Direct-To-Home Tele-Neuropsychological Assessment in Older Adults: A Systematic Review.

BACKGROUND: Neuropsychological assessment via remote videoconference and telephone administration in the home setting (i.e., direct-to-home tele-neuropsychological assessment) could increase service provision to older adults. However, current evidence has not yet been synthesized to guide use. OBJECTIVE: A systematic review was conducted to summarize and evaluate available data on (1) the feasibility and acceptability of direct-to-home tele-neuropsychological assessment in older adults; and (2) the reliability of neuropsychological tests compared to clinic standard. METHODS: Six databases were searched (PubMed, Web of Science, PsycINFO, CINAHL, Medline, and Scopus) capturing studies published from January 2014 to May 2025. Eligible studies described feasibility, acceptability, or test reliability with direct-to-home tele-neuropsychological assessment in older adults. The Mixed Methods Appraisal Tool was used for quality assessment. Feasibility and acceptability data were summarized descriptively. A pooled reliability value was calculated per neuropsychological test and compared to repeat in-person assessment as clinic standard. RESULTS: Forty-four studies were included. Feasibility was supported by high assessment completion rates and minimal disruptive faults during direct-to-home administration. Responses on acceptability questionnaire items mapped positively onto constructs from the Theoretical Framework for Acceptability of Healthcare Interventions. Ten of sixteen neuropsychological tests with available evidence had reliability comparable to clinic standard. These included: verbal fluency, Craft story 21, Rey Complex Figure, Judgment of Line Orientation, Boston Naming, Peabody Picture Vocabulary, Letter-Number Sequencing, Written Trail Making Part B, word list memory test recognition, and Montreal Cognitive Assessment. Written materials were provided to administer Rey Complex Figure, Written Trail Making Part B, and Montreal Cognitive Assessment. CONCLUSION: Consistent with the broader tele-neuropsychology literature, direct-to-home assessment is feasible and acceptable in older adults, with evidence indicating comparable test reliability to clinic standards. Embracing this practice model may promote greater support and access to neuropsychological assessment for older adults.