None listed
Conditions
Brief summary
Cognitive impairments are common for individuals with brain conditions, however adequate assessment and intervention for such cognitive impairments continue to remain an area of high unmet need. In today’s era of resource-limited healthcare, it is becoming increasingly important to determine the value and impact of health services, including neuropsychology, through high quality clinical trial research to facilitate resourcing and allocation of such services. This trial therefore aims to evaluate the value and impact of neuropsychological assessment on improving outcomes for individuals with brain conditions and their families. Specifically, this project aims to evaluate whether comprehensive neuropsychological assessment with feedback, compared with brief cognitive screening with no feedback, results in: a. improved participant and/or support person understanding of the presenting cognitive and behavioural problems, and how to cope with and manage these problems; b. increased referrer satisfaction; c. more changes to clinical management; and/or more improvements to depression/anxiety symptomatology, self-efficacy, health-related quality of life, and carer burden.
Interventions
Intervention Condition: Neuropsychological evaluation
This will involve an individualised comprehensive neuropsychological assessment and invitation to a feedback session, to which family members/support persons may also be invited. The assessments and feedback sessions will be conducted by registered clinical neuropsychologists/clinical neuropsychology registrars employed at the clinical site and provisional psychologists under supervision by registered clinical neuropsychologists.
The neurops
Intervention Condition: Neuropsychological evaluation This will involve an individualised comprehensive neuropsychological assessment and invitation to a feedback session, to which family members/support persons may also be invited. The assessments and feedback sessions will be conducted by registered clinical neuropsychologists/clinical neuropsychology registrars employed at the clinical site and provisional psychologists under supervision by registered clinical neuropsychologists. The neuropsychological assessments will be conducted using a flexible evaluation approach, which involves adjustment of the neuropsychology test battery on the basis of suspected cognitive impairments, differential diagnoses, and the specific referral question. Where clinically indicated all major cognitive domains will be assessed as well as measures of performance validity. Major cognitive domains include attention, memory, language, visuospatial abilities and executive function. Because this is an intervention that follows a flexible evaluation approach, the length of the neuropsychological assessment can vary from a minimum 90 minutes to a maximum of five hours. Feedback sessions typically last between 30 to 90 minutes. Typically a feedback session would include explanation of the participant's cognitive strengths and weaknesses, formulation of the underlying causes for any cognitive difficulties identified, and strategies and recommendations for how to manage those difficulties. A more detailed account of the typical content in neuropsychological feedback sessions can be found in Longley et al. (2023) and the Psychology Competency Assessment Tool - Feedback checklist (PsyCET-F; Wong et al., 2023), the latter of which will be utilised in this trial to assess intervention fidelity. To establish adherence to the neuropsychological assessment intervention condition, this will be achieved by attendance at the neuropsychological appointment. The clinician will have needed to complete the Clinician PrONTo outcome measure, which will confirm that this has occurred. Adherence to the brief cognitive screen intervention condition will be established by attendance at the brief cognitive screen (MoCA) appointment and the generation of a score that is sent back to the referrer. Thus, adherence to the intervention will be assessed by attendance at these appointments plus the clinician's ratings on the PsyCET-F for a random subset of participants to ensure competency of delivered feedback. Family members/support persons are not typically present for the full neuropsychological assessment, nor the brief cognitive screen, however they will be invited to attend the feedback session with the participant's consent. References: Longley, W. A., Tate, R. L., & Brown, R. F. (2023). The psychological benefits of neuropsychological assessment feedback as a psycho-educational therapeutic intervention: A randomized-controlled trial with cross-over in multiple sclerosis. Neuropsychological Rehabilitation, 33(5), 764-793. Wong, D., Pinto, R., Price, S., Watson, L., & McKay, A. (2023). What does competently delivered neuropsychological assessment feedback look like? Development and validation of a competency evaluation tool. The Clinical Neuropsychologist, 38(1), 116-134.
Sponsors
The University of Western Australia
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inclusion criteria will be that participants; i) have been referred to the clinical site for a neuropsychological assessment to assist clinical management or diagnostic clarification, ii) are able to provide informed consent to participate in research, and iii) are able to complete the baseline and outcome measures. One support person of each participant will also be invited to participate if they are willing and available. Inclusion criteria for the support person will be that they: i) have known the participant for a minimum of 12 months (e.g., family member or paid carer), ii) are able to provide informed consent to participate in the study, iii) are aged 18 years or older, and iv) able to complete the informant baseline and outcome assessment measures administered in English.
Exclusion criteria
Exclusion criteria will include participants: i) who do not meet the referral criteria for the Adult General Diagnostic program at the clinical site. ii) who have been referred for a decision-making capacity assessment, iii) who have been referred for a joint neuropsychological assessment and speech pathology assessment, iv) who are unable to provide informed consent for themselves, v) who require an urgent neuropsychological assessment (e.g., for discharge from an acute setting), vi) who have severe communication difficulties (e.g., secondary to aphasia) or are not fluent in English, impacting their ability to complete the outcome measures in English, vii) with acute risk of harm to self and/or others, and viii) participants who have previously had a neuropsychological assessment.
Outcome results
None listed