Questions and answers about the new Telephone Follow-up Packet

General guidance

What is the purpose of the new Telephone Follow-up Packet (TFP), v3.2?

The new version of the TFP — that is, the one containing the C2T neuropsych battery (T-cog) — was created by the CTF as a replacement for the original UDS v3 TFP. In other words, there are still only three packet types:

  • Initial Visit (in person)
  • Follow-up Visit (in person), and
  • Telephone follow-up.

(A telephone version of the Initial Visit Packet is being developed, however.) The new TFP can still be used with participants and co-participants who have physical or cognitive issues that prevent them from making in-person visits, since the two additional forms (i.e., B6, C2T) are optional.

Why isn’t Form Z1X in the Guidebook?

As a strictly administrative form, Z1X is not typically included in the coding guidebook that NACC creates.

Do I fill out a Milestone Form?

NACC does not ask for milestone form when a participant transitions from in-person to telehealth visits because of COVID-19. Instead, the CTF amended Form T1 to include COVID-19 as a reason for completing a telephone visit.

May we continue to submit the old version of the TFP (v3.0)?

NACC will accept the old TFP version for any visits that occur before February 1, 2021. Any visits that occur on or after that date must be conducted using the new TFP version. This should give ADRCs a six-month window, starting July 2020 with the release the TFP 3.2 DED and data templates.

How should we record responses?

In addition to the fillable forms provided by NACC, staff are strongly encouraged to make and store an audio or video recording of each session. If staff is calling from home, the participant can be put on speakerphone and recorded with an external recorder. If interviewers are calling from the clinic, they can use recorders that interface with the phone and store recordings that can be transferred via USB. The CTF also hopes to have more information soon about specific digital recording devices.

Why is there no language question for Form C2T on Form Z1X?

Spanish translations exist for those C2T tests that are required; however, the decision was made not to include a language check box on Form Z1X until a Spanish-language translation for the full C2T battery (i.e., required and optional tests) is available. A translation work group is currently engaged in this effort.

Are there norms for remote assessment?

A validation study is expected to begin in four to six months, as in-person visits are allowed, to establish norms and determine questions such as whether phone testing is more difficult than in-person, or vice-versa.

Neuropsych test administration guidance

How do we score the Verbal Naming Test?

Form C2T Question 12b (i.e., Total correct with phonemic cue) is the sum of correct responses with a phonemic cue provided. It is not the sum of correct responses with and without a phonemic cue. The sum of Question 12a (i.e., Total correct without a cue) and 12b should not exceed 50.

How should we select participants to test with the T-cog?

Each Center may determine which participants to test based on local considerations. Centers that participate in the inter-ADRC validation study will receive a plan for randomizing participants, who will receive both in-person and T-cog visits.

How can we distinguish distractions from interruptions?

It can be difficult to determine this remotely. Occasionally someone at the participant’s home interrupts (you may hear them speaking in the background, for instance). When permitted by the Neuropsychologic Battery Instructions, we suggest repeating. However, it is also important to ask participants before starting if they are alone in a quiet spot where they will not be disturbed.

Is there a separate battery for controls? Currently there is no separate battery for controls. With additional experience, this may change, e.g., for participants with AD, we may recommend administering only the core battery.

How should we determine inability to proceed?

The same cut-offs are used for UDS3 tests, and others are specified for new tests (i.e., Oral Trail Making Test). For other tests, presumably experienced examiners will use the same considerations for discontinuing (frustration, refusal to continue, etc.).

How much repetition is permitted?

Guidelines for interviewers are given in the Neuropsychologic Battery Instructions. For tests that have been part of the UDS battery, the guidelines have not changed.

Why are there multiple attempts on the scoring sheets for the Oral Trail Making Test?

The multiple attempts were there initially to record errors but were removed in the updated version for clarity.

How should we track frequently misunderstood words?

A text box has been provided on the test sheet to note words that are frequently misunderstood. Sites may wish to collect and discuss them with interviewers to make sure they are not interviewer-specific (in which case we suggest working with interviewer on clarity, enunciation, accent, etc.). We would then create a rule that allows for presumably misunderstood words, provided the same word is recalled throughout testing.

Video vs. phone assessment?

Video is preferred when possible. The script provided for phone assessment is considered appropriate for video assessment as well. If using video, examiners may wish to assess the participant’s video quality by presenting a small drawing in the beginning of the assessment.

How should we handle high GDS scores?

The script provided in the Neuropsychologic Battery Instructions is offered as one way to deal with this situation. Each Center is to adopt and implement its own procedures, if these are not already in place.

May we add tests to the battery?

Centers that wish to add tests (e.g., MINT or Benson, important for FTLD) may do so. As always, however, the tests must be given separately. The T-cog battery must be given in the established order, with no site-specific tests interspersed.

Will Verbal Naming be translated?

This test will be difficult to translate into Spanish because of all the regional variations possible. Fortunately, the core tests are already available in translation.

Why does the MoCA change position in the test order?

In the shortest form of the battery (see Table 1 on page xii of the Neuropsychologic Battery Instructions), the MoCA is used to create the appropriate time lapse between the immediate and delayed Craft Story tests. Tables 2 and 3 show the longer batteries, which incorporate the RAVLT list recall test. Here, the MoCA was moved before the Craft Story to minimize interference by creating a lapse between the MoCA and RAVLT. A brief questionnaire or other NACC telephone follow-up form (e.g., medications, updating demographics and family history) could be placed in the delay if needed.

Can Centers who historically administer other forms of the RAVLT or other VLTs continue to do do?

Use of a verbal learning test is strongly encouraged and standardized RAVLT instructions are provided at part of the C2T (T-cog) Battery, but Centers can employ alternate forms of the RAVLT or other VLTs and should document locally the specific test and form administered.

Is there a discontinuation rule for the Verbal Naming Test?

The CTF recommends discontinuing testing after six consecutive failures (i.e., failure to name correctly without assistance or with a phonemic cue.) This guidance is similar to the discontinuation criteria for the Boston Naming Test and Multilingual Naming Test, and has been added to the C2T (T-cog) instructions.

What should be said to a participant if they make a mistake during the Oral Trail Making Test?

The CTF has recommended that the following instructions, which have been added to the C2T (T-cog) instructions.

If the patient makes an error on Part A, the examiner is to reorient them to the last correct number by saying: “You last said ‘[specific number],’ please continue from there.”

If the patient makes an error on Part B, the examiner is to reorient them to the last correct pair by saying: “You said ‘[specific number] [specific letter];’ Continue from there.”

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NACC is funded by the National Institute on Aging (U01 AG016976) and located in the Department of Epidemiology at the University of Washington School of Public Health, Walter A. Kukull, Ph.D., Director. © 2021 University of Washington