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The effects of mask-wearing and teleneuropsychological assessment on people's memory performance on neuropsychological tests

Abstract
In the wake of the Coronavirus disease (COVID-19), the standardised conditions of neuropsychological assessments were greatly impacted to prevent the spread of COVID-19. Neuropsychological assessment conditions were altered to be conducted remotely on Zoom (teleneuropsychological) or continued in-person with the use of face masks. The changes to standardised assessment conditions led to an increase in people’s worries around assessment, made it harder to hear the assessor which led people to increase their listening effort and created more ambiguous non-verbal social cues (Bottalico et al., 2020; Aguilar & Leguizamon, 2021). These additional assessment aspects may be leading to increased pressure on people’s cognitive load by taking up more of their cognitive resources and attention, then leaving less cognitive resources to focus on the assessment. Moreover, memory tests require high rates of attention and focus to accurately encode, manipulate and retrieve information that is presented. However, the added pressure on cognitive load leaves less available cognitive resources to focus on the memory tests, which in turn may influence people’s performance on these tests. When cognitive load is overloaded, people have issues with attention, encoding and later retrieving or remembering that same information (Lezak et al., 2004). To determine whether the changes to assessment conditions (test environment and mask-wearing) impact people’s memory performance, we conducted a 2x2 mixed methods design (between-subjects factor: test environment (zoom/in-person), within-subjects factor: mask-wearing (mask/no mask). Our sample consisted of 64 participants, aged 18-59, with 43 females, 20 males and 1 participant who preferred to self-describe. Participants were included based on a screening criteria and were required to complete a range of neuropsychological tests for two sessions, either via Zoom or in-person, 1-2 weeks apart. All participants completed one session with the assessor wearing a mask and one session without. Participants scores were compared on the Verbal Learning, Digit Span and Verbal Fluency subtests between the test environments (Zoom/In-person) and mask-wearing (Mask/no mask) variables, to assess their impacts on people’s memory functioning. Results showed no significant differences between participants’ performance on these tests between the in-person and teleneuropsychological assessments or mask-wearing compared to no mask. A statistically significant but not clinically significant interaction effect was found on Verbal Learning trial 5, where participants performed the worst in the Zoom condition when the assessor was wearing a mask. This result was not clinically significant and overall, our results suggest teleneuropsychological assessment and mask wearing during assessment do not impact people’s memory performance and, therefore, are valid and reliable methods of assessment in a population aged 18-59 years with no cognitive impairments. However, we did find that the alternate forms used for the Verbal Learning subtest were not equivalent. Participants’ performed statistically significantly worse and recalled fewer words on the Crawford Verbal Learning test compared to the Rey Auditory Verbal Learning Test (RAVLT). This result was not clinically significant but is a clinically meaningful finding for neuropsychologists in New Zealand to consider when administering alternate forms of the RAVLT test.
Type
Thesis
Type of thesis
Series
Citation
Date
2023
Publisher
The University of Waikato
Rights
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