Serial neuropsychological testing potentially provides a powerful tool for tracking disease progress and identifying treatment response. Formal neuropsychometric assessment by a clinical psychologist is ideal but impractical for regular testing. Remote computerised assessment resolves this difficulty by allowing frequent home assessment, but is potentially limited by patient compliance and practise effects. We study the feasibility of this approach in an on-going clinical trial investigating the effects of methylphenidate on cognition after traumatic brain injury (TBI): Dopamine's Role in Enhancing Attention and Memory (DREAM).
A battery of neuropsychological tests was delivered on an iPad. 12 patients with moderate/severe TBI and on-going cognitive complaints completed 7 tasks assessing information processing speed, memory, attention and executive functions. The 25-minute-long battery was performed daily for 4 weeks, following an initial training period. Compliance was good, with over 80% of the sessions completed, and patients found it both beneficial and enjoyable. Despite optimising the battery to minimise learning effects, differing tasks showed varying degrees of practise effects.
We demonstrate a proof of principle that TBI patients will enthusiastically complete regular computerised neuropsychological tests at home. This provides a potentially powerful tool to assess treatment response, but also offers the prospect of facilitating self-directed cognitive rehabilitation.