A Comparative Evaluation of Two Telehealth Neurocognitive Assessments for Older Adults With and Without Traumatic Brain Injury in A Quasi-randomized Trial

Objective: The purpose of the study was to investigate acceptable and appropriate testing modalities for older adults with and without traumatic brain injuries (TBI) and efficient service delivery models for clinicians. Setting: Two neurocognitive assessments were administered in telehealth settings to older adults with and without TBI. Participants: Forty-two older adults with no more than mild cognitive impairment, 21 with a history of TBI, and 21 without (aged 71.0 ± 4.45 years) were included. All adults with TBI were in chronic stages post-TBI (5-56 years). Design: Participants from a quasi-randomized self-management intervention study were enrolled in 2 visits. The first virtual visit included neurocognitive assessments. Assessment order was randomized, and intervention providers were blinded to the injury status. Main Measures: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) on the QInteractive platform and CNS Vital Signs (CNSVS). Both validated assessments provide a global cognitive score and subscales. Time to administer and qualitative clinical notes on participation, acceptance, and preference (patient and clinician) were also collected. Results: There was a positive correlation between RBANS and CNSVS, r = .710, P < .001, indicating that both assessments produced similar neurocognitive scores. Participants without TBI had higher global neurocognitive scores than participants with TBI across both RBANS ( t = −4.29, P = < .001) and CNSVS ( t = −2.97, P = .002). When examining subscale scores, CNSVS captured more differences in individual subscales than RBANS. The RBANS administration time (34.86 min, SD = 8.4) was longer than CNSVS (31.29 min, SD = 4.79), but did not differ across injury status (RBANS: t = 1.37, P = .179; CNSVS: t = −1.56, P = .127). Patient preference was unremarkable, and older adults were reported to participate well, but clinicians preferred CNSVS. Conclusion: Regardless of the assessment, both were acceptable and appropriate for older adults with and without TBI. However, CNSVS was preferred by clinicians and captured more differences, suggesting an increased sensitivity for evaluating neurocognition.