Mask wearing during neuropsychological assessment negatively impacts performance on verbal tests in older patients

Face masks are recommended to minimize the spread of COVID-19 and are required in many health care settings. Although masks have documented health advantages, they also negatively impact communication, an essential element of clinical neuropsychological assessment. Using a large clinical data set from a major academic medical center, we investigated the effect of mask wearing on neuropsychological test performance. Specifically, we examined performance on eight standard, widely used neuropsychological tests between a prepandemic (unmasked) and postpandemic (masked) group, composed of 754 and 837 adult patients, respectively. We compared performance on verbally mediated versus visually mediated tests, hypothesizing that the postpandemic group, compared to the prepandemic group, would perform significantly lower on the verbally mediated tests but not on the visually mediated tests. In partial support of the hypothesis, we found that the postpandemic group performed significantly worse on the Auditory Verbal Learning Test (AVLT; p = .001). Secondary analyses showed that age moderated the mask-related effect (p = .038), whereby patients 65 and older had significantly worse performance on Digit Span (p = .0027) and the AVLT (p = .0002) with masks on, while patients younger than 65 showed no significant differences. There were no significant differences on any visually mediated tests. These findings suggest that mask wearing during neuropsychological assessment compromises performance on verbally mediated tests in older patients. These findings are particularly relevant for neuropsychologists practicing in geriatric settings. Neuropsychologists performing assessments with masks should be aware that masks may artificially deflate patient scores for reasons unrelated to cognition or clinical condition. (PsycInfo Database Record (c) 2023 APA, all rights reserved).