Integrating Home-Based Video Teleneuropsychology into Clinical Practice: Typical Versus Atypical Alzheimer's Disease

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PROJECT SUMMARY/ABSTRACT The overarching goal of this R21 application is to a) assess the feasibility and preliminary validity of home- based delivery of teleneuropsychology (TeleNP) to patients with suspected Alzheimer's Disease (AD), referred for cognitive assessments in a Neurology Clinic; and b) elucidate whether TeleNP is equivalent to face-to-face evaluation (FF) for diagnostic adjudication of atypical versus typical AD. Although remote administration of brief cognitive assessments has been shown to be a valid alternative to in-person testing with typical, memory-predominant Mild Cognitive Impairment (MCI), these studies have focused primarily on the remote delivery of testing services to a patient in a clinic rather than appraising feasibility and validity of remote administration to a patient in their home. Moreover, prior studies have selectively focused on research participants with uncomplicated presentations of MCI and AD dementia, raising questions as to the generalizability of TeleNP to patients who are diagnostically challenging. In order to increase access to neuropsychological assessments, improve the precision of neurodegenerative diagnoses, and ensure that TeleNP is generalizable to complex presentations of AD and related disorders (ADRD), appraisal of the feasibility and preliminary validity of home-based TeleNP in both typical and atypical AD is critically needed. We will address the following Aims: Aim 1: Determine the validity of home-based video administration of neuropsychological tests (TeleNP) for assessing AD; Aim 2: Evaluate the impact of home-based TeleNP on the differential diagnosis of typical and atypical AD; Aim 3: Appraise the feasibility and acceptability of TeleNP in the evaluation of AD patients. To accomplish these goals, we will conduct a pilot clinical trial of two testing modalities, TeleNP versus FF, for delivery of neuropsychological evaluations. Neurologist-referred patients with typical (i.e., memory-predominant; n=40) and atypical (i.e., complex and/or non-memory predominant; n=40) presentations of possible AD will be enrolled in the study. Care partners of participants will also be consented to the study and included in stakeholder surveys/interviews. Using a cross- over design, all participants will undergo neuropsychological evaluations (clinical interview + Core Battery of cognitive tests) in both modalities, approximately one month apart to account for potential practice effects. Some cognitive tests are not readily adaptable to video-based delivery due to tactile/ physical stimuli; as such, we will assess whether a Flexible Assessment (i.e., include additional tests with physical stimuli) in the FF modality alters diagnostic conclusions. Finally, in an exploratory aim, we will identify stakeholder perspectives of TeleNP that inform pragmatic implementation of remote neuropsychological evaluations. This pilot clinical trial will provide an important platform for delineating the feasibility of implementing home-based TeleNP and thereby prepare us for a future definitive pragmatic trial of TeleNP effectiveness across multiple clinics.