Telemedicine-Based Cognitive Examinations During COVID-19 and Beyond: Perspective of the Massachusetts General Hospital Behavioral Neurology & Neuropsychiatry Group
Publication: The Journal of Neuropsychiatry and Clinical Neurosciences
Abstract
Telehealth and telemedicine have encountered explosive growth since the beginning of the COVID-19 pandemic, resulting in increased access to care for patients located far from medical centers and clinics. Subspecialty clinicians in behavioral neurology & neuropsychiatry (BNNP) have implemented the use of telemedicine platforms to perform cognitive examinations that were previously office based. In this perspective article, BNNP clinicians at Massachusetts General Hospital (MGH) describe their experience performing cognitive examinations via telemedicine. The article reviews the goals, prerequisites, advantages, and potential limitations of performing a video- or telephone-based telemedicine cognitive examination. The article shares the approaches used by MGH BNNP clinicians to examine cognitive and behavioral areas, such as orientation, attention and executive functions, language, verbal learning and memory, visual learning and memory, visuospatial function, praxis, and abstract abilities, as well as to survey for neuropsychiatric symptoms and assess activities of daily living. Limitations of telemedicine-based cognitive examinations include limited access to and familiarity with telecommunication technologies on the patient side, limitations of the technology itself on the clinician side, and the limited psychometric validation of virtual assessments. Therefore, an in-person examination with a BNNP clinician or a formal in-person neuropsychological examination with a neuropsychologist may be recommended. Overall, this article emphasizes the use of standardized cognitive and behavioral assessment instruments that are either in the public domain or, if copyrighted, are nonproprietary and do not require a fee to be used by the practicing BNNP clinician.
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History
Received: 18 August 2022
Revision received: 30 May 2023
Revision received: 9 September 2023
Accepted: 10 September 2023
Published online: 19 December 2023
Published in print: Spring 2024
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Competing Interests
Dr. Camprodon has served on the scientific advisory boards for Hyka and Flow Neuroscience, and she has served as a consultant for Mifu Technologies and Neuroelectrics. Dr. Newhouse has served as a consultant for Musculo. Dr. Perez has received honoraria for continuing medical education lectures; he has received royalties from Springer Nature; he serves on the editorial boards of Brain and Behavior, Epilepsy & Behavior, and The Journal of Neuropsychiatry and Clinical Neurosciences; and he has received funding from NIH and the Sidney R. Baer Jr. Foundation. Dr. Razafsha is a shareholder with Masimo Corporation. Dr. Schmahmann is site principal investigator for Biohaven (NCT03701399, NCT02960893, and NCT03952806); he has received royalties from Elsevier, MacKeith Press, Oxford University Press, and Springer; and he holds a license with the General Hospital Corporation for the Brief Ataxia Rating Scale, the Cerebellar Cognitive Affective/Schmahmann syndrome scale, the Cerebellar Neuropsychiatry Rating Scale, and the Patient-Reported Outcome Measure of Ataxia. The other authors report no financial relationships with commercial interests.
Funding Information
Supported by the Sidney R. Baer Jr. Foundation (fellowship to Dr. Josephy-Hernandez), NIMH (grant T32MH112485 to Dr. Kritzer), Harvard Medical School Dupont-Warren Fellowship (to Dr. Kritzer), and the U.S. Veterans Affairs Office of Research and Development (research grants to Dr. Moo).
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