DECODE: An innovative tool to aid cross-linguistic neuropsychological assessment

Objective: Interpreter-mediated neuropsychological assessments are commonly used when working with culturally and linguistically diverse populations, yet interpreter involvement can compromise test standardization, validity, and patient engagement. This study introduces DECODE (Distant Evaluation of Cognitive Deficits), a digital platform designed to enable clinician-to-clinician collaboration for remote neuropsychological assessment conducted in the patient's native language, thereby reducing reliance on interpreters. The study aimed to evaluate the usability, feasibility, and perceived clinical value of DECODE. Method: A three-phase mixed-methods usability study was conducted. Phase 1, was a simulated neuropsychological assessment workflow using the platform and vetted by usability measures. In Phase 2 pairs of health professionals conducted simulated assessment sessions using DECODE. Phase 3 consisted of a multidisciplinary focus group that explored feasibility, implementation considerations, and integration into clinical practice. Quantitative usability scores were analyzed descriptively against established acceptability thresholds, while qualitative data from simulations and the focus group were analyzed thematically. Results: Usability ratings exceeded established benchmarks for acceptable digital health tools, indicating that the platform is intuitive and easy to use. Participants reported that DECODE could facilitate linguistically appropriate assessments and reduce risks associated with interpreter-mediated testing. Qualitative findings highlighted benefits including improved equity in access to assessment, enhanced patient engagement, and greater confidence in diagnostic interpretation. Conclusions: DECODE represents an innovative and scalable approach to culturally responsive neuropsychological assessment. The findings suggest that clinician-to-clinician digital collaboration platforms improves equity and linguistic accessibility while maintaining clinical rigor. Further research is warranted to evaluate effectiveness and implementation in real-world clinical settings.