Remote Cognitive Assessment in Severe Mental Illness: A Scoping Review

Abstract

Background: Many individuals living with mental illness present cognitive deficits and reasoning biases negatively impacting clinical and functional trajectories. Within the context of the current COVID-19 pandemic, clinicians and researchers must adapt traditional in-person assessments for remote delivery, but little guidance is available for this endeavor. To synthesize the literature and facilitate guideline development, we conducted a scoping review of remote cognitive assessment in psychiatry.Objectives: We sought to (1) map the literature, (2) identify potential barriers and facilitators, and (3) highlight current knowledge gaps of remote cognitive assessment in psychiatry.Eligibility Criteria: Articles were selected based on the following criteria: (a) peer-reviewed; (b) included individuals with a diagnosis of a severe mental illness (e.g., schizophrenia-spectrum disorders); and (c) reported on remote assessment of cognitive capacity or cognitive biases.Information and Evidence Sources: Our literature search was conducted using the OVID and EBSCO databases. Additionally, repositories of tests (PsycTESTS, Health and Psychosocial Instruments, Mental Measurements Yearbook) were searched, experts in the field were contacted for unpublished findings, and reference lists of selected articles were examined for additional studies. Evidence sources included original research articles, reviews and letters to the editor.Charting Methods: Data extraction was performed according to a predetermined form, defining study parameters, remote measure characteristics, psychometric properties, facilitators, barriers, and future directions. Extracted data were synthesized and illustrated using the logic model methodology.Results: Of 25,374 retrieved articles, 32 articles were selected, including 80 different measures across 11 cognitive domains and four remote platforms. Remote measures were generally comparable to traditional versions, though psychometric properties were infrequently reported. Facilitators included standardized procedures and wider recruitment, whereas barriers included imprecise measure adaptations, technology inaccessibility, low patient engagement and poor digital literacy.Conclusions: Our review identified several potential remote cognitive assessment measures used in psychiatry across all cognitive domains. However, there is a need for more rigorous validation of these measures as well as development of new open source alternatives, and consideration of potential influential factors, such as sex and gender. We discuss implications for conducting remote cognitive assessment in psychiatry and fostering high quality research using digital technologies.

Structural brain correlates of cognitive function in schizophrenia: A meta-analysis

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Longitudinal Trajectories of Participant- and Study Partner-Rated Cognitive Decline, in Relation to Alzheimer’s Disease Biomarkers and Mood Symptoms

“…However, recent research has suggested that remote (i.e., delivered via online or via mail) assessments are both acceptable and feasible for many participants and study partners (Geddes et al, 2020). Remote assessment has not only been shown to be feasible in young, cognitively unimpaired individuals, but also in older individuals with and without neurological and/or psychiatric disorders (D'Arcy et al, 2013;George et al, 2016;Wadsworth et al, 2016;Jacobs et al, 2021;Lavigne et al, 2021). For impaired participants, remote assessment might be preferred to reduce participant and study-partner burden as traveling into clinic becomes more physically challenging.…”

Smartphone digital phenotyping, surveys, and cognitive assessments for global mental health: Initial data and clinical correlations from an international first episode psychosis study

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“…A 2022 scoping review of remote cognitive assessments for the field suggested few approaches have actually been deployed into truly remote settings, and more research is needed to explore this approach across different cultures and settings like in this present study. 41 …”