Teleneuropsychology: Exploring the Link between Sociodemographic Variables and Cognitive Performance in Virtual Contexts

Carrizo R and Gonzalez Aguilar MJ

Published on: 2024-04-04

Abstract

Teleneuropsychology (TNP) has emerged as an essential tool, especially amid the COVID-19 pandemic, where telemedicine platforms experienced significant growth. While TNP holds promise, disparities in its adoption exist among healthcare providers and patients, notably influenced by educational and socioeconomic factors. Lower educational levels correlate with reduced computer literacy, delaying TNP utilization, while socioeconomic status affects access to essential resources, impacting health outcomes. Educational level and socioeconomic status significantly influence cognitive reserve, a protective mechanism against neurocognitive decline. Higher educational levels correlate positively with cognitive function throughout adulthood, reducing dementia risk. Likewise, higher socioeconomic status is associated with better neurocognitive development, particularly in language and executive functions. Despite its potential, TNP faces challenges in addressing disparities. Studies comparing in-person and virtual assessments have shown comparable results, yet research including lower-educated populations remains scarce. Further investigations are warranted to understand the impact of educational and socioeconomic factors on TNP adoption and effectiveness fully. Addressing these disparities is crucial for optimizing the effectiveness of TNP and enhancing neurocognitive care delivery in the digital age.

Keywords

Teleneuropsychology; ICTs; Sociodemographic variables; Cognitive assessment

Mini-Review

The convergence of science and technology in the digital era has facilitated a precise and easy characterization of health and disease [1]. Telemedicine, which extensively utilizes information and communication technologies (ICT), has become a fundamental service for improving healthcare and enabling remote patients to connect with healthcare professionals [2]. Particularly, the provision of telemedicine has experienced a significant increase and has been integrated as a routine component in clinical practice [3]. Social distancing during the COVID-19 pandemic has increased the implementation of telemedicine platforms [4], with teleneuropsychology (TNP) specifically growing at an accelerated pace [5]. TNP refers to the application of audiovisual technologies to enable remote clinical sessions aimed at conducting neuropsychological assessments [6]. However, not all healthcare providers or patients are equally prepared to adopt TNP [7]. In this context, educational level becomes an important factor for computer and internet strategic competencies, especially in healthcare [8]. Additionally, patients with lower educational levels are less likely to use the internet to communicate with healthcare professionals. Significant differences have also been observed based on socioeconomic status, especially concerning healthcare access [9]. Regarding educational level and neuropsychological assessment, education is associated with the acquisition of cognitive and non-cognitive skills, such as self-efficacy, intelligence, sense of control, motivation, and problem-solving ability. Furthermore, education plays a fundamental role as a socializing institution in adulthood, influencing the formation of healthy behaviors [10]. While some research indicates that education does not exhibit a significant impact on neuropsychological assessment, others suggest otherwise [28-33]. Regarding socioeconomic status and neurocognitive assessment, occupation significantly influences individuals' income and purchasing power, affecting variables such as healthcare expenditure, housing quality, and geographic location. Additionally, it plays a fundamental role as a socializing institution in adulthood, promoting and maintaining psychosocial resources associated with better health [10]. Individuals with higher financial capital in later life have been associated with better cognitive performance, while those with lower socioeconomic status demonstrated poorer performance in evaluated domains [11]. It is relevant to mention the theory of cognitive reserve, which can be subdivided into two models: a passive one and an active one [12]. Within the passive model is the brain reserve, referring to structural brain differences that may increase tolerance to pathology ([13]. The active model relates to cognitive reserve, which refers to differences in individuals' susceptibility to age- or pathology-related brain changes. It indicates that some people can tolerate more of these changes than others and still maintain certain functions [13]. This explains why individuals with higher intelligence quotient, more years of education, higher occupational level, or greater engagement in leisure activities show less severe clinical changes in the presence of pathologies such as Alzheimer's [14,15]. Variables related to exposure and cognitive activity throughout life, such as years of education, literacy level, leisure activities, or occupational complexity, are used to estimate cognitive reserve [16].

Formal education is strongly correlated with cognitive reserve [17-20] each additional year of formal education is positively associated with cognitive function throughout adulthood and reduces the risk of dementia later in life [19]. It has been demonstrated that for each additional year of education, the risk of dementia decreases by 7% [15]. Therefore, lower educational levels could be considered an indicator of dementia risk compared to higher educational levels [21]. Socioeconomic status is an important predictor of neurocognitive development, especially in areas such as language and executive functions [22]. Additionally, socioeconomic status can be a fundamental cause of disease, as it affects multiple health outcomes due to its influence on access to essential resources. It is essential to pay attention to these disparities to ensure the effectiveness of intervention strategies [23]. TNP has proven to be an excellent tool for addressing cognitive diagnoses [24] as it has been used for several years with good clinical and research results [34]. Previous studies have compared in-person and virtual neurocognitive assessments and obtained similar results in both assessment modalities [5, 25] currently, there is substantial support for the use of videoconferencing technology in remote neuropsychological assessments [26]. However, studies including patients with less than 12 years of education have not been conducted, limiting the ability to make recommendations regarding the use of TNP in populations with lower educational levels [26]. This is because not all individuals with lower educational levels may have fully adopted the use of computer technology, as they may face difficulties in understanding how to use it [27]. In conclusion, TNP appears to be a valuable modality for conducting neurocognitive assessments in adults under virtual modalities. Considering that educational level and socioeconomic status affect cognitive performance, it is crucial to have TNP studies that include samples with low educational levels. Although previous research has found similar results in the performance of adults evaluated under in-person or virtual modalities, the relationship between these variables and sociodemographic variables has been limitedly investigated. In this regard, the purpose of this work is to highlight the importance of evaluating performance in in-person and virtual neuropsychological assessments in adults, considering educational and socioeconomic levels.

Journal of Aging Science and Gerontology

Teleneuropsychology: Exploring the Link between Sociodemographic Variables and Cognitive Performance in Virtual Contexts

Abstract

Keywords

Mini-Review

References