Telehealth-based assessment of cognition, social cognition, mood, and functional independence in older adults
Michelle Kelly
A * , Simon Mierendorff A , Kylie Wales B , Johanna Voeste A , Joanne Allen A and Skye McDonald C
A
B
C
Abstract
Mild cognitive impairment affects over 15% of adults aged 50+ years and is a primary risk indicator for dementia. Although access to assessment is crucial, many older adults face barriers to in-person evaluation.
This study used a randomised cross-over design to assess the practicality, acceptability, and adaptation of a telehealth-based screening battery tailored for older adults. Forty-three volunteers aged 50+ years (m = 70.3, s.d. = 10.8) completed in-person or videoconference assessments, including the Addenbrooke’s Cognitive Examination-III (ACE-III), Brief Assessment of Social Skills (BASS), Hospital Anxiety and Depression Scales (HADS), Modified Barthel Index (MBI), and Assessment of Living Skills And Resources-2 (ALSAR-R2). The alternate format was administered after 3 weeks. Practicality was assessed with reference to task modifications, completion, and administration time. Acceptability was evaluated via questionnaire. Reliability was assessed using intraclass correlation coefficients (ICCs).
Minimal modifications were needed for the videoconference format, and it was highly acceptable to respondents. Reliability across formats was excellent for BASS Empathy, HADS Depression, MBI and ALSAR-R2 (ICC = 1.00–0.92) and good for ACE-III, HADS Anxiety, and BASS Face Emotion Perception, Face Identification, and Social Disinhibition scales (ICC = 0.77–0.89).
Findings support the feasibility of telehealth-based administration of the screening battery; however, biases in emotion perception performance between modalities require further research.
Keywords: accessibility, cognitive assessment, dementia, functional assessment, screening battery, screening tool, social neuroscience, telehealth.
References
Aaronson N, Alonso J, Burnam A, Lohr KN, Patrick DL, Perrin E, Stein RE (2002) Assessing health status and quality-of-life instruments: Attributes and review criteria. Quality of Life Research: 11(3), 193-205.
| Crossref | Google Scholar | PubMed |
ABS (2018) ‘Australian Statistical Geography Standard (ASGS): Volume 5—Remoteness Structure, July 2016 Correspondence, 2017 Postcode to 2016 Remoteness Area (1270.0.55.005).’ (Australian Bureau of Statistics) Available at https://www.abs.gov.au/
Adolphs R (2003) Cognitive neuroscience of human social behaviour. Nature Reviews Neuroscience 4(3), 165-178.
| Crossref | Google Scholar | PubMed |
Agboola S, Hale TM, Masters C, Kvedar J, Jethwani K (2014) Real-World” Practical Evaluation Strategies: A Review of Telehealth Evaluation. JMIR Research Protocols 3(4), e75.
| Crossref | Google Scholar | PubMed |
Bai W, Chen P, Cai H, Zhang Q, Su Z, Cheung T, Jackson T, Sha S, Xiang Y-T (2022) Worldwide prevalence of mild cognitive impairment among community dwellers aged 50 years and older: A meta-analysis and systematic review of epidemiology studies. Age and Ageing 51(8), afac173.
| Crossref | Google Scholar | PubMed |
Banbury A, Parkinson L, Nancarrow S, Dart J, Gray L, Buckley J (2014) Multi-site videoconferencing for home-based education of older people with chronic conditions: The Telehealth Literacy Project. Journal of Telemedicine and Telecare 20(7), 353-359.
| Crossref | Google Scholar | PubMed |
Bartko JJ (1966) The Intraclass Correlation Coefficient as a Measure of Reliability. Psychological Reports 19(1), 3-11.
| Crossref | Google Scholar | PubMed |
Bentvelzen A, Aerts L, Seeher K, Wesson J, Brodaty H (2017) A Comprehensive Review of the Quality and Feasibility of Dementia Assessment Measures: The Dementia Outcomes Measurement Suite. Journal of the American Medical Directors Association 18(10), 826-837.
| Crossref | Google Scholar | PubMed |
Blackberry I, Morris N (2023) The Impact of Population Ageing on Rural Aged Care Needs in Australia: Identifying Projected Gaps in Service Provision by 2032. Geriatrics (Basel, Switzerland) 8(3), 47.
| Crossref | Google Scholar | PubMed |
Bland JM, Altman DG (1990) A note on the use of the intraclass correlation coefficient in the evaluation of agreement between two methods of measurement. Computers in Biology and Medicine 20(5), 307-310.
| Crossref | Google Scholar |
Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, Bakken S, Kaplan CP, Squiers L, Fabrizio C, Fernandez M (2009) How We Design Feasibility Studies. American Journal of Preventive Medicine 36(5), 452-457.
| Crossref | Google Scholar | PubMed |
Campbell NL, Unverzagt F, LaMantia MA, Khan BA, Boustani MA (2013) Risk factors for the progression of mild cognitive impairment to dementia. Clinics in Geriatric Medicine 29(4), 873-893.
| Crossref | Google Scholar | PubMed |
Carotenuto A, Traini E, Fasanaro AM, Battineni G, Amenta F (2021) Tele-Neuropsychological Assessment of Alzheimer’s Disease. Journal of Personalized Medicine 11(8), 688.
| Crossref | Google Scholar | PubMed |
Clemson L, Bundy A, Unsworth C, Singh MF (2009) Validation of the modified assessment of living skills and resources, an IADL measure for older people. Disabil Rehabil 31(5), 359-69.
| Crossref | Google Scholar | PubMed |
DeYoung N, Shenal BV (2019) The reliability of the Montreal Cognitive Assessment using telehealth in a rural setting with veterans. Journal of Telemedicine and Telecare 25(4), 197-203.
| Crossref | Google Scholar | PubMed |
Fiske A, Wetherell JL, Gatz M (2009) Depression in older adults. Annual Review of Clinical Psychology 5, 363-389.
| Crossref | Google Scholar | PubMed |
FRONTIER (2020) ‘ACE-III Remote Administration Guidelines and Forms (Addenbrooke’s Cognitive Examination-III (ACE-III)).’ (Frontotemporal Dementia Research Group, University of Sydney) Available at https://frontierftd.org/
Greenhalgh T, Wherton J, Sugarhood P, Hinder S, Procter R, Stones R (2013) What matters to older people with assisted living needs? A phenomenological analysis of the use and non-use of telehealth and telecare. Social Science & Medicine 93, 86-94.
| Crossref | Google Scholar | PubMed |
Grubaugh AL, Cain GD, Elhai JD, Patrick SL, Frueh BC (2008) Attitudes Toward Medical and Mental Health Care Delivered Via Telehealth Applications Among Rural and Urban Primary Care Patients. Journal of Nervous & Mental Disease 196(2), 166-170.
| Crossref | Google Scholar | PubMed |
Harrell KM, Wilkins SS, Connor MK, Chodosh J (2014) Telemedicine and the Evaluation of Cognitive Impairment: The Additive Value of Neuropsychological Assessment. Journal of the American Medical Directors Association 15(8), 600-606.
| Crossref | Google Scholar | PubMed |
Hernandez HHC, Ong PL, Anthony P, Ang SL, Salim N, Yew PYS, Ali NB, Lim JP, Lim WS, Chew J (2022) Cognitive Assessment by Telemedicine: Reliability and Agreement between Face-to-Face and Remote Videoconference-Based Cognitive Tests in Older Adults Attending a Memory Clinic. Annals of Geriatric Medicine and Research 26(1), 42-48.
| Crossref | Google Scholar | PubMed |
Hsieh S, Schubert S, Hoon C, Mioshi E, Hodges JR (2013) Validation of the Addenbrooke’s Cognitive Examination III in Frontotemporal Dementia and Alzheimer’s Disease. Dementia and Geriatric Cognitive Disorders 36(3–4), 242-250.
| Crossref | Google Scholar | PubMed |
Hwang R, Mandrusiak A, Morris NR, Peters R, Korczyk D, Russell T (2017) Assessing functional exercise capacity using telehealth: Is it valid and reliable in patients with chronic heart failure? Journal of Telemedicine and Telecare 23(2), 225-232.
| Crossref | Google Scholar | PubMed |
Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J (1998) Importance of Functional Measures in Predicting Mortality Among Older Hospitalized Patients. JAMA 279(15), 1187.
| Crossref | Google Scholar | PubMed |
Jang SY, Seon JY, Oh IH (2020) Influencing Factors of Transportation Costs Regarding Healthcare Service Utilization in Korea. Journal of Korean Medical Science 35(35), e290.
| Crossref | Google Scholar | PubMed |
Kann MR, Zeiger PJ, Rizer SJ, Cosentino S, Azar M (2023) Virtual Assessment as a Way to Reduce Help-seeking Barriers in Older Adults With Subjective Cognitive Decline. Alzheimer Disease & Associated Disorders 37(4), 373-378.
| Crossref | Google Scholar | PubMed |
Kelly M, McDonald S (2020) Assessing social cognition in people with a diagnosis of dementia: Development of a novel screening test, the Brief Assessment of Social Skills (BASS-D). Journal of Clinical and Experimental Neuropsychology 42(2), 185-198.
| Crossref | Google Scholar | PubMed |
Kobak KA (2004) A comparison of face-to-face and videoconference administration of the Hamilton Depression Rating Scale. Journal of Telemedicine and Telecare 10(4), 231-235.
| Crossref | Google Scholar | PubMed |
Koo TK, Li MY (2016) A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. Journal of Chiropractic Medicine 15(2), 155-163.
| Crossref | Google Scholar | PubMed |
Krasniuk S, Crizzle AM (2023) Impact of health and transportation on accessing healthcare in older adults living in rural regions. Transportation Research Interdisciplinary Perspectives 21, 100882.
| Crossref | Google Scholar |
Kumfor F, Irish M, Hodges JR, Piguet O (2013) Discrete Neural Correlates for the Recognition of Negative Emotions: Insights from Frontotemporal Dementia. PLoS One 8(6), e67457.
| Crossref | Google Scholar | PubMed |
Kumfor F, Hutchings R, Irish M, Hodges JR, Rhodes G, Palermo R, Piguet O (2015) Do I know you? Examining face and object memory in frontotemporal dementia. Neuropsychologia 71, 101-111.
| Crossref | Google Scholar | PubMed |
Lavingia R, Jones K, Asghar-Ali AA (2020) A Systematic Review of Barriers Faced by Older Adults in Seeking and Accessing Mental Health Care. Journal of Psychiatric Practice 26(5), 367-382.
| Crossref | Google Scholar | PubMed |
Lee J, Koh D, Ong CN (1989) Statistical evaluation of agreement between two methods for measuring a quantitative variable. Computers in Biology and Medicine 19(1), 61-70.
| Crossref | Google Scholar | PubMed |
Leyhe T, Reynolds CF, Melcher T, Linnemann C, Klöppel S, Blennow K, Zetterberg H, Dubois B, Lista S, Hampel H (2017) A common challenge in older adults: Classification, overlap, and therapy of depression and dementia. Alzheimer’s & Dementia 13(1), 59-71.
| Crossref | Google Scholar | PubMed |
Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, Ballard C, Banerjee S, Burns A, Cohen-Mansfield J, Cooper C, Fox N, Gitlin LN, Howard R, Kales HC, Larson EB, Ritchie K, Rockwood K, Sampson EL, et al. (2017) Dementia prevention, intervention, and care. The Lancet 390(10113), 2673-2734.
| Crossref | Google Scholar | PubMed |
Luxton DD, Pruitt LD, Osenbach JE (2014) Best practices for remote psychological assessment via telehealth technologies. Professional Psychology: Research and Practice 45(1), 27-35.
| Crossref | Google Scholar |
Mahon S, Webb J, Snell D, Theadom A (2022) Feasibility of administering the WAIS-IV using a home-based telehealth videoconferencing model. The Clinical Neuropsychologist 36(3), 558-570.
| Crossref | Google Scholar | PubMed |
Marra DE, Hamlet KM, Bauer RM, Bowers D (2020) Validity of teleneuropsychology for older adults in response to COVID-19: A systematic and critical review. The Clinical Neuropsychologist 34(7–8), 1411-1452.
| Crossref | Google Scholar | PubMed |
McDonald S, Flanagan S, Rollins J, Kinch J (2003) TASIT: A New Clinical Tool for Assessing Social Perception After Traumatic Brain Injury. The Journal of Head Trauma Rehabilitation 18(3), 219-238.
| Crossref | Google Scholar | PubMed |
McDonald S, Bornhofen C, Shum D, Long E, Saunders C, Neulinger K (2006) Reliability and validity of The Awareness of Social Inference Test (TASIT): A clinical test of social perception. Disability and Rehabilitation 28(24), 1529-1542.
| Crossref | Google Scholar | PubMed |
Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR (2006) The Addenbrooke’s Cognitive Examination Revised (ACE‐R): A brief cognitive test battery for dementia screening. International Journal of Geriatric Psychiatry 21(11), 1078-1085.
| Crossref | Google Scholar | PubMed |
Mueller KD, Koscik RL, Hermann BP, Johnson SC, Turkstra LS (2018) Declines in Connected Language Are Associated with Very Early Mild Cognitive Impairment: Results from the Wisconsin Registry for Alzheimer’s Prevention. Frontiers in Aging Neuroscience 9, 437.
| Crossref | Google Scholar | PubMed |
Munro Cullum C, Hynan LS, Grosch M, Parikh M, Weiner MF (2014) Teleneuropsychology: Evidence for Video Teleconference-Based Neuropsychological Assessment. Journal of the International Neuropsychological Society 20(10), 1028-1033.
| Crossref | Google Scholar | PubMed |
Parks AC, Davis J, Spresser CD, Stroescu I, Ecklund-Johnson E (2021) Validity of In-Home Teleneuropsychological Testing in the Wake of COVID-19. Archives of Clinical Neuropsychology 36(6), 887-896.
| Crossref | Google Scholar | PubMed |
Petersen RC, Lopez O, Armstrong MJ, Getchius T, Ganguli M, Gloss D, Gronseth GS, Marson D, Pringsheim T, Day GS, Sager M, Stevens J, Rae-Grant A (2018) Practice guideline update summary: Mild cognitive impairment: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology 90(3), 126-135.
| Crossref | Google Scholar | PubMed |
Prestia A, Rossi R, Geroldi C, Galluzzi S, Ettori M, Alaimo G, Frisoni GB (2006) Validation Study of the Three-Objects-Three-Places Test: A Screening Test for Alzheimer’s Disease. Experimental Aging Research 32(4), 395-410.
| Crossref | Google Scholar | PubMed |
Shah S, Vanclay F, Cooper B (1989) Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology 42(8), 703-709.
| Crossref | Google Scholar | PubMed |
Tabert MH, Albert SM, Borukhova-Milov L, Camacho Y, Pelton G, Liu X, Stern Y, Devanand DP (2002) Functional deficits in patients with mild cognitive impairment: Prediction of AD. Neurology 58(5), 758-764.
| Crossref | Google Scholar | PubMed |
Tousignant M, Boissy P, Moffet H, Corriveau H, Cabana F, Marquis F, Simard J (2011) Patients’ Satisfaction of Healthcare Services and Perception with In-Home Telerehabilitation and Physiotherapists’ Satisfaction Toward Technology for Post-Knee Arthroplasty: An Embedded Study in a Randomized Trial. Telemedicine and E-Health 17(5), 376-382.
| Crossref | Google Scholar | PubMed |
Turner TH, Brearly TW (2023) Videoconference teleneuropsychology. In ‘APA Handbook of Neuropsychology, Volume 2: Neuroscience and Neuromethods. Vol. 2’. (Eds GG Brown, B Crosson, KY Haaland, TZ King) pp. 313–332. (American Psychological Association) 10.1037/0000308-015
Van Gaans D, Dent E (2018) Issues of accessibility to health services by older Australians: A review. Public Health Reviews 39(1), 20.
| Crossref | Google Scholar | PubMed |
Wolfe MK, McDonald NC, Holmes GM (2020) Transportation Barriers to Health Care in the United States: Findings From the National Health Interview Survey, 1997–2017. American Journal of Public Health 110(6), 815-822.
| Crossref | Google Scholar | PubMed |
Woodward M, Brodaty H, McCabe M, Masters CL, Naismith SL, Morris P, Rowe CC, Walker P, Yates M (2022) Nationally Informed Recommendations on Approaching the Detection, Assessment, and Management of Mild Cognitive Impairment. Journal of Alzheimer’s Disease 89(3), 803-809.
| Crossref | Google Scholar | PubMed |
Zeghari R, Guerchouche R, Tran-Duc M, Bremond F, Langel K, Ramakers I, Amiel N, Lemoine MP, Bultingaire V, Manera V, Robert P, König A (2022) Feasibility Study of an Internet-Based Platform for Tele-Neuropsychological Assessment of Elderly in Remote Areas. Diagnostics 12(4), 925.
| Crossref | Google Scholar | PubMed |
Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica 67(6), 361-370.
| Crossref | Google Scholar | PubMed |
