Integrating Home-Based Video Teleneuropsychology into Clinical Practice: Typical Versus Atypical Alzheimer's Disease - PROJECT SUMMARY/ABSTRACT
The overarching goal of this R21 application is to a) assess the feasibility and preliminary validity of home-
based delivery of teleneuropsychology (TeleNP) to patients with suspected Alzheimer's Disease (AD),
referred for cognitive assessments in a Neurology Clinic; and b) elucidate whether TeleNP is equivalent to
face-to-face evaluation (FF) for diagnostic adjudication of atypical versus typical AD. Although remote
administration of brief cognitive assessments has been shown to be a valid alternative to in-person testing with
typical, memory-predominant Mild Cognitive Impairment (MCI), these studies have focused primarily on the
remote delivery of testing services to a patient in a clinic rather than appraising feasibility and validity of remote
administration to a patient in their home. Moreover, prior studies have selectively focused on research
participants with uncomplicated presentations of MCI and AD dementia, raising questions as to the
generalizability of TeleNP to patients who are diagnostically challenging. In order to increase access to
neuropsychological assessments, improve the precision of neurodegenerative diagnoses, and ensure that
TeleNP is generalizable to complex presentations of AD and related disorders (ADRD), appraisal of the
feasibility and preliminary validity of home-based TeleNP in both typical and atypical AD is critically needed.
We will address the following Aims: Aim 1: Determine the validity of home-based video administration of
neuropsychological tests (TeleNP) for assessing AD; Aim 2: Evaluate the impact of home-based
TeleNP on the differential diagnosis of typical and atypical AD; Aim 3: Appraise the feasibility and
acceptability of TeleNP in the evaluation of AD patients. To accomplish these goals, we will conduct a pilot
clinical trial of two testing modalities, TeleNP versus FF, for delivery of neuropsychological evaluations.
Neurologist-referred patients with typical (i.e., memory-predominant; n=40) and atypical (i.e., complex and/or
non-memory predominant; n=40) presentations of possible AD will be enrolled in the study. Care partners of
participants will also be consented to the study and included in stakeholder surveys/interviews. Using a cross-
over design, all participants will undergo neuropsychological evaluations (clinical interview + Core Battery of
cognitive tests) in both modalities, approximately one month apart to account for potential practice effects.
Some cognitive tests are not readily adaptable to video-based delivery due to tactile/ physical stimuli; as such,
we will assess whether a Flexible Assessment (i.e., include additional tests with physical stimuli) in the FF
modality alters diagnostic conclusions. Finally, in an exploratory aim, we will identify stakeholder perspectives
of TeleNP that inform pragmatic implementation of remote neuropsychological evaluations. This pilot clinical
trial will provide an important platform for delineating the feasibility of implementing home-based TeleNP and
thereby prepare us for a future definitive pragmatic trial of TeleNP effectiveness across multiple clinics.