Integrating home-based video teleneuropsychology into neurology clinical practice: Utility in patients with suspected typical or atypical Alzheimer’s disease presentations

We assessed the reliability of home-based video teleneuropsychology (TeleNP) compared to face-to-face (FF) neuropsychological assessments in clinic-referred patients for whom a typical or atypical Alzheimer's disease (AD) syndrome was on the neurologist's differential diagnosis. We conducted a randomized, cross-over clinical trial in which participants underwent neuropsychological evaluations with a core battery of tests in two modalities: FF and TeleNP, conducted approximately 4-6 wk apart. Participants included patients ≥ age 60 years and <90 years who were undergoing evaluation in a memory disorders clinic (n = 63). Board-certified neuropsychologists submitted diagnostic impressions (i.e. syndrome and severity classifications) after the core battery in each modality. Neuropsychologists were able to include a flexible assessment (i.e. inclusion of tests not readily adaptable to TeleNP) after the core battery, only in the FF condition. The intraclass correlation coefficients (ICC) were at least moderate to good (≥0.50) for 91% of administered tests. Computing ICC adjusting for alternate forms, sequence order, practice effects, referring diagnostic complexity, and supervising neuropsychologist did not substantively change interpretation of ICCs. Across modality types, Cohen's kappa of neuropsychologist impressions for syndrome classifications was 0.74 (95% CI: 0.60, 0.88), and for severity classifications was 0.89 (95% CI: 0.79, 0.99). Within the FF modality, kappa of neuropsychologist impressions was 0.90 (95% CI: 0.81, 0.99) and 0.97 (95% CI: 0.92, 1.0), respectively, for syndrome and severity across core and flexible batteries. Home-based, video TeleNP is a reliable alternative to FF neuropsychological assessment in older adult patients with suspected cognitive impairment.