Neuropsychology in the Age of Digital Health

A groundbreaking and accurate guide to the latest digital technology relevant to neuropsychology clinicians, researchers, and trainees Neuropsychology in the Age of Digital Health: Exploration, Application, and Practical Implementation, delivers a practical, up-to-date guide to the implementation of digital health tools in clinical and training settings. This includes authoritative and accurate discussions of the incorporation of digital screening tools and comprehensive assessment methods into neuropsychology practice environments, while also discussing the use of digital cognitive health tools in disease management and how those tools can be used as part of stepped-care models and population health management. Readers will find: Practical advice for integrating new digital tech into clinical and educational settings, with original data gleaned from a survey of current clinical neuropsychology trainees Effective strategies for addressing the most pertinent ethical challenges that arise from the use of digital technology in this field Examinations of exploratory tools that are useful in research settings and that have potential applications in clinical work Neuropsychology in the Age of Digital Health is an essential resource for undergraduate and graduate students with an interest in clinical and research neuropsychology, practicing clinical and research neuropsychologists, and students of graduate-level cognitive assessment courses.

List of Contributors xv About the Authors xix Part I Transformation of Neuropsychology in the Digital Age 1 1 The Digital Evolution in Neuropsychology 3 Section 1: Digital Transformation in Neuropsychological Assessment 3 Shifali Singh Introduction 3 Past and Present: Paper-and-Pencil Tests 4 The Rise of Computerized Neuropsychological Testing 5 A Digital Revolution in Neuropsychology 7 Mobile and Cloud-Based Assessments 7 Passive Digital Biomarkers 8 AI and ml 8 Neurotechnology Integration 8 The Imperative for Continued Technological Evolution 8 Section 2: Neuropsychologists and Digital Tools for Cognitive Health Management 10 Sara Weisenbach Population Cognitive Health Management 10 Stepped Care for Neuropsychology 10 Challenged to Utilization of Digital Tools in Clinical Settings 11 Part II Current Applications of Technology in Neuropsychology 17 2 Advancing Cognitive Health: Digital Screening Tools 19 Kathryn Marton, Adaeze Njoku, Brianna Clark, and Michelle H. Chen Introduction 19 Overview of Digital Cognitive Screening Tools 21 Cambridge Neuropsychological Test Automated Battery 21 The Brain Health Assessment 61 Montreal Cognitive Assessment Digital Version 62 Cognivue 63 NIH Toolbox-Cognition Battery 64 Neurotrack 66 BrainCheck 66 Integrated Cognitive Assessment 67 Immediate Post-Concussion and Cognitive Testing 68 The Cogstate Brief Battery 70 NeuroTrax 71 Central Nervous System Vital Signs 72 The Quantified Behavioral Test 74 The MicroCog 76 mci Screen 77 Comparison of Tools by Use Cases 78 Early Detection of mci 78 Concussion Assessments 79 Processing Speed Tests 80 Attention Tests 80 Tests Validated in Pediatric Population 81 Conclusions and Future Directions 81 3 Digital Tools for Assessing Cognitive Health in the Aging Brain 111 Kelly Atkins and Elena Tsoy Introduction 111 Advantages of Digital Cognitive Assessment 112 Challenges Related to the Use of Digital Cognitive Assessment 114 Overview of Current Digital Cognitive Assessments in Aging Research 115 Special Considerations for the Use of Digital Cognitive Assessments in Low-resource Settings and Diverse Populations 117 Recommendations for Implementation of Digital Cognitive Assessments in Aging Research and Clinical Care 119 Conclusion 120 4 Incorporating and Validating Digital Tools in Clinical Assessment 125 Shifali Singh Introduction 125 Psychometric Properties and Validation Considerations 126 Reliability 126 Validity 127 Construct Validity 128 Criterion Validity 128 Ecological Validity 128 Benefits of Integrating Digital Neuropsychological Assessment 129 Enhanced Data Collection and Analysis 130 Improved Diagnostic Precision Through Multimodal Assessment 130 Efficiency and Accessibility Through Remote Administration 130 Detailed Process Analysis 131 Integration with Wearable Devices for Continuous Monitoring 131 Scalability and Standardization for Large-scale Applications 132 Data Collection and Interpretation Challenges and Opportunities 132 Environmental and Technology Variability 132 Generalizability Across Devices 133 Access to Novel Tools and Upkeep 133 Sensitivity and Specificity 133 Cultural and Demographic Considerations 133 Standardization and Interoperability 134 Task-based Integration of Clinical Utility 134 Applications in Clinical Practice 134 Future Directions 136 5 Exploratory Digital Tools for Measuring Cognitive Health 141 Section 1: Capturing Behavior in the Real-world with Digital Tools 141 Maureen Schmitter-Edgecombe Introduction 141 Enhancing Real-world Assessment with Digital Tools 143 Enhancing Real-world Interventions with Digital Tools 145 Clinical Integration of Digital Tools 147 Section 2: Digital Neuropsychology and the Assessment of Cognitive Change 148 Nelson Arley Roque and Laura Thi Germine Introduction 148 Designing Digital Cognitive Assessments for Broad Accessibility 149 Key Accessibility Barriers and Approaches to Addressing Them 150 Addressing Language Barriers 150 Cultural Barriers to Usability 151 Perceptual–Motor Barriers 151 Digital Literacy 151 Return of Individual Research Results 152 Quantifying Cognitive Changes on Short and Long Timescales 152 Typical Approaches to Measuring Cognitive Change 152 High-frequency Assessment using Digital Technology 153 Dynamic Cognitive Features 153 Selecting Cognitive Tests for Capturing Dynamic Cognitive Features 154 Conclusion 155 Section 3: AI in Clinical Practice 155 Liz Angoff and Gerald Angoff Introduction 155 Integrating AI into Clinical Practice 156 Limitations and Cautions 159 Conclusions 160 Part III Leveraging Technology for Integration in the Broader Medical System 175 6 Utilizing Digital Tools in Psychiatric Practice 177 Ana F. Trueba-Yepez and Ipsit V. Vahia Introduction 177 Integration of Technology into Clinical Workflow 178 Lessons Learned from Implementing EMRs 178 Anticipating and Mitigating Roadblocks in Medical Technology Integration 180 Setting-up Office Spaces for the Use of Technological Devices 180 Determining Digital Literacy 181 Digital Literacy and Need for Support in Medical Technology Integration 181 Privacy and Confidentiality 182 Insurance Coverage 182 Digitizing Interventions 183 VR in Psychotherapy 183 Enhancing Mindfulness Through VR 183 Barriers to Pragmatic VR Interventions 183 Accessibility and Cost Considerations 184 Developing a Clinical Workforce Adept at Working with Technologies 184 Digital Phenotypes to Digital Biomarkers 184 New Approaches to Generating and Incorporating Evidence 185 A New Generation of Practice Guidelines 185 New Training Curricula and a New Language of Psychiatry 186 Ethical and Regulatory Concerns and the Potential for New Forms of Liability 187 Conclusion and Summary 187 Sources of Support 188 Disclosures of Potential Conflicts of Interest 188 Other Sources of Funding 188 7 Digital Health Tools in Stepped Care Models 191 Sara Weisenbach Introduction 191 Stepped Care Models 193 Stepped Care for ADHD Evaluation 194 Stepped Care for Mild and Major Neurocognitive Disorder 195 Integration of Neurotechnology in Neuropsychology Stepped Care Models 196 Conclusion 198 Disclosure Statement 199 Funding Sources 199 8 Population Health Management 203 Section 1: The Role of Neurotechnology in Population Health Management 203 Margaret Lanca Introduction 203 Factors that Promote Health of a Population 204 Healthcare Spending 204 Social Determinants of Health 205 Healthcare Delivery Imperatives 206 The Critical Need for Technology in Population Healthcare Management 206 Security Considerations 208 Neuropsychology Population Health 208 The Role of Neurotechnology in Neuropsychology 210 Data Structures in Neuropsychology 210 Expanding Neurotechnology Innovations 210 Conclusion 212 Section 2: Leveraging Technology to Tackle Inequalities in Research and Clinical Settings 212 Meredith C. Rowe, Christopher Gonzalez, Averi Giudicessi, Daniel Saldana, and Yakeel T. Quiroz Current Digital Technologies in Research and Clinical Settings 214 Top of Form 215 Remote and Unsupervised Assessments for Detection of Cognitive Impairment 215 Challenges and Solutions 218 Conclusion and Future Directions 219 Part IV Implementation, Future Directions, and Ethical Challenges 233 9 Training in Technology and Innovation for Clinical Neuropsychology 235 Robert M. Bilder The “New” Competency in Technology and Innovation: Where Did It Come from? 235 The Minnesota Update Conference 237 Functional Competency in Technology and Innovation: What Is It? 237 Demonstrate Awareness of and the Ability to Incorporate Innovative Methods and Technologies 238 Critically Evaluate Relevant Technologies and Show Awareness and Appreciation for Advantages and Potential Limitations 249 Consider Ethical Issues 250 Training Technology and Innovation Competencies at Different Levels 255 Concluding Remarks 268 10 Neurotechnology in Clinical Practice 273 Stephen Gillaspy and Scott Sperling Section 1: Financial Considerations When Billing Using Digital Tools 273 Introduction 273 Interprofessional Consultation Services 274 Online Digital Assessment and Management Services 276 Remote Therapeutic Monitoring Services 277 Digital Mental Health Treatment Services 279 11 Neurotechnology and Trainees 285 Ross Divers, Rini Kaplan, Jessica Lanctot, Travis Marchman, Katelin Curtis, Shifali Singh and Sara Weisenbach Introduction 285 Trainees’ Perspectives on the State of Education on Neurotechnology 287 A Guide for Addressing Training Gaps 289 Envisioning the Future of Neurotechnology in Neuropsychology 290 Appendix A: Survey Questions 293 Appendix B: Survey Results 294 12 Ethical Challenges for Artificial Intelligence in Clinical Practice and Research: A Case Study on People with Dementia 297 Bettina S. Husebo, Justin Haugland-Pruitt, and Monica Patrascu Introduction 297 AI-driven Tools: a Double-edged Sword 299 Bias in Design 299 Bias in Assumptions 299 Bias in Data 300 Bias in Use 300 Trustworthy AI 301 Legal Framework for Responsible Research and Innovation 302 AI and People with Dementia 304 Consent 304 Data Privacy 304 Algorithmic Bias 305 Case Study 305 Phase I. Pre-funding Assessment 306 Phase II. Post-funding Ethical Approval 311 Discussion 312 Recommendations 313 Index 321