# Telehealth enabled neuropsychological testing (TENT): a new platform for examiner-led, digital cognitive assessment

## TL;DR

TENT is a new digital platform for remote cognitive testing that modernizes traditional neuropsychological assessments using telehealth technology.

## Contribution

TENT introduces a browser-based, videoconference-integrated system for examiner-led cognitive assessments with validated performance and user experience.

## Key findings

- TENT showed comparable correlations to in-person cognitive measures and captured expected cognitive patterns in epilepsy patients.
- User experience feedback was positive, indicating TENT's usability and acceptance among participants.
- TENT is sensitive to demographic and clinical factors affecting cognition, such as age and medication load.

## Abstract

Cognitive testing provides an essential marker of brain function. Despite the widespread availability of technology, cognitive testing in contemporary practice largely remains rooted in the manual administration and scoring of analog materials. Here we introduce telehealth enabled neuropsychological testing (TENT): browser-based, videoconference-integrated software for examiner-led cognitive assessment.

TENT incorporates a battery of tasks assessing memory, language, processing speed, attention and executive functions. We used TENT to conduct remote, telehealth-based assessments in 531 healthy volunteers, and validated the software in a sample of 452 individuals with drug-resistant epilepsy (DRE) and 392 individuals with newly diagnosed seizures. TENT-acquired measures were compared against clinically acquired, in-person, traditional cognitive measures where available. Participant user experience feedback was obtained in a subset of participants.

Comparison of healthy volunteers and DRE participants yielded a pattern of cognitive compromise characteristic of chronic, drug-resistant epilepsy. TENT data was sensitive to demographic and clinical parameters (e.g., age, antiseizure medication load, lateralised structural pathology, age at seizure onset) known to affect aspects of cognition. Correlations between TENT data and reference in-person measures were comparable to published test–retest coefficients for the reference measures. Participant user experience was overall positive.

TENT modernizes traditional neuropsychological testing by providing for human-led cognitive assessments that exploit the benefits of technology-assisted testing and can be used for remote assessment. It offers a modular, normed and standardized system applicable across a range of neuropsychological conditions, providing reach, convenience, efficiencies and data richness. This approach draws upon the strengths of the traditional assessment model while modernizing contemporary neuropsychological practice.

The online version contains supplementary material available at 10.1007/s00415-026-13732-1.