Clinical Utility of Home-to-Home Tele-neuropsychology (TeleNP) in the Assessment of Post-Operative Deep Brain Stimulation (DBS) Outcomes in Parkinson’s disease (PD) Patients
Hannah Bullock1, Scott Harcourt2, Dayana Rodriguez3, Annelly Bure2, Corneliu Luca3, Jonathan Jagid2, Bonnie Levin3, Julia See1, Ihtsham Haq4, Marina Sarno2
1University of Miami - Miller School of Medicine, 2University of Miami Department of Neurology, 3University of Miami, 4University of Miami Miller School of Medicine
Objective:
The coronavirus pandemic facilitated widespread implementation of tele-neuropsychological assessment of DBS candidates due to physical distancing and safety requirements. Our prior work has demonstrated preoperative home-to-home TeleNP feasibility and patient satisfaction in determining candidacy for DBS in PD patients. To our knowledge the implementation and feasibility of TeleNP in assessing postoperative outcomes have not been assessed.
Background:
Neurologists work closely with neuropsychologists who evaluate postoperative cognitive, behavioral, and mood outcomes in PD patients. For PD patients with barriers to accessing care, home-to-home TeleNP post-DBS management provides a much-needed resource to increase care access.
Design/Methods:
PD patients [n=28, Mage=62.6(8.8), 75% male, Medu=16.1(3.0), 46.4% Hispanic, 64.3% pretested in English/35.7% in Spanish, 92.9% STN), underwent pre- and post-cognitive (global cognition, language, memory, attention, processing speed, visuospatial ability) and emotional assessments via home-to-home TeleNP between May 2020 and March 2022. PD patients underwent either in-person (n=23) or TeleNP (n=5) evaluation pre-DBS and in-person (n=1) or home-to-home TeleNP (n=27) assessments post-surgery. Paired t-tests were conducted to assess differences between pre and post assessments.
Results:
To date, 28 candidates completed both pre- and post-DBS neuropsychological assessment. Significant differences in semantic fluency (Animals: t(53)=3.89, d=.53, mz-diff=0.6), short- and long-delay verbal recall (CVLT: t(43)=2.95, d=.44, mz-diff=0.4 and t(47)=3.13, d=.45, mz-diff=0.4 respectively), and processing speed (SDMT: t(23)=3.57, d=.73, mz-diff=0.8) were noted at p<.005 (Bonferroni-adjusted for family-wise error), where mz-diff represents z-score decrease from pre- to post-test. In contrast, no significant change was noted in orientation, naming, phonemic fluency, working memory, executive functioning, verbal reasoning, depression, anxiety, or PD symptom dysfunction (PDQ-39).
Conclusions:
TeleNP is a feasible platform for comprehensively assessing short- and long-term outcomes in PD patients post-DBS in English and Spanish. Remote care reduces the risk of patients being lost to follow-up by offering time- and cost advantages to those who have physical or transportation limitations or are living in remote areas.