Objective: To assess the reliability and diagnostic validity of in-home tele-neuropsychological testing (in-home tele-npt) in individuals with Parkinson’s disease (PD).

Background: Neuropsychological testing is inaccessible in the majority of the United States. Validation of in-home tele-npt in PD would mitigate systemic inequities in healthcare access and reduce the indirect costs of attending in-person evaluations.

Method: Seventy-nine patients with PD were randomized to in-person npt or in-home tele-npt at Baseline [table 1]. Patients were again randomized to the same or crossover group at Week 4 to compare the test-retest reliability of all three potential scenarios in which tele-npt might be used clinically, relative to the standard of care (i.e., repeated in-person npt). Between group differences in mean scores on 24 tests were assessed using ANOVAs with Dunnett’s t tests. Test-retest reliability was assessed using intraclass correlation coefficients and compared across groups using 95% confidence intervals and z-tests with Fisher’s z transformations. We classified patients as cognitively impaired using MDS diagnostic criteria and assessed between group differences in the percentage of patients classified as impaired using Pearson’s Chi-square tests or Fisher’s Exact tests.

Results: There were no significant differences between the in-person npt and in-home tele-npt groups in mean scores on tests of attention and working memory, verbal memory, language, visuospatial ability or all but one executive functioning test [table 2]. The in-home tele-npt had weaker processing speed scores (p <.01). Test-retest reliability scores were similar in the repeated in-person npt and repeated tele-npt groups [table 3]. The crossover groups had weaker test-retest reliability scores on tests of processing speed, verbal fluency, and memory. There were no significant differences in the percentage of patients classified as cognitively impaired between the groups using z-scores of < -1.5 SD below the mean to define impairment (in-person npt = 31.7%, tele-npt = 39.5%; p = 0.47) or after adjusting the cutoffs to z-scores of < -1 SD or < -2 SD below the mean [table 4]. Testing disruptions were minimal and satisfaction was high.

Conclusion: In-home tele-npt is a feasible and reliable method of obtaining diagnostically valid npt results in patients with PD.

Table 1. Demographic and clinical characteristics

Table 2. Baseline neuropsychological test scores

Table 3. Test-retest reliability

Table 4. Diagnostic validity

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MDS Abstracts - https://www.mdsabstracts.org/abstract/reliability-and-validity-of-in-home-tele-neuropsychological-testing-in-patients-with-parkinsons-disease-a-randomized-trial/