Visual tests, touch responses: Computer-based neuropsychological tools.

Objective: Investigate three new computer tests of visual abilities relative to traditional paper-and-pencil (P&P) tests on groups with and without cerebral neurological impairment (CNI, Non-CNI) based on MRI and EEG criteria. The new tests employ an intuitive interface with audio instructions, touch responses, non-response prompts, and videography of test behavior. The Presidents Test was designed as an achievement-related measure of visual knowledge; the Railroad Test - visual perception and delayed recognition; and the Swamp Test - visual attention. Attitudes toward testing were assessed with an original Testing Experience Questionnaire (TEQ). Method: Of the 129 participants, 84 were women, 73 identified as non-White, average age 45.5 and education 14.3 years. Procedures included the new computer tests and a selection of standard neuropsychological measures including performance validity tests (PVT). Participants who failed two or three PVTs or had missing PVT data were excluded from main analyses, resulting in N = 115. Results: The new computer tests demonstrated adequate reliability. Correlations and factor analyses confirmed the computer tests as functioning in accordance with design. The Presidents Test was associated with academic achievement. The Railroad and Swamp Tests were linked to visual perception and visual attention. Correlations between computer total test duration time and traditional speed of processing tasks were modest. Computer and traditional tests demonstrated similar discriminability between CNI and Non-CNI groups. TEQ indicated positive attitudes toward testing in general, and computer testing in particular. Conclusions: The new computer tests evaluated in this study were found to be reliable, functioned to assess the designed cognitive domains, and discriminated between CNI and Non-CNI participants similarly to the traditional neuropsychological measures. Attitudes toward computer testing were favorable.

Trajectories of Neurologic Recovery 12 Months After Hospitalization for COVID-19: A Prospective Longitudinal Study.

BACKGROUND AND OBJECTIVE: Little is known about trajectories of recovery 12 months after hospitalization for severe COVID-19. METHODS: We conducted a prospective, longitudinal cohort study of patients with and without neurologic complications during index hospitalization for COVID-19 from March 10, 2020, to May 20, 2020. Phone follow-up batteries were performed at 6 and 12 months after COVID-19 onset. The primary 12-month outcome was the modified Rankin Scale (mRS) score comparing patients with or without neurologic complications using multivariable ordinal analysis. Secondary outcomes included activities of daily living (Barthel Index), telephone Montreal Cognitive Assessment (t-MoCA), and Quality of Life in Neurologic Disorders (Neuro-QoL) batteries for anxiety, depression, fatigue, and sleep. Changes in outcome scores from 6 to 12 months were compared using nonparametric paired-samples sign test. RESULTS: Twelve-month follow-up was completed in 242 patients (median age 65 years, 64% male, 34% intubated during hospitalization) and 174 completed both 6- and 12-month follow-up. At 12 months, 197/227 (87%) had ≥1 abnormal metric: mRS >0 (75%), Barthel Index <100 (64%), t-MoCA ≤18 (50%), high anxiety (7%), depression (4%), fatigue (9%), or poor sleep (10%). Twelve-month mRS scores did not differ significantly among those with (n = 113) or without (n = 129) neurologic complications during hospitalization after adjusting for age, sex, race, pre-COVID-19 mRS, and intubation status (adjusted OR 1.4, 95% CI 0.8-2.5), although those with neurologic complications had higher fatigue scores (T score 47 vs 44; p = 0.037). Significant improvements in outcome trajectories from 6 to 12 months were observed in t-MoCA scores (56% improved, median difference 1 point; p = 0.002) and Neuro-QoL anxiety scores (45% improved; p = 0.003). Nonsignificant improvements occurred in fatigue, sleep, and depression scores in 48%, 48%, and 38% of patients, respectively. Barthel Index and mRS scores remained unchanged between 6 and 12 months in >50% of patients. DISCUSSION: At 12 months after hospitalization for severe COVID-19, 87% of patients had ongoing abnormalities in functional, cognitive, or Neuro-QoL metrics and abnormal cognition persisted in 50% of patients without a history of dementia/cognitive abnormality. Only fatigue severity differed significantly between patients with or without neurologic complications during index hospitalization. However, significant improvements in cognitive (t-MoCA) and anxiety (Neuro-QoL) scores occurred in 56% and 45% of patients, respectively, between 6 and 12 months. These results may not be generalizable to those with mild or moderate COVID-19.

Keeping the team together: Transformation of an inpatient neurology service at an urban, multi-ethnic, safety net hospital in New York City during COVID-19.

The COVID-19 pandemic dramatically affected the operations of New York City hospitals during March and April of 2020. This article describes the transformation of a neurology division at a 450-bed tertiary care hospital in a multi-ethnic community in Brooklyn during this initial wave of COVID-19. In lieu of a mass redeployment of staff to internal medicine teams, we report a novel method for a neurology division to participate in a hospital's expansion of care for patients with COVID-19 while maintaining existing team structures and their inherent supervisory and interpersonal support mechanisms.