Neuropsychological Outcomes of COVID-19: A Multicenter, Cross-Cultural Study of Patients Referred for Outpatient Assessment

Objective: Cognitive dysfunction is one of the most frequently reported symptoms in post-acute sequelae of COVID-19 (PASC) and has become a common reason for neuropsychological referral. While data are emerging, we aimed to address possible cross-cultural patterns of neuropsychological outcomes that remain underexplored. Methods: In this cross-sectional, retrospective study, we characterize the cognitive performance, demographic makeup, and clinical characteristics of 84 PASC patients (Mage = 57 years) referred for neuropsychological evaluation to three USA sites and one in Germany. Neuropsychological data (mean demographically adjusted z-scores and frequencies of impairment) were examined across six cognitive domains. Independent t-tests compared performances of previously hospitalized and non-hospitalized patients. Results: Patients were assessed on average seven months post-COVID-19 infection. The majority were women and non-hospitalized. Mean cognitive performance was within the normative range, but high variability existed within and between sites. Deficits were generally mild and most frequent in processing speed (range across sites: 9–57% of patients), executive functioning (range across sites: 4–43% of patients) and attention/working memory (range across sites: 0–43% of patients). Hospitalized patients showed greater cognitive impairment than those not requiring hospitalization. Mood symptoms and fatigue/sleep disturbance were more frequent than objective cognitive impairments. At the time of assessment, most patients were unable to return to work. Conclusions: Cognitive performance in clinically referred PASC patients was, overall, within the normative range. Mild deficits were most frequent in time-based attentional/executive tasks. Other factors, such as affective symptoms and fatigue, were frequent and may significantly impact functioning, perhaps more than cognition. Further work with larger samples and longitudinal measures is needed to clarify the impact of COVID-19 on cognitive function and psychiatric distress.

The development and implementation of teleneuropsychology in an academic lifespan neuropsychology center: Lessons learned from the COVID-19 pandemic.

INTRODUCTION: Teleneuropsychology (TNP) became a critical means for providing care during the COVID-19 pandemic and may continue as an option for delivery of neuropsychological services. To understand how patient characteristics impact clinician decisions and service models, this study examines practice patterns within a lifespan outpatient neuropsychology center before, during and post-pandemic. METHODS: Patient volume, demographics, and characteristics were compared across four, 3-month time intervals in 2019-2020. Two baseline intervals when the center was physically open (PO) were compared to one interval when the center was physically closed (PC) (all evaluations were conducted via direct-to-home TNP) and a fourth interval when the center was physically reopened (RO) and evaluations were conducted in one of the three modalities: in-person, virtual only or hybrid (both virtual/in-person). RESULTS: A total of 1,459 total neuropsychological evaluations were conducted with a 64.6% reduction during PC. At RO, the number of evaluations returned to pre-COVID baseline during which in-person (72.4%) evaluations were conducted at a higher rate than hybrid (7.1%) or virtual only (20.4%). Across the lifespan, mean number of appointments to complete evaluations was significantly greater during PC (p< .001) than at other time intervals, and during RO, hybrid evaluations required significantly more appointments (p < .001) than in-person and virtual. The majority of evaluations were conducted with adult patients (71.4%). For adult patients, neurodegenerative/memory disorders received TNP evaluations at a higher rate during PC and RO. Pediatric patients were significantly older during PC (p < .001); neurodevelopmental referrals received more hybrid and virtual evaluations. CONCLUSIONS: Results indicate that patient characteristics, especially age and referral categories, impact the feasibility of TNP. Data from the RO period suggest that in-person evaluations not surprisingly remain the mainstay; however, for adult patients, and especially older adults with neurodegenerative/memory disorders, TNP may provide an important option for delivery of neuropsychological evaluations.

Feasibility and Acceptance of Direct-to-Home Tele-neuropsychology Services during the COVID-19 Pandemic.

OBJECTIVE: Neuropsychological assessment via video conferencing has been proposed during the COVID-19 pandemic. Existing literature has demonstrated feasibility and acceptance of neuropsychological measures administered by videoconference, although few studies have examined feasibility and patient acceptance of TNP visits directly to patients' homes (DTH-TNP). METHODS: We modified a previously published patient satisfaction survey for DTH-TNP and developed a clinician feasibility survey to examine experiences during DTH-TNP. RESULTS: Seventy-two patients (age range: preschool-geriatric) evaluated by DTH-TNP for cognitive problems at an academic medical center responded to voluntary surveys between April 20, 2020, and August 19, 2020, and 100% indicated satisfaction. Fifty-nine percent of patients reported limitations (e.g., technological concern) during the appointment. 134 clinician surveys were collected and indicated that clinicians achieved the goal of their appointment in 90% of encounters. CONCLUSIONS: These qualitative data suggest that patients and clinicians found DTH-TNP to be satisfactory during the COVID-19 pandemic, while also recognizing limitations of the practice. These results are limited in that voluntary surveys are subject to bias. They support the growing body of literature suggesting that DTH-TNP provides a valuable service, though additional research to establish reliability and validity is needed.