Videoconference-Integrated Symbol Digit Modalities and Trail Making Tasks Reproduce their Evidence-Based Written Formats, Overcoming Shortcomings of Remote Oral Assessments

Abstract

Aim Processing speed and attention are commonly affected across various neurological and psychological conditions. The written Symbol Digit Modalities Task (SDMT) and Trail Making Test (TMT) are popular neuropsychological measures assessing these domains and are underpinned by a large body of literature. We aimed to evaluate oral and digital versions of these tasks, adapted for use via telehealth, in individuals with seizure disorders.

Methods One-hundred and fifty-five Australian Epilepsy Project (AEP) participants (55.5% female, 43.9% male; Mage = 36.3, SDage = 12.4, Age Range: 18.3 – 62.9) completed the oral SDMT and TMT during a remote videoconference-based teleneuropsychology consultation and the standard written alternatives in-person. A second sample of 182 AEP participants (55.5% female, 43.4% male; Mage = 36.9, SDage = 14.0, Age Range: 18.1 – 66.7) remotely completed a novel digital SDMT and TMT via a custom teleneuropsychology software (TeleNP) and the standard written alternatives in-person.

Results Both oral and digital SDMT were strongly correlated with written SDMT (r (133) = .77, p < .001 and r (125) = .75, p < .001, respectively). Oral TMT-B exhibited a weaker association (r (126) = .52, p < .001) with written TMT-B than digital TMT-B (r (157) = .69, p < .001). Oral TMT-B was less strongly related to measures of sustained attention and spatial working memory than its written counterpart.

Conclusion Oral, digital and written SDMT are comparable measures, with the oral and digital forms suitable in a teleneuropsychology context. Digital TMT more closely reflects written TMT than does oral TMT, reproducing the visual search, visuospatial working memory, and sustained attention elements absent from oral TMT.

Impact Digital tasks offer increased standardisation and automation in administration and scoring. Further, they can provide additional, clinically useful, metrics of performance and are, therefore, preferable to oral tasks in a teleneuropsychology context.