During the COVID-19 pandemic, many neuropsychological services shifted from an in-person assessment to a tele-neuropsychological assessment format. Prior research studies support the use of telemedicine assessments but have also noted some limitations (i.e., tasks involving direct manipulation of physical stimuli and visuospatial tasks). We sought to examine the relationship between the same neuropsychological tasks administered via a telemedicine versus inperson format in a treatment seeking clinical sample of Veterans with history of TBI.

Veterans with history of mild to severe TBI (predominantly mild TBI) referred to the TBI Cognitive Rehabilitation Clinic within the San Diego Veterans Affairs Medical Center completed a comprehensive neuropsychological assessment to help inform diagnosis and treatment recommendations. 515 Veterans completed traditional in-person assessment (pre-pandemic) and 45 Veterans completed neuropsychological assessment via a telemedicine platform during the pandemic (Veteran was in their home and examiner was in their home or facility office). The total sample consisted of 93% male and 7% female, average age of 33, 13 years of education, 63% White, 13% Other/Non-reported, 12% Black, 6% Asian, 6% Pacific Islander, 2% Alaskan Native, and 1% Multi-Racial, 73% Non-Hispanic, and 27% Hispanic. For the purposes of this study, we used age-corrected subtest scores from the Delis-Kaplan Executive Function System (D-KEFS): Color Word Interference (CWI) and Verbal Fluency (VF), WASI-II Matrix Reasoning, California Verbal Learning Test (CVLT-II), Wechsler Memory Scale (WMS-IV): Logical Memory, and WRAT-IV Reading. We also examined symptoms of anxiety (BAI), sleep quality (PSQI), neurological symptoms (NSI), and symptoms of PTSD (PCL-5). ANOVAs were used to analyze the relationship between tele-neuropsychological versus in-person administration. Additionally, we controlled for performance validity failure.

Tele-neuropsychological task results were comparable to in-person assessment across all tasks, except for D-KEFS CWI color naming subtest where individuals completing the task via telemedicine performed approximately 2 scaled scores below the in-person assessment group, F (1, 278)=6.44, p=.012. Individuals who completed the tele-neuropsychological assessment during the COVID-pandemic did not differ on scores of self-reported symptoms of PTSD or neuropsychological symptoms when compared to in-person assessment of pre-pandemic individuals within our clinic. However, the telemedicine group reported better sleep quality (F (1, 377)=11.94, p=.001) but a trend towards more symptoms of anxiety (F (1, 552)=2.90, p=.089.

These results suggest that many of the verbal memory, language, premorbid functioning, and verbal/visual tasks of executive function can be adequately administered via telemedicine. Substantial variability may exist on measures of processing speed administered via telemedicine, however. Additionally, changes in lifestyle and daily demands during the COVID-19 pandemic may have created unique circumstances that benefited sleep quality for some individuals but also increased symptoms of anxiety/uncertainty.