Objective:

To characterize potential differences in Montreal Cognitive Assessment (MoCA) performance between in-person cognitive testing and video telehealth administration.  In addition to global MoCA scores, we examined potential telehealth effects on mood (PHQ-8, GAD-7), and explored whether the presence of an observer at the participant’s home during remote MoCA testing influenced task performance. 

Background:

Telehealth cognitive testing has become a common assessment approach following the COVID-19 pandemic when in-person testing was restricted for safety considerations.  Although the equivalence of telehealth results to the traditional face-to-face testing is often assumed, formal equivalence validation is limited.

Design/Methods:

Scores from participants in the Emory Health Brain Study (EHBS) were contrasted based upon whether they were tested in the standard face-to-face (F2F) assessment (n=1205) or using a video telehealth administration (n=491).  All EHBS participants were cognitively normal via self-report. 

Results:

Total MoCA scores did not differ across administration method (F2F MoCA=26.6, SD=2.4, telehealth MoCA=26.5, SD=2.4).  The 95% confidence interval for difference in administration was small (CI = - 0.16 – 0.34).  When examining individual MoCA domain scores, administration differences were either associated with no statistically significant effect, or if present were due to large sample sizes, were associated with small effect sizes and differences < 0.5 point. Groups did not differ on GAD-7, although F2F patients reported slightly higher GAD-7 scores of 0.4 point but well within the normal range. The presence of an observer during telehealth testing did not influence MoCA scores.

Conclusions:

While no single study design provides complete evidence of task equivalence between in-person and video telehealth assessment, this report with its large sample size and between subject cohort provides reassurance that administration mode does not introduce systematic performance differences for MoCA test administration.  Continuing studies in clinically impaired groups will be needed to demonstrate the robustness of our findings.