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Online neurocognitive test is versatile clinical tool.


NEW YORK -- An online neurocognitive test designed to provide reliable objective information about memory, concentration, and emotional well-being is a highly effective tool not only for guiding patients to appropriate therapy but for establishing the credibility of the clinician, according to the description of one such tool at the American Psychiatric Association's Institute on Psychiatric Services.

The neurocognitive evaluation, which most patients complete on their home computers, "employs explicitly measured scales that reassure patients that I have considered multiple factors and am not just giving my off-the-hip guess and impression," reported Dr. Joseph J. Parks, director of MOHealthNet, the Medicaid authority for Missouri in Jefferson City.

Several proprietary evaluation systems are available, according to Dr. Parks, but his experience has been with a tool called WebNeuro. Physicians develop an account on this online system and then assign a unique code to patients for access. The assessment, which employs validated and standardized tests of cognitive function and related psychometric fields, such as mood and coping skills, takes about 35 minutes to complete.

Results, which are based on comparisons with normative data in a large database, are generated almost immediately. For typical patients, Dr. Parks estimated that it takes 3-5 minutes to interpret the results. Validation studies include one published in 2007 (Behav Res Methods. 2007 Nov;39[4]:940-9).

This assessment tool has a broad number of options over other alternatives, according to Dr. Parks, who called traditional bedside neurocognitive tests "lame." He suggested that the information gleaned from asking patients to spell words backward or perform uncommon math problems is "unimpressive.' Ultimately, "you don't perform these tests most of the time because you have no respect for their value."

Referring patients for assessment by a neurocognitive psychologist or psychiatrist is another option, but Dr. Parks noted that these specialists are in short supply and not always willing to perform evaluations not linked to treatment. Moreover, it might take weeks for a referral to lead to an appointment and then another delay before the specialist provides a report that is "longer than I need."

In contrast, the online neurocognitive tests are available at any time and generate data in hard numbers, showing individual patient performance on a variety of scales relative to normal performance. Dr. Parks reports that he uses this evaluation to gain insight on a broad array of potential diagnoses, such as attention-deficit/hyperactivity disorder (ADHD) and dementia. The test allows the clinician to document impaired memory or concentration, and provide information about relative severity. The data are particularly helpful in cases when the patient is not convinced.

"When patients are not happy that I am not prescribing the stimulant that they requested, I can point to the results to say you don't have ADHD," Dr. Parks explained. He described patients complaining of problems of concentration who can be reassured when the data suggest that, in fact, their performance is on the upper limits of normal.

"When we discuss the results, having taken the test provides the patient with a much clearer understanding of what I mean by concentration or memory," Dr. Parks said. "Results of the test make both sides of the conversation more explicit."

The test also can be repeated to demonstrate the effect of treatment, according to Dr. Parks. Again, an improvement in key scores provides reassurance to the patient when subjective assessments of improvement are doubted.

The test is available in several languages, including Spanish, and it is geared for a third- or fourth-grade reading level. Although Dr. Parks estimated that about 80% of his patients take the test at home, 20% complete the evaluation on a computer at his facility or with assistance from a proctor, such as a behavioral therapist.

Dr. Parks said the test is reimbursed by Medicare and about two-thirds of health insurers in Missouri.

Online neurocognitive testing addresses a large number of the deficiencies associated with previous options, according to Dr. Parks. "This is an area that has been so ripe for change."

Dr. Parks reported no relevant financial relationships.
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Title Annotation:NEUROLOGY
Author:Bosworth, Ted
Publication:Clinical Psychiatry News
Date:Nov 1, 2015
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