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

项目摘要/摘要 此R21应用程序的首要目标是a)评估HOME的可行性和初步有效性 向疑似阿尔茨海默病(AD)患者提供远程神经心理学(TeleNP)， 在神经病学诊所进行认知评估；以及b)阐明TeleNP是否等同于 非典型性与典型性阿尔茨海默病的面对面评价。虽然偏远 管理简单的认知评估已被证明是面对面测试的有效替代方法 典型的以记忆为主的轻度认知障碍(MCI)，这些研究主要集中在 远程向诊所中的患者提供测试服务，而不是评估远程测试的可行性和有效性 在病人家中对病人进行管理。此外，以前的研究选择性地集中在研究上。 参与者的MCI和AD痴呆的表现并不复杂，这引发了对 TeleNP对诊断具有挑战性的患者的普适性。为了增加对 神经心理评估，提高神经退行性诊断的准确性，并确保 TeleNP可概括为AD及相关障碍(ADRD)的复杂表现，评估 基于家庭的TeleNP在典型和非典型AD中的可行性和初步有效性是迫切需要的。 我们将解决以下目标：目标1：确定基于家庭的视频管理的有效性 用于评估AD的神经心理测试(TeleNP)；目标2：评估以家庭为基础的 TeleNP对典型和非典型AD的鉴别诊断；目的3：评价 TeleNP在AD患者评估中的可接受性。为了实现这些目标，我们将进行试点 两种测试模式的临床试验，TeleNP和FF，用于提供神经心理评估。 神经科医生推荐的典型(即记忆占优势；n=40)和非典型(即复杂和/或)患者 非记忆占优势；40)对可能的阿尔茨海默病的陈述将纳入研究。关爱合作伙伴 参与者还将被同意进行这项研究，并包括在利益攸关方调查/访谈中。使用一个十字架- 通过设计，所有参与者都将接受神经心理评估(临床访谈+核心小组 认知测试)，大约相隔一个月，以说明潜在的练习效果。 由于触觉/物理刺激，一些认知测试不容易适应基于视频的传送；因此， 我们将评估在FF中是否有灵活的评估(即，包括带有物理刺激的额外测试) 医疗模式会改变诊断结论。最后，为了探索性的目标，我们将确定利益相关者的观点 为远程神经心理评估的实际实施提供信息。这是一个试点诊所 试验将为描述实施基于家庭的TeleNP的可行性提供一个重要平台 因此，我们为未来跨多个诊所的TeleNP有效性的最终实用试验做好准备。

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.