Virtual Neuropsychological Assessment After Severe or Critical COVID-19: The NeuroCov Pilot Feasibility Study

Purpose Survivors of COVID-19 experience a myriad of psychological and cognitive complications that persist beyond the period of acute illness. Neuropsychological assessment has traditionally involved in-person testing, which may be inconvenient and costly. We evaluated the feasibility of a remote/virtual assessment tool to characterize neuropsychological outcomes among survivors of severe or critical COVID-19 illness. Methods We conducted a pilot feasibility study evaluating neuropsychological outcomes of a convenience sample of adult patients who survived severe/critical COVID-19 (the "NeuroCov" study) at six and 12 months after discharge from one of two participating hospital sites in London, Canada. Primary feasibility outcomes included recruitment and completion rates, as well as reported technological issues. Secondary outcomes included neuropsychological and functional assessment. Patients completed the web-based Creyos neurocognitive battery (Creyos, Toronto, Canada), questionnaires for depression, anxiety, and post-traumatic stress, and a telephone interview to assess functional status. Patients remotely self-administered the assessments using a computer or tablet device. Results We enrolled 28 patients six and/or 12 months after hospitalization for severe or critical COVID-19 (recruitment rate of 14.3%). Technological challenges with the remote testing platform were rare. Consent rates were 63% for the six-month and 61% for the 12-month follow-up. Nineteen of 28 patients (68%) had at least mild impairment on two or more of the six Creyos tests administered, primarily on verbal processing; 25 (89%) had at least mild depression, 19 (68%) had at least mild generalized anxiety, and seven (25%) reported symptoms of probable post-traumatic stress. Patients reported persistent fatigue, pain/discomfort, and problems with mobility after hospital discharge. Conclusion A virtual neuropsychological assessment platform is feasible to self-administer by patients after hospital discharge, but data were limited by somewhat low participation rates. Future research should examine the accuracy and reliability of the Creyos tool in hospital settings so that the virtual platform may be used in future clinical research evaluating various therapeutic interventions.