2 Mask Wearing During Neuropsychological Assessment Negatively Impacts Performance on Verbal Tests in Older Patients
Authors: Thomas Amber C , Tranel Daniel 
Published: December 2023

Objective:

Face masks are required in many healthcare settings. Face masks have well documented health advantages, but they can negatively impact interpersonal communication, an essential element of neuropsychological assessment. The purpose of this study was to quantify the impact of face masks on neuropsychological assessment in a large clinical setting.

Participants and Methods:

Participants included 755 pre-pandemic onset (51.3 % men, M = 59.54 years, SD = 17.23) and 838 (51.7% men, M = 60.63 years, SD = 16.71) post-pandemic onset outpatients from a large academic medical center in the Midwest. Performance was compared on selected assessments characterized by visual function (WAIS-IV Block Design, WAIS-IV Matrix Reasoning, and the Rey-Osterrieth Complex Figure Test - Copy trial) and assessments characterized by verbal function (WAIS-IV Digit Span (DS), Rey Auditory Verbal Learning Test (AVLT) total score, and Complex Ideational Material). Secondary analyses compared performance between the groups by age: in an older group (greater than 65 years old) and a younger group (less than 65 years old).

Results:

The pre-and-post pandemic onset groups did not differ with respect to age, gender, education, or clinical diagnosis. Independent Samples T-tests showed that the post-pandemic onset group performed significantly worse on two verbal tests, DS (p =.005, Cohen’s d = 0.131) and the AVLT (p <.001, Cohen’s d = 0.245). Within the older group, the frequency of patients with dementia (54.1 vs 54.8 percent), and all other diagnoses, was comparable pre-and-post pandemic onset. The younger group also had comparable rates of clinical diagnoses at each time point. Secondary analyses showed that the older group was the only group to perform significantly worse on the two verbal tests post-pandemic onset: DS (p =.004, Cohen’s d = 0.20) and AVLT (p <.001, Cohen’s d = 0.39). The younger group had no differences in their performance on any of the verbal tests. For both the primary and secondary analyses, none of the groups had a significant change in performance on the tests that were characterized by visual function.

Conclusions:

These results suggest that mask use during neuropsychological assessment may hinder performance on tests that require close attention to verbal output in older patients. This finding is not otherwise explained by demographic or clinical differences. In fact, these patients had nearly identical rates of dementia before and after the onset of the pandemic. In contrast, performance on tests that rely mainly on visual function was not affected. Attending to masked speech may be more cognitively demanding for older individuals, thus influencing their performance during testing. This may be particularly relevant for neuropsychologists working in geriatric settings.

Neuropsychologists performing assessments inperson, with masks, should be aware that patient scores on certain tests may be artificially deflated for reasons unrelated to cognition or clinical condition.