationships between performance on a brief, self-administered, web-based cognitive assessment tool (SMART) and user perceptions (e.g., ratings of challenge and length), technology confidence, brain health activities, and memory complaints. Participants were 1336 adults without a diagnosis of cognitive impairment (Mage=60.48 years, SD=15.18; 65.8% female; 81.8% White; 21.2% with subjective memory complaints). Most participants (97%) were willing to complete the SMART again, with over half (53.5%) willing to complete the SMART on at least a weekly basis. After adjusting for age and education, better SMART performance (i.e., faster completion time) was associated with user ratings of greater ease of completion, higher technology confidence, and greater participation in brain health activities (p<.05). In a subsample aged 60+, individuals with memory complaints took longer to complete certain SMART tasks (Trail Making Test B, Total SMART) than those without memory complaints (p<.05). Results suggest that the SMART is a well-accepted tool for frequent remote cognitive screening and highlight the importance of user perceptions, technology confidence, and memory complaints on online cognitive test performance.

Remote cognitive assessment of older adults in rural areas by telemedicine and automatic speech and video analysis

AbstractBackgroundEarly detection of cognitive impairments is crucial for successful implementation of preventive strategies. However, in rural isolated areas or so‐called ‘medical deserts’, access to diagnosis and care is very limited. With the current pandemic crisis, now even more than ever, remote solutions such as telemedicine platforms represent great potential and can help to overcome this barrier. Moreover, current advances made in voice and image analysis can help overcoming the barrier of the physical distance by providing additional information of a patients’ emotional and cognitive state. Therefore, the aim of this study is to evaluate the feasibility and reliability of a videoconference system for remote cognitive testing empowered by automatic speech and video analysis.Method60 participants (aged 55 and older) with and without cognitive impairment are recruited. A complete neuropsychological assessment including a short clinical interview are administered in two conditions, once by telemedicine and once by face‐to‐face. The administration procedure is randomized. Acceptability and user experience are assessed among participants and clinicians in qualitative and quantitative manner. Speech and video features will be extracted and analyzed to obtain additional information on mood and engagement levels.ResultSimilar results were obtained on the several cognitive test measures when comparing the remote to the face‐to‐face administration method. Word recall (r=0,928) and picture naming task (r=0,939) showed the strongest correlation. Acceptability of the tool was relatively high with preference even in the remote method for more convenience.ConclusionResults support the feasibility and reliability of remote cognitive testing through administration via a telemedicine tool. These systems can be used for remote disease monitoring, enabling patients to be assessed in their own homes and improve utilization of expert assessors allowing them to conduct neurocognitive testing remotely.

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

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.

Survey Findings About the Experiences, Challenges, and Practical Advice/Solutions Regarding Teleneuropsychological Assessment in Adults.

ObjectiveIn the wake of the coronavirus pandemic, teleneuropsychology utilization has increased. There is a need to characterize the first-hand experiences of individuals using teleneuropsychology, identify the common teleneuropsychology challenges, and devise practical strategies for mitigating/resolving these challenges.MethodSurvey data were collected from U.S. based neuropsychologists and other individuals (e.g., graduate students and research assistants) who were engaged in remote cognitive assessment with adults (n = 87). Frequency analyses were conducted to examine: how respondents used teleneuropsychology (e.g., duration of use, types of measures and devices/technology platforms used); challenges that were encountered with different technology platforms and teleneuropsychology use; and advice for navigating these challenges.ResultsMost respondents began using teleneuropsychology relatively recently in the context of the coronavirus pandemic, with home-to-home or clinic-to-home settings being the most frequently reported teleneuropsychology settings. Zoom®, Doxy.Me®, and MyChart® were the most frequently used platforms, largely due to workplace mandates and/or Health Insurance Portability and Accountability Act-compliant features. Common challenges with teleneuropsychology included internet connection issues and environmental distractions in examinees’ homes, and examinees having limited-to-no access to technologies requisite for teleneuropsychology. Providing clear instructions to the examinee prior to the teleneuropsychology visit was the most common advice for ensuring a successful teleneuropsychology evaluation. Similar response patterns were generally noted for those who used TeleNP for clinical or research purposes.ConclusionsThese survey results reflect common experiences and challenges with teleneuropsychology and identify priority targets for increasing its feasibility, reliability, and validity. Findings provide context for the development of formal teleneuropsychology competencies.

A-189 Survey Findings of Challenges with Teleneuropsychological Assessment and Advice in Mitigating these Challenges

Abstract Objective Teleneuropsychology (TeleNP) has experienced tremendous uptake during the coronavirus pandemic, and there is a need to document the challenges and practical advice for conducting remote cognitive assessments. Method 87 respondents (licensed neuropsychologists = 56; others [e.g., trainees] = 31) conducting TeleNP evaluations with adult populations in the United States completed an online survey which was distributed via social media and list-servs in winter 2020–2021. Respondents were asked about their TeleNP experiences, including issues encountered and solutions to TeleNP challenges. Frequency analyses were conducted to examine the proportion of respondents endorsing specific TeleNP challenges. TeleNP advice was thematically coded to identify the most common suggestions to overcome/navigate these challenges. Results The most frequently reported TeleNP challenges included: poor internet connectivity (examinee’s home: 82.8%; an unknown source 58.6%); environmental distractions in the examinee’s location (78.2%); poor audio quality (55.2%); examinee’s unfamiliarity with the videoconferencing technology (52.9%); inability to easily conduct visuoconstructional tasks (52.9%) or adapt tests/find TeleNP norms (47.1%); and examinees’ limited access to technology (57.5%) or complete lack of access (35.6%). The most common responses to mitigate these challenges included: providing detailed instructions about the TeleNP visit and examinee expectations in advance; having a clear back-up or assistive plan (e.g., telephone call); and using TeleNP sparingly (e.g., for interview only). Conclusion These survey results reflect widely-encountered challenges with remote cognitive assessment and identify priority targets for increasing the feasibility and reliability of TeleNP. Findings can be incorporated into discussion about formalized TeleNP competencies.

The COVID-19 pandemic altered the modality, but not the frequency, of formal cognitive assessment

Purpose We investigated the impacts of the COVID-19 pandemic on the modality of formal cognitive assessments (in-person versus remote assessments). Materials and methods We created a web-based survey with 34 items and collected data from 114 respondents from a range of health care professions and settings. We established the proportion of cognitive assessments which were face-to-face or via video or telephone conferencing, both pre- and post-March 2020. Further, we asked respondents about the assessment tools used and perceived barriers, challenges, and facilitators for the remote assessment of cognition. In addition, we asked questions specifically about the use of the Oxford Cognitive Screen. Results We found that the frequency of assessing cognition was stable compared to pre-pandemic levels. Use of telephone and video conferencing cognitive assessments increased by 10% and 18% respectively. Remote assessment increased accessibility to participants and safety but made observing the subtleties of behaviour during test administration difficult. The respondents called for an increase in the availability of standardised, validated, and normed assessments. Conclusions We conclude that the pandemic has not been detrimental to the frequency of cognitive assessments. In addition, a shift in clinical practice to include remote cognitive assessments is clear and wider availability of validated and standardised remote assessments is necessary. IMPLICATIONS FOR REHABILITATION We caution the wider use and interpretation of remote formal cognitive assessments due to lack of validated, standardised, and normed assessments in a remote format. Clinicians should seek out the latest validation and normative data papers to ensure they are using the most up to date tests and respective cut offs. Support is needed for individuals who lack knowledge/have anxiety over the use of technology in formal cognitive assessments

Remote Cognitive Assessment in Psychiatry: A Scoping Review

Psychiatric disorders (e.g., schizophrenia) present cognitive deficits and biases that greatly impact functional outcome. Due to the COVID-19 pandemic, traditional in-person assessments and interventions must be adapted for remote delivery, but many clinicians and researchers are rapidly embarking on this path with little guidance. We synthesized the literature on remote cognitive assessment in psychiatry to facilitate development of these guidelines.

A survey of smartphone and interactive video technology use by participants in Alzheimer's disease research: Implications for remote cognitive assessment.

IntroductionParticipants from a longitudinal cohort study were surveyed to evaluate the practical feasibility of remote cognitive assessment.MethodsAll active participants/informants at the University of California San Diego Alzheimer's Disease Research Center were invited to complete a nine‐question survey assessing technology access/use and willingness to do cognitive testing remotely.ResultsThree hundred sixty‐nine of 450 potential participants/informants (82%) completed the survey. Overall, internet access (88%), device ownership (77%), and willingness to do cognitive testing remotely (72%) were high. Device access was higher among those with normal cognition (85%) or cognitive impairment (85%) than those with dementia (52%), as was willingness to do remote cognitive testing (84%, 74%, 39%, respectively). Latinos were less likely than non‐Latinos to have internet or device access but were comparable in willingness to do remote testing.DiscussionRemote cognitive assessment using interactive video technology is a practicable option for nondemented participants in longitudinal studies; however, additional resources will be required to ensure representative participation of Latinos.

Remote cognitive assessment approaches in the Dominantly Inherited Alzheimer Network (DIAN)

AbstractBackgroundThe “one‐shot” paradigm used in traditional in‐clinic cognitive assessments often produces unreliable data due to daily fluctuations in stress, sleep, test anxiety, and fatigue. In DIAN, an international study of familial Alzheimer’s disease (AD), these difficulties are compounded by the scarcity and younger age of the population. We have developed two assessment strategies to address these issues, which we are also validating in the Knight ADRC cohort. The first is a smartphone‐based cognitive assessment platform based on principles from ecological momentary assessment that uses frequent but extremely short (&lt;60 seconds) tests of episodic memory, attentional control, and processing speed administered at random times over 7 days. We examine average performance and variability metrics across 7 days of assessments. The second is a web‐based assessment that focuses on repeated daily administration to measure long‐term memory decay and also skill acquisition learning. The rates of forgetting and rates of learning become the outcome measures.MethodDigital assessments were completed on cognitively normal DIAN participants (n = 56 mutation carriers, n = 60 non‐carriers) and 120 mostly cognitively normal older adults from the Knight ADRC. Follow‐up evaluations were available for approximately 40 DIAN participants. Digital assessments were compared with standard in‐clinic cognitive tests and also with AD biomarkers including amyloid PET, cerebrospinal fluid (CSF) tau, tau PET, and structural MRI.ResultReliabilities of all remote cognitive measures ranged from 0.90‐0.98. All measures (Smartphone and web‐based) correlated with age (r’s 0.22‐0.69), indicating worse performance with increasing age. Correlations with standard in‐clinic measures ranged from 0.24‐0.77, suggesting that remote tests are valid measures of cognition. Test‐retest reliability from repeated smartphone assessments was exceptional for two smartphone measures (ICC’s = 0.89‐0.94). Critically, smartphone measures and web‐based measures demonstrated sensitivity to all AD biomarkers, including amyloid PET, tau PET, CSF tau, and structural MRI. We will present data on relationships with AD biomarkers and data on technical validation of smartphone cognitive measures and adherence strategies for remote studies.ConclusionRemote assessments that rely on short‐term but high frequency testing can be deployed worldwide in adults of all ages and demonstrate excellent reliability and validity compared to standard in‐clinic cognitive assessments.

Examining Older Adult Cognitive Status in the Time of COVID‐19

Examining Older Adult Cognitive Status in the Time of <scp>COVID</scp>‐19

Evaluating the Feasibility of Frequent Cognitive Assessment Using the Mezurio Smartphone App: Observational and Interview Study in Adults With Elevated Dementia Risk

BackgroundBy enabling frequent, sensitive, and economic remote assessment, smartphones will facilitate the detection of early cognitive decline at scale. Previous studies have sustained participant engagement with remote cognitive assessment over a week; extending this to a period of 1 month clearly provides a greater opportunity for measurement. However, as study durations are increased, the need to understand how participant burden and scientific value might be optimally balanced also increases.ObjectiveThis study explored the little but often approach to assessment employed by the Mezurio app when prompting participants to interact every day for over a month. Specifically, this study aimed to understand whether this extended duration of remote study is feasible, and which factors promote sustained participant engagement over such periods.MethodsA total of 35 adults (aged 40-59 years) with no diagnosis of cognitive impairment were prompted to interact with the Mezurio smartphone app platform for up to 36 days, completing short, daily episodic memory tasks in addition to optional executive function and language tests. A subset (n=20) of participants completed semistructured interviews focused on their experience of using the app.ResultsParticipants complied with 80% of the daily learning tasks scheduled for subsequent tests of episodic memory, with 88% of participants still actively engaged by the final task. A thematic analysis of the participants’ experiences highlighted schedule flexibility, a clear user interface, and performance feedback as important considerations for engagement with remote digital assessment.ConclusionsDespite the extended study duration, participants demonstrated high compliance with the schedule of daily learning tasks and were extremely positive about their experiences. Long durations of remote digital interaction are therefore definitely feasible but only when careful attention is paid to the design of the users’ experience.