Validating virtual administration of neuropsychological testing in Parkinson disease: a pilot study

Abstract

COVID-19 has highlighted the need for remote cognitive testing, but the reliability and validity of virtual cognitive testing in Parkinson disease (PD) is unknown. Therefore, we assessed PD participants enrolled in an observational, cognition-focused study with an extensive cognitive battery completed both in-person and via video conference close in time. Data for 35 PD participants with normal cognition to mild dementia were analyzed. Only one test (semantic verbal fluency) demonstrated a difference in score by administration type, with a significantly better score virtually. Only three tests demonstrated good reliability for in-person versus virtual testing, but reliability values for visit 1 versus visit 2 were similarly low overall. Trail Making Test B was successfully administered virtually to only 18 participants due to technical issues. Virtual and in-person cognitive testing generate similar scores at the group level, but with poor to moderate reliability for most tests. Mode of test administration, learning effects, and technical difficulties explained little of the low test–retest reliability, indicating possible significant short-term variability in cognitive performance in PD in general, which has implications for clinical care and research. In-person cognitive testing with a neuropsychologist remains the gold standard, and it remains to be determined if virtual cognitive testing is feasible in PD.

Online unsupervised performance-based cognitive testing: a feasible and reliable approach to scalable cognitive phenotyping of Parkinson’s patients

“…Though these studies did not include any performance-based tasks, which are likely more susceptible to the effects of poor task engagement than self-report questionnaires, the results nonetheless suggest that fully remote and unsupervised interactions with participants are feasible for Parkinson's disease research. Second, with respect to reliability, one study compared the test-retest reliability of standard in-person testing to supervised virtual testing in Parkinson's patients, where patients were at home and supervised by a rater on a video call [10]. The results of this study showed that though test-retest reliability between the in-person and virtual administration varied across tasks, many of the tasks achieved at least moderate reliability, which is a level of reliability comparable to that of standard in-person paper-based cognitive testing in Parkinson's patients [11].…”