Neuropsychological assessments for dementia research in the COVID-19 era: comparing remote and face-to-face testing

Objectives We explored whether adapting traditional neuropsychological tests for online administration against the backdrop of COVID-19 was feasible for people with diverse forms of dementia and healthy older controls. We compared face-to-face and remote settings to ascertain whether remote administration affected performance. Design We used a longitudinal design for healthy older controls who completed face-to-face neuropsychological assessments between three and four years before taking part remotely. For patients, we used a cross-sectional design, contrasting a prospective remote cohort with a retrospective face-to-face cohort matched in age, education, and disease duration. Setting Remote assessments were performed using video-conferencing and online testing platforms, with participants using a personal computer or tablet and situated in a quiet room in their own home. Face-to-face assessments were carried out in dedicated testing rooms in our research centre. Participants The remote cohort comprised ten healthy older controls (also seen face-to-face 3-4 years previously) and 25 patients (n=8 Alzheimer’s disease (AD); n=3 behavioural variant frontotemporal dementia (bvFTD); n=4 semantic dementia (SD); n=5 progressive nonfluent aphasia (PNFA); n=5 logopenic aphasia (LPA)). The face-to-face patient cohort comprised 64 patients (n=25 AD; n=12 bvFTD; n=9 SD; n=12 PNFA; n=6 LPA). Primary and secondary outcome measures The outcome measures comprised the strength of evidence under a Bayesian analytic framework for differences in performances between face-to-face and remote testing environments on a general neuropsychological (primary outcomes) and neurolingustic battery (secondary outcomes). Results There was evidence to suggest comparable performance across testing environments for all participant groups, for a range of neuropsychological tasks across both batteries. Conclusions Our findings suggest that remote delivery of neuropsychological tests for dementia research is feasible. Methodological strengths of this study include Limitations include ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The Dementia Research Centre is supported by Alzheimer's Research UK, Brain Research UK, and The Wolfson Foundation. This work was supported by the Alzheimer's Society, the Royal National Institute for Deaf People, Alzheimer's Research UK, the National Institute for Health Research University College London Hospitals Biomedical Research Centre, and the University College London Leonard Wolfson Experimental Neurology Centre (grant PR/ylr/18575). MCRK is supported by a Wellcome Trust PhD Studentship (102129/B/13/Z). JJ is supported by a Frontotemporal Dementia Research Studentship in Memory of David Blechner (funded through The National Brain Appeal). EB was supported by a Brain Research UK PhD Studentship. RLB was supported by an MRC PhD Studentship in Mental Health. SJC was supported by grants from ESRC-NIHR (ES/L001810/1), EPSRC (EP/M006093/1) and Wellcome Trust (200783). CJDH was supported by a Royal National Institute for Deaf People-Dunhill Medical Trust Pauline Ashley Fellowship (grant PA23 Hardy) and a Wellcome Institutional Strategic Support Fund Award (204841/Z/16/Z). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was granted by the University College London and National Hospital for Neurology and Neurosurgery Joint Research Ethics Committees in accordance with the Declaration of Helsinki. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes The data that support the findings of this study are available on request from the corresponding author.