Remote cognitive testing with older people with hearing and vision impairment

Speakers

• Chair: Prof Iracema Leroi, Associate Professor in geriatric psychiatry, Trinity College Dublin and one of the directors of Dementia Academy
• Dr Walter Wittich, School of Optometry, Université de Montréal, Montréal, Canada
• Dr Natalie Phillips, Dept of Psychology , Concordia Univ, Quebec, Canada

Dr Natalie Phillips is one of the original co-developers of the Montreal Cognitive Assessment (MOCA), one of the most widely use cognitive tools in the world. The initial developer team consisted of Ziad Nasreddine, Howard Chertkow and Natalie in 2005. Dr Walter Wittich became involved in 2010 when he was interested in the effect of eliminating visual items from the test. Recently, due to the push for remote assessments, there has a been a lot of interest in using the MOCA remotely.

Background

The COVID-19 pandemic is having a significant impact on all of us and how we are practicing, medicine, particularly in the way we are supporting older people with dementia and their care partners. In adapting to this new reality, many clinicians around the world have started to adapt their clinical practices to remote working using telemedicine approaches. For those working in the realm of memory services, a key element involves cognitive testing.

Remotely delivered cognitive testing can be quite basic, or, it can involve much more complex approaches under the rubric of ‘teleneuropsychology’.

Questions answered during the webinar

• For older people with dementia, how common are hearing and vision impairments? (2:20)
• What is the impact of single – or dual sensory impairment on individuals living with dementia? (4:13)
• What are some of the challenges in undertaking cognitive assessments, or memory assessments in general, in older people with HV problems? (6:02)
• Please outline briefly the guidance offered by the MOCA developers regarding its use by telephone or videolink (8:06)
• Considering then the special circumstances of people over the age of 70 who might have hearing and vision impairment, what are some of the challenges a person being tested may face? (11:34)
• Some have suggested adapting the items on the test or altering the mode of administration? Is this appropriate? (14:10)
• Can you suggest ways to ascertain whether undertaking the MOCA, or any other cognitive test using remote methods, is appropriate, from the perspective of hearing and vision impairment? (20:12)
• Considering all this information, what is your advice regarding the use of the MOCA or similar cognitive tests in the remote setting for this population? (23:53)

Resources

Special Issues on Using the Montreal Cognitive Assessment for telemedicine Assessment During COVID‐19

The Montreal Cognitive Assessment After Omission of Hearing‐Dependent Subtests: Psychometrics and Clinical Recommendations

First impressions of performing bedside cognitive assessment of COVID‐19 inpatients

Clinical judgement is paramount when performing cognitive screening during COVID‐19

Sensitivity and Specificity of the Montreal Cognitive Assessment Modified for Individuals Who Are Visually Impaired