Investigating Equivalence of In-Person and Telehealth-Based Neuropsychological Assessment Performance for Individuals Being Investigated for Younger Onset Dementia

Aimee D Brown; Wendy Kelso; Dhamidhu Eratne; Samantha M Loi; Sarah Farrand; Patrick Summerell; Joanna Neath; Mark Walterfang; Dennis Velakoulis; Renerus J Stolwyk

doi:10.1093/arclin/acad108

Investigating Equivalence of In-Person and Telehealth-Based Neuropsychological Assessment Performance for Individuals Being Investigated for Younger Onset Dementia

Arch Clin Neuropsychol. 2024 Jan 20:acad108. doi: 10.1093/arclin/acad108. Online ahead of print.

Authors

Aimee D Brown^{1

2}, Wendy Kelso^{1

3}, Dhamidhu Eratne^{3

4}, Samantha M Loi^{3

4}, Sarah Farrand³, Patrick Summerell³, Joanna Neath³, Mark Walterfang³, Dennis Velakoulis³, Renerus J Stolwyk^{1

2}

Affiliations

¹ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia.
² Monash-Epworth Rehabilitation Research Centre, Melbourne, Australia.
³ Neuropsychiatry, Royal Melbourne Hospital, Parkville, Australia.
⁴ Department of Psychiatry, University of Melbourne, Parkville, Australia.

PMID: 38251841
DOI: 10.1093/arclin/acad108

Abstract

Objective: Given the rapid shift to in-home teleneuropsychology models, more research is needed to investigate the equivalence of non-facilitator models of teleneuropsychology delivery for people with younger onset dementia (YOD). This study aimed to determine whether equivalent performances were observed on neuropsychological measures administered in-person and via teleneuropsychology in a sample of people being investigated for YOD.

Method: Using a randomized counterbalanced cross-over design, 43 participants (Mage = 60.26, SDage = 7.19) with a possible or probable YOD diagnosis completed 14 neuropsychological tests in-person and via teleneuropsychology, with a 2-week interval. Repeated measures t-tests, intraclass correlation coefficients (ICC), and Bland Altman analyses were used to investigate equivalence across the administration conditions.

Results: No statistical differences were found between in-person and teleneuropsychology conditions, except for the Hospital Anxiety and Depression Scale Anxiety subtest. Small to negligible effect sizes were observed (ranging from .01 to .20). ICC estimates ranged from .71 to .97 across the neuropsychological measures. Bland Altman analyses revealed that the Wechsler Adult Intelligence Scale-Fourth Edition Block Design subtest had slightly better overall performance in the in-person condition and participants reported higher levels of anxiety symptoms during the teleneuropsychology condition; however, average anxiety symptoms remained within the clinically normal range. Participants reported a high level of acceptability for teleneuropsychology assessments.

Conclusions: These results suggest that performances are comparable between in-person and teleneuropsychology assessment modalities. Our findings support teleneuropsychology as a feasible alternative to in-person neuropsychological services for people under investigation of YOD, who face significant barriers in accessing timely diagnoses and treatment options.

Keywords: Dementia; Equivalence; Reliability; Telehealth; Teleneuropsychology; Younger onset dementia.