03/18/2020
Neuropsychology in the time of COVID-19
Michael W. Parsons, PhD, ABPP and Dustin B. Hammers, PhD, ABPP
Dramatic changes have occurred in daily life over the past weeks as a result of the novel coronavirus and neuropsychologists are among the many professionals impacted.
Impact on Neuropsychology Practice: Epidemiologists urge us to “flatten the curve” of this pandemic, and neuropsychologists are committed to doing their part. Issues to consider include:
• patient safety and mitigation of infection risk for in person testing, such as limiting the touching of test stimuli, sanitization procedures, and distancing
• methods necessary for remote clinical decision making, including either tele-neuropsychological testing or triaging
Regarding tele-neuropsychology, important factors include proper use of measures and ethical/logistical considerations. Numerous tests have been validated for tele-neuropsychology assessment including measures of verbal memory, executive function, working memory, and even some drawing or visual memory tasks (e.g., Cullum et al, 2014).
In a recent talk at a professional conference, Dr. Hammers identified a host of issues that must be considered regarding distance neuropsychological assessment, including validity issues (testing conditions, psychometrics of tests), patient severity, and logistical concerns.
Perhaps most critically, the neuropsychologist must determine which patients and clinical questions are best suited for remote assessment. While the Centers for Medicare & Medicaid Services (CMS) may relax regulations during the current national state of emergency to reduce some licensure and financial barriers, prior to their doing so neuropsychologists must consider all of these important issues.
Neurocognitive impact of COVID-19: A recent literature search revealed only one known case of COVID-19 directly affecting the central nervous system (CNS). Specifically, a 56 year-old man in China developed severe respiratory symptoms followed by altered level of consciousness. CT scan of the head was normal but CSF testing revealed the presence of COVID-19. He recovered and was released from the hospital approximately one month later. Thus, direct CNS infiltration appears rare, but possible.
Immune responses can have secondary impacts on the CNS. COVID-19 appears to result in a massive immune response in some individuals causing a cytokine release syndrome (CRS). CRS is associated with neurocognitive symptoms in other hyper-inflammatory states, and can be managed using immunosuppressant approaches.
It is unknown whether CRS encephalopathy (brain dysfunction) may occur in COVID-19 patients and whether treatments will be effective. Fortunately, many of the patients who experience CRS encephalopathies in other conditions appear to recover well. In the future neuropsychologists may be asked to evaluate survivors of these syndromes for long-term cognitive consequences.
Image source: https://pixabay.com/illustrations/virus-microscope-infection-illness-1812092/
