Scientist Florey Institute of Neuroscience and Mental Health Heidelberg, Victoria, Australia
Rationale: Traditional, face-to-face neuropsychological testing typically involves a temporally extended interpersonal interaction that occurs within a small, enclosed testing space. This carries elevated COVID-19 risk for both examinee and examiner, with significant implications for both clinical and research practice. Here we describe how the pilot study of the Australian Epilepsy Project (AEP) – a large-scale, multimodal clinical research project – has transitioned to tele-neuropsychology (teleNP), enabling continued safe operations during periods of COVID-19 related restrictions. Methods: The AEP includes three cohorts of adults (age 18-60): those with a first unprovoked seizure, those with a new diagnosis of epilepsy, and those with drug resistant focal epilepsy. Neuropsychological data collection within the AEP pilot study was originally implemented via traditional, face-to-face testing. Shortly after launching the study, COVID-related restrictions necessitated rapid adaptation of the neuropsychological protocol for remote assessment, including: delivery of verbal tasks via videoconference (RAVLT, Digit Span, WASI Vocabulary, Verbal Fluency); use of a document camera for stimulus delivery (e.g., ToPF, WASI, BNT); adoption of web-hosted, computerized assessment (CANTAB); use of oral versions of tests (e.g., Trail Making Test, Symbol Digit Modalities); online delivery of questionnaires; and discontinuation of certain tasks that require face-to-face interaction or are difficult to administer reliably via telehealth.
Results: To date, we have completed 24 teleNP assessments: 18 remotely (participant in own home) and six on-site (participant using videoconferencing equipment at research facility). Five face-to-face assessments were conducted prior to the transition to teleNP. Eight of 408 tests administered via teleNP (1.9%) have been invalidated, for a variety of reasons (difficulties with task administration, e.g., Stroop; distorted audio; participant distraction; participant writing down answers). Aggregate data confirm typical patterns of epilepsy related deficits (p< .05) affecting processing speed, executive, language and memory domains. Questionnaire responses also indicated elevated rates of patients at high risk of mood (34%) and anxiety disorder (38%).
Conclusions: Research teleNP assessments reveal a typical pattern of impairments in epilepsy. A range of issues must be considered when introducing teleNP, such as technical and administrative set up, test selection and delivery, and cohort suitability. TeleNP enables large-scale neuropsychological research during periods of social distancing (and beyond), and offers a tremendous opportunity to expand the reach and breadth of neuropsychological services.
Funding: Please list any funding that was received in support of this abstract.: This project was supported by an Australian Government Medical Research Future Fund Frontier Health and Medical Research Program Stage One grant (MRFF75908); the National Health and Medical Research Council of Australia (Program Grant 1091593 and Project Grant APP1157145); a grant from Brain Australia; and the Victorian Government including Victorian-led Frontier Health and Medical Research project funding and funding from the Operational Infrastructure Support Grant. The authors acknowledge the facilities and scientific and technical assistance of the National Imaging Facility, a National Collaborative Research Infrastructure Strategy (NCRIS) capability, at The Florey Institute of Neuroscience and Mental Health.