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Wadsworth HE, Dhima K, Womack KB, Hart J, Weiner MF, Hynan LS, Cullum CM. Validity of Teleneuropsychological Assessment in Older Patients with Cognitive Disorders. Arch Clin Neuropsychol 2018; 33:1040-1045. [PMID: 29329363 PMCID: PMC6887729 DOI: 10.1093/arclin/acx140] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 11/11/2017] [Accepted: 12/16/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The feasibility and reliability of neuropsychological assessment at a distance have been demonstrated, but the validity of this testing medium has not been adequately demonstrated. The purpose of this study was to determine the ability of video teleconferencing administration of neuropsychological measures (teleneuropsychology) in discriminating cognitively impaired from non-impaired groups of older adults. It was predicted that measures administered via video teleconference would distinguish groups and that the magnitude of differences between impaired and non-impaired groups would be similar to group differences achieved in traditional administration. METHODS The sample consisted of 197 older subjects, separated into two groups, with and without cognitive impairment. The cognitive impairment group included 78 individuals with clinical diagnoses of mild cognitive impairment or Alzheimer's disease. All participants completed counterbalanced neuropsychological testing using alternate test forms in both a teleneuropsychology and a traditional face-to-face (FTF) administration condition. Tests were selected based upon their common use in dementia evaluations, brevity, and assessment of multiple cognitive domains. Results from FTF and teleneuropsychology test conditions were compared using individual repeated measures ANCOVA, controlling for age, education, gender, and depression scores. RESULTS All ANCOVA models revealed significant main effects of group and a non-significant interaction between group and administration condition. All ANCOVA models revealed non-significant main effects for administration condition, except category fluency. CONCLUSIONS Results derived from teleneuropsychologically administered tests can distinguish between cognitively impaired and non-impaired individuals similar to traditional FTF assessment. This adds to the growing teleneuropsychology literature by supporting the validity of remote assessments in aging populations.
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Affiliation(s)
- Hannah E Wadsworth
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kaltra Dhima
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kyle B Womack
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Myron F Weiner
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Hodge MA, Sutherland R, Jeng K, Bale G, Batta P, Cambridge A, Detheridge J, Drevensek S, Edwards L, Everett M, Ganesalingam K, Geier P, Kass C, Mathieson S, McCabe M, Micallef K, Molomby K, Ong N, Pfeiffer S, Pope S, Tait F, Williamsz M, Young-Dwarte L, Silove N. Agreement between telehealth and face-to-face assessment of intellectual ability in children with specific learning disorder. J Telemed Telecare 2018; 25:431-437. [DOI: 10.1177/1357633x18776095] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Introduction Access to cognitive assessments for children living remotely is limited. Telehealth represents a potential cost- and time-effective solution. A pilot study was conducted to determine the feasibility of telehealth to assess cognitive function in children with learning difficulties. Methods Thirty-three children (median age = 9 years 11 months), recruited from the New South Wales (NSW) Centre for Effective Reading, underwent assessment of intellectual ability. Comparisons were made between the intellectual ability index scores obtained by a psychologist sitting face-to-face with the children and another psychologist via telehealth using a web-based platform, Coviu. Results The telehealth administration method yielded comparable results to the face-to-face method. Correlation analyses showed high associations between the testing methodologies on the intellectual ability indices (correlation coefficient range = 0.981–0.997). Discussion Findings indicate that telehealth may be an alternative to face-to-face cognitive assessment. Future work in a broader range of cognitive tests and wider range of clinical populations is warranted.
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Affiliation(s)
| | | | - Kelly Jeng
- The Children’s Hospital at Westmead, Australia
| | - Gillian Bale
- New South Wales (NSW) Department of Education, Australia
| | - Paige Batta
- New South Wales (NSW) Department of Education, Australia
| | - Aine Cambridge
- New South Wales (NSW) Department of Education, Australia
| | | | | | - Lynda Edwards
- New South Wales (NSW) Department of Education, Australia
| | | | | | - Philippa Geier
- New South Wales (NSW) Department of Education, Australia
| | - Carol Kass
- New South Wales (NSW) Department of Education, Australia
| | | | - Michael McCabe
- New South Wales (NSW) Department of Education, Australia
| | - Kay Micallef
- New South Wales (NSW) Department of Education, Australia
| | - Kirsty Molomby
- New South Wales (NSW) Department of Education, Australia
| | - Natalie Ong
- The Children’s Hospital at Westmead, Australia
| | | | - Sylvia Pope
- New South Wales (NSW) Department of Education, Australia
| | - Francine Tait
- New South Wales (NSW) Department of Education, Australia
| | | | | | - Natalie Silove
- The Children’s Hospital at Westmead, Australia
- CSIRO Data 61, Australia
- The University of Sydney
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Dang S, Gomez-Orozco CA, van Zuilen MH, Levis S. Providing Dementia Consultations to Veterans Using Clinical Video Telehealth: Results from a Clinical Demonstration Project. Telemed J E Health 2018; 24:203-209. [DOI: 10.1089/tmj.2017.0089] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stuti Dang
- Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, Florida
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Carlos A. Gomez-Orozco
- South Florida Veterans Affairs Foundation for Research and Education, Inc., Miami, Florida
| | - Maria H. van Zuilen
- Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, Florida
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Silvina Levis
- Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Healthcare System, Miami, Florida
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
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Barth J, Nickel F, Kolominsky-Rabas PL. Diagnosis of cognitive decline and dementia in rural areas - A scoping review. Int J Geriatr Psychiatry 2018; 33:459-474. [PMID: 29314221 DOI: 10.1002/gps.4841] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/21/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Due to the demographic change, the global prevalence of dementia will continually rise. Barriers to diagnosis and care are still high. But timely diagnosis is associated with valuable benefits and can promote timely and optimal management. Receiving an early diagnosis is especially in rural areas a problem due to the limited access to assessments. Therefore, the aim of our scoping review is to investigate different interventions targeted at rural living elderly to screen and diagnose cognitive decline and dementia. METHODS A scoping review was conducted in line with the framework of Arksey and O'Malley. The following databases were systematically searched: PubMed, PsycINFO, Cochrane Library, and ScienceDirect. The interventions were categorized in four main categories (interventions for general practitioners/institutions; online/mobile offers; telehealth applications; telephone-based screenings). RESULTS Thirty studies were included. The four categories show different scopes of application. Telehealth applications show that it is feasible and valid to diagnose dementia via videoconference. Assessments described in three other categories show that remotely used tools are appropriate to screen for mild cognitive impairment or cognitive decline, but are not valid to establish a dementia diagnosis. CONCLUSIONS Telehealth applications can appropriately be used to diagnose dementia. However, most of the studies included only small sample sizes and did not test the applications explicitly in rural or remote populations. Therefore, studies taking these limitations into account are needed. On top, only two RCTs are included in this review indicating that more high quality studies in this field are needed.
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Affiliation(s)
- Janina Barth
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University of Erlangen-Nürnberg, Germany.,National Graduate College "Optimization strategies in Dementia (OptiDem)", Karl and Veronica Carstens-Foundation, Essen, Germany
| | - Franziska Nickel
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University of Erlangen-Nürnberg, Germany.,National Graduate College "Optimization strategies in Dementia (OptiDem)", Karl and Veronica Carstens-Foundation, Essen, Germany
| | - Peter L Kolominsky-Rabas
- Interdisciplinary Centre for Health Technology Assessment (HTA) and Public Health (IZPH), Friedrich-Alexander-University of Erlangen-Nürnberg, Germany.,National Graduate College "Optimization strategies in Dementia (OptiDem)", Karl and Veronica Carstens-Foundation, Essen, Germany
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Wallack EM, Harris C, Ploughman M, Butler R. Telegerontology as a Novel Approach to Address Health and Safety by Supporting Community-Based Rural Dementia Care Triads: Randomized Controlled Trial Protocol. JMIR Res Protoc 2018; 7:e56. [PMID: 29472178 PMCID: PMC5843794 DOI: 10.2196/resprot.8744] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/30/2017] [Accepted: 01/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background Telegerontology is an approach using videoconferencing to connect an interdisciplinary team in a regional specialty center to patients in rural communities, which is becoming increasingly practical for addressing current limitations in rural community-based dementia care. Objective Using the remotely-delivered expertise of the Telegerontology dementia care team, we aim to enhance the caregiver/patient/physician triad and thereby provide the necessary support for the person with dementia to “age in place.” Methods This is a cluster randomized feasibility trial with four rural regions in the province of Newfoundland and Labrador, Canada (2 regions randomly assigned to “intervention” and 2 to “control”). The study population includes 22 “dementia triads” that consist of a community-dwelling older Canadian with moderate to late dementia, their family caregivers, and their Primary Care Physician (PCP). Over the 6-month active study period, all participants will be provided an iPad. The intervention is intended as an adjunct to existing PCP care, consisting of weekly Skype-based videoconferencing calls with the Telegerontology physician, and other team members as needed (occupational therapist, physical therapist etc). Control participants receive usual community-based dementia care with their PCP. A baseline (pre-) assessment will be performed during a home visit with the study team. Post intervention, 6- and 12-month follow-up assessments will be collected remotely using specialized dementia monitoring applications and Skype calls. Primary outcomes include admission to long-term care, falls, emergency room visits, hospital stays, and caregiver burden. Results Results will be available in March of 2018. Conclusions Results from this study will demonstrate a novel approach to dementia care that has the potential to impact both rural PCPs, family caregivers, and people with dementia, as well as provide evidence for the utility of Telegerontology in models of eHealth-based care.
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Affiliation(s)
- Elizabeth M Wallack
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Chelsea Harris
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Michelle Ploughman
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Roger Butler
- Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
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Lindauer A, Seelye A, Lyons B, Dodge HH, Mattek N, Mincks K, Kaye J, Erten-Lyons D. Dementia Care Comes Home: Patient and Caregiver Assessment via Telemedicine. THE GERONTOLOGIST 2017; 57:e85-e93. [PMID: 28158415 PMCID: PMC5654345 DOI: 10.1093/geront/gnw206] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/28/2016] [Indexed: 01/18/2023] Open
Abstract
Purpose of the Study We evaluated the feasibility and reliability of commonly used clinical dementia assessments when administered via direct-to-home telemedicine videoconferencing. To date, few studies assessed the suitability of these measures when used in this setting. Design and Methods Sixty-six participants (33 patients with Alzheimer's disease (AD) and their 33 caregivers) consented to assessment with a battery of tests in both the clinic setting and via telemedicine. We administered cognitive, behavior, and mood assessments to persons with mild, moderate, and severe AD both in the clinic setting and via direct-to-home telemedicine videoconferencing; test-retest reliability was assessed. We also explored how three caregiver measures performed when administered via telemedicine. Assessments were administered 2 weeks apart. Participant feedback about their experience was solicited. Results Twenty-eight dyads completed the assessments. Reliability was found to be good to excellent in all measures when used with direct-to-home telemedicine. For the most part, participants and clinicians found telemedicine to be a feasible option for assessing cognitive function and caregiver coping. Implications Findings indicate that these measures can be used to assess persons with AD, as well as their caregivers, across the telemedicine platform, directly to their homes. Use of this technology can expand access to care to the millions across the United States with AD and their caregivers.
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Affiliation(s)
- Allison Lindauer
- Department of Neurology, Oregon Health & Science University, Layton Aging and Alzheimer’s Disease Center, Portland
| | - Adriana Seelye
- Department of Neurology, Oregon Health & Science University, Layton Aging and Alzheimer’s Disease Center, Portland
- Department of Psychiatry, University of Minnesota, South Minneapolis
| | - Bayard Lyons
- Department of Neurology, Oregon Health & Science University, Layton Aging and Alzheimer’s Disease Center, Portland
| | - Hiroko H Dodge
- Department of Neurology, Oregon Health & Science University, Layton Aging and Alzheimer’s Disease Center, Portland
- Michigan Alzheimer’s Disease Center, Department of Neurology, University of Michigan, Ann Arbor
| | - Nora Mattek
- Department of Neurology, Oregon Health & Science University, Layton Aging and Alzheimer’s Disease Center, Portland
| | - Katherine Mincks
- Department of Neurology, Oregon Health & Science University, Layton Aging and Alzheimer’s Disease Center, Portland
| | - Jeffrey Kaye
- Department of Neurology, Oregon Health & Science University, Layton Aging and Alzheimer’s Disease Center, Portland
| | - Deniz Erten-Lyons
- Department of Neurology, Oregon Health & Science University, Layton Aging and Alzheimer’s Disease Center, Portland
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Park HY, Jeon SS, Lee JY, Cho AR, Park JH. Korean Version of the Mini-Mental State Examination Using Smartphone: A Validation Study. Telemed J E Health 2017; 23:815-821. [DOI: 10.1089/tmj.2016.0281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Hae-yeon Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-soo Jeon
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Youn Lee
- Department of Rehabilitation Medicine, HU and U Hospital, Bucheon, Korea
| | - Ah-Ra Cho
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Hyun Park
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Brearly TW, Shura RD, Martindale SL, Lazowski RA, Luxton DD, Shenal BV, Rowland JA. Neuropsychological Test Administration by Videoconference: A Systematic Review and Meta-Analysis. Neuropsychol Rev 2017. [DOI: 10.1007/s11065-017-9349-1] [Citation(s) in RCA: 172] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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59
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Miller JB, Barr WB. The Technology Crisis in Neuropsychology. Arch Clin Neuropsychol 2017; 32:541-554. [DOI: 10.1093/arclin/acx050] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/10/2017] [Indexed: 11/12/2022] Open
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Castanho TC, Sousa N, Santos NC. When New Technology is an Answer for Old Problems: The Use of Videoconferencing in Cognitive Aging Assessment. J Alzheimers Dis Rep 2017; 1:15-21. [PMID: 30480225 PMCID: PMC6159700 DOI: 10.3233/adr-170007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 12/15/2022] Open
Abstract
People living with cognitive impairment and dementia require regular screening of their symptomatology and needs. Brief cognitive screening is crucial for assessing these conditions. Such screening can give health professionals a snapshot of the patient's cognitive abilities and help in their monitoring and adaptation. An appropriate administration of brief cognitive screening using telemedicine technology, such as videoconference, can improve access to care and treatment planning. Moreover, the burden that rural and underserved communities often suffer because of limited access to specialty mental health services is also of concern. Herein, in this review, we describe the existing and relevant research regarding the administration of neuropsychological instruments via videoconferencing, and suggest methodological improvements for further studies. To date, only a handful of scientific studies have been published documenting the feasibility and acceptability of videoconferencing among older people and health professionals. Varying in their assessment tools, the studies demonstrate the reliability of cognitive testing and clinical diagnosis of dementia via videoconferencing, as noted by the associations between results of several cognitive tests using it as compared to face-to-face interviews. Further research is required to replicate findings and bring new solutions for their adaptation to a wide range of individuals, health professionals, areas of practice and settings.
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Affiliation(s)
- Teresa Costa Castanho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B’s, PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Clinical Academic Center-Braga (CCAB), Braga, Portugal
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Powers BB, Homer MC, Morone N, Edmonds N, Rossi MI. Creation of an Interprofessional Teledementia Clinic for Rural Veterans: Preliminary Data. J Am Geriatr Soc 2017; 65:1092-1099. [PMID: 28295142 DOI: 10.1111/jgs.14839] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The teledementia clinic is a new model of care that expands the reach of specialized geriatric and dementia care using clinical video telehealth (CVT) to rural veterans, who frequently lack access to specialty care. The clinic is a Veterans Affairs (VA) Geriatric Research, Education, and Clinical Center clinical demonstration project. It is located in the Pittsburgh VA Healthcare System tertiary referral hospital and serves veterans in affiliated rural community-based outpatient clinics (CBOCs). Rural CBOC primary care providers refer clinic patients, or referral is according to previous cognitive impairment diagnosis in a VAPHS geriatric clinic. Patients undergo interprofessional dementia assessment by a geriatrician, geropsychologist, geriatric psychiatrist or neurologist, and social worker using CVT technology. Metrics for clinic evaluation included rural patients served and savings in travel time, distance, and costs. Assessments collected depended upon individual presentation and included cognitive tests, geriatric depression scales, functional assessment, and the Zarit Burden Interview. A patient satisfaction survey was created and administered. In the first year, 95 individuals were served in 156 clinic visits and 251 interprofessional provider encounters. Of patients served, 61 lived in rural ZIP codes, 72 were diagnosed with dementia, 19 were diagnosed with mild cognitive impairment, and four were found to have primarily psychiatric diagnoses rather than cognitive impairment. The average Functional Assessment Staging of Alzheimer's Disease Scale score was 4.3 ± 1.3. This clinic model demonstrates that CVT technology is a feasible means of providing interprofessional dementia evaluations and follow-up to rural presidents.
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Affiliation(s)
- Becky B Powers
- Geriatrics Research Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, Texas
- Division of Geriatrics, Gerontology and Palliative Care, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Marcia C Homer
- Geriatrics Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Natalia Morone
- Geriatrics Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Natali Edmonds
- Geriatrics Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Phoenix Veterans Affairs Health Care System, Phoenix, Arizona
| | - Michelle I Rossi
- Geriatrics Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
- Division of Geriatric Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Meiland F, Innes A, Mountain G, Robinson L, van der Roest H, García-Casal JA, Gove D, Thyrian JR, Evans S, Dröes RM, Kelly F, Kurz A, Casey D, Szcześniak D, Dening T, Craven MP, Span M, Felzmann H, Tsolaki M, Franco-Martin M. Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics. JMIR Rehabil Assist Technol 2017; 4:e1. [PMID: 28582262 PMCID: PMC5454557 DOI: 10.2196/rehab.6376] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/16/2016] [Accepted: 10/24/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. OBJECTIVE The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. METHODS Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. RESULTS According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. CONCLUSIONS Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them.
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Affiliation(s)
- Franka Meiland
- Department of Psychiatry, VU University medical centre, Amsterdam, Netherlands
| | - Anthea Innes
- Universities of Salford and Stirling UK, Manchester, Stirling, United Kingdom
| | - Gail Mountain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Louise Robinson
- Institute for Ageing, Newcastle University, Newcastle, United Kingdom
| | - Henriëtte van der Roest
- Department of General Practice and Elderly Care Medicine, VU university medical centre, Amsterdam, Netherlands
| | - J Antonio García-Casal
- Iberian Research Psychosciences Institute, Psychosocial Rehabilitation Centre, Intras Foundation, Zamora, Spain
| | | | - Jochen René Thyrian
- German Center for Neurodegenerative Diseases (DZNE), Site Rostock, Greifswald, Germany
| | - Shirley Evans
- Association for Dementia Studies, University of Worcester, Worcester, United Kingdom
| | - Rose-Marie Dröes
- Department of Psychiatry, VU University medical centre, Amsterdam, Netherlands
| | - Fiona Kelly
- Centre for Person-centred Practice Research, Queen Margaret University, Edinburgh, United Kingdom
| | | | - Dympna Casey
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Dorota Szcześniak
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Tom Dening
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Michael P Craven
- NIHR MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, United Kingdom
- Bioengineering Research Group, Faculty of Engineering, University of Nottingham, Nottingham, United Kingdom
| | - Marijke Span
- Windesheim University of Applied Sciences, Zwolle, Netherlands
| | | | - Magda Tsolaki
- Memory and dementia outpatient clinic, 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Manuel Franco-Martin
- Iberian Research Psychosciences Institute, Psychiatric Department in Zamora Hospital, Salamanca University, Zamora, Spain
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Tso JV, Farinpour R, Chui HC, Liu CY. A Multidisciplinary Model of Dementia Care in an Underserved Retirement Community, Made Possible by Telemedicine. Front Neurol 2016; 7:225. [PMID: 28066313 PMCID: PMC5179531 DOI: 10.3389/fneur.2016.00225] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 11/28/2016] [Indexed: 01/18/2023] Open
Abstract
The need for memory specialists is increasing as the incidence of dementia rapidly rises across the globe. In rural areas, demand for these specialists far outstrips supply. It is increasingly difficulty for patients to receive care in a timely manner. In this paper, we document our experience using videoconference telemedicine to bring a multidisciplinary model of care to a rural retirement community in Southern California. To our knowledge, we are one of the first to integrate telemedicine into dementia care on this large a scale. Given the relatively remote location, patients and neurologists have previously had to travel great distances and bear with long wait times. With neurological consultation by telemedicine and a local team consisting of a geriatrician, a neuropsychologist, and a case manager, we have been able to provide comprehensive dementia care in this underserved area, comparable to university-affiliated California Alzheimer’s Disease Centers, typically found only in major metropolitan areas. We have shown that telemedicine can be very effective in improving access and quality of dementia care.
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Affiliation(s)
- Jason V Tso
- Keck School of Medicine of the University of Southern California , Los Angeles, CA , USA
| | - Roxanna Farinpour
- Department of Neurology, Keck School of Medicine of the University of Southern California , Los Angeles, CA , USA
| | - Helena C Chui
- Department of Neurology, Keck School of Medicine of the University of Southern California , Los Angeles, CA , USA
| | - Collin Y Liu
- Department of Neurology, Keck School of Medicine of the University of Southern California , Los Angeles, CA , USA
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Castanho TC, Amorim L, Moreira PS, Mariz J, Palha JA, Sousa N, Santos NC. Assessing Cognitive Function in Older Adults Using a Videoconference Approach. EBioMedicine 2016; 11:278-284. [PMID: 27515687 PMCID: PMC5049917 DOI: 10.1016/j.ebiom.2016.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/22/2016] [Accepted: 08/01/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The use of communication technologies is an emerging trend in healthcare and research. Despite efficient, reliable and accurate neuropsychological batteries to evaluate cognitive performance in-person, more diverse and less expensive and time consuming solutions are needed. Here we conducted a pilot study to determine the applicability of a videoconference (VC, Skype®) approach to assess cognitive function in older adults, using The Telephone Interview for Cognitive Status-Modified - Portuguese version (TICSM-PT). METHODS After inclusion and exclusion criteria, 69 individuals (mean age=74.90±9.46years), selected from registries of local health centers and assisted-living facilities, were assessed on cognitive performance using videoconference, telephone and in-person approaches. FINDINGS The videoconference administration method yielded comparable results to the traditional application. Correlation analyses showed high associations between the testing modalities: TICSM-PT VC and TICSM-PT telephone (r=0.885), TICSM-PT VC and MMSE face-to-face (r=0.801). Using the previously validated threshold for cognitive impairment on the TICSM-PT telephone, TICSM-PT VC administration presented a sensitivity of 87.8% and a specificity of 84.6%. INTERPRETATION Findings indicate for the range of settings where videoconference approaches can be used, and for their applicability and acceptability, providing an alternative to current cognitive assessment methods. Continued validation studies and adaptation of neuropsychological instruments is warranted.
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Affiliation(s)
- Teresa Costa Castanho
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - Liliana Amorim
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - Pedro Silva Moreira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - José Mariz
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal; Emergency Department, Intermediate Care Unit (EDIMCU), Hospital de Braga, Braga, Portugal
| | - Joana Almeida Palha
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal
| | - Nadine Correia Santos
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Braga, Guimarães, Portugal; Clinical Academic Center-Braga (CCAB), Braga, Portugal.
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Wadsworth HE, Galusha-Glasscock JM, Womack KB, Quiceno M, Weiner MF, Hynan LS, Shore J, Cullum CM. Remote Neuropsychological Assessment in Rural American Indians with and without Cognitive Impairment. Arch Clin Neuropsychol 2016; 31:420-5. [PMID: 27246957 PMCID: PMC4954610 DOI: 10.1093/arclin/acw030] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To determine the feasibility and reliability of a brief battery of standard neuropsychological tests administered via video teleconference (VTC) to a sample of rural American Indians compared with traditional face-to-face administration. METHODS The sample consisted of 84 participants from the Choctaw Nation in Oklahoma, including 53 females and 31 males [M age = 64.89 (SD = 9.73), M education = 12.58 (SD = 2.35)]. Of these, 29 had a diagnosis of mild cognitive impairment or dementia, and 55 were cognitively normal. Tests included the MMSE, Clock Drawing, Digit Span Forward and Backward, Oral Trails, Hopkins Verbal Learning Test-Revised, Letter and Category Fluency, and a short form Boston Naming Test. Alternative forms of tests were administered in counterbalanced fashion in both face-to-face and VTC conditions. Intraclass correlation coefficients (ICCs) were used to compare test scores between test conditions across the entire sample. RESULTS All ICCs were significant (p< .0001) and ranged from 0.65 (Clock Drawing) to 0.93 (Boston Naming Test), with a mean ICC of 0.82. CONCLUSION Results add to the expanding literature supporting the feasibility and reliability of remote videoconference-based neuropsychological test administration and extend findings to American Indians.
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Affiliation(s)
- Hannah E Wadsworth
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Kyle B Womack
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Mary Quiceno
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Myron F Weiner
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Clinical Science, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jay Shore
- Department of Psychiatry, University of Colorado Denver, Denver, CO, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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66
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Galusha-Glasscock JM, Horton DK, Weiner MF, Cullum CM. Video Teleconference Administration of the Repeatable Battery for the Assessment of Neuropsychological Status. Arch Clin Neuropsychol 2016; 31:8-11. [PMID: 26446834 PMCID: PMC4718188 DOI: 10.1093/arclin/acv058] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2015] [Indexed: 12/26/2022] Open
Abstract
Teleneuropsychology applications are growing, but a limited number of assessment tools have been studied in this context. The present investigation was designed to determine the feasibility and reliability of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) administration by comparing video teleconference (VTC) with face-to-face (FF) test conditions. Eighteen adult subjects over age 55 with and without cognitive impairment were administered Forms A and B of the RBANS in VTC and FF settings in counterbalanced fashion. Similar RBANS scores were obtained in both test conditions, with generally high correlations between administration methods. Results support the feasibility and reliability of remote administration of the RBANS via VTC.
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Affiliation(s)
| | - Daniel K Horton
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Myron F Weiner
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - C Munro Cullum
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Chakrabarti S. Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World J Psychiatry 2015; 5:286-304. [PMID: 26425443 PMCID: PMC4582305 DOI: 10.5498/wjp.v5.i3.286] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/07/2015] [Accepted: 06/09/2015] [Indexed: 02/05/2023] Open
Abstract
Telepsychiatry, i.e., the use of information and communication technologies to provide psychiatric services from a distance, has been around for more than half a century now. Research over this period has shown that videoconferencing-based telepsychiatry is an enabling and empowering form of service delivery, which promotes equality of access, and high levels of satisfaction among patients. The range of services offered by videoconferencing-based telepsychiatry, potential users and points of delivery of such services are theoretically limitless. Telepsychiatry has both clinical utility and non-clinical uses such as administrative, learning and research applications. A large body of accumulated evidence indicates that videoconferencing-based telepsychiatric assessments are reliable, and clinical outcomes of telepsychiatric interventions are comparable to conventional treatment among diverse patient populations, ages and diagnostic groups, and on a wide range of measures. However, on many aspects of effectiveness, the evidence base is still relatively limited and often compromised by methodological problems. The lack of cost-effectiveness data in particular, is a major hindrance, raising doubts about the continued viability of telepsychiatric services. Added to this are the vagaries of technology, negative views among clinicians, poor uptake by providers, and several legal, ethical and administrative barriers. These hamper the widespread implementation of telepsychiatry and its integration with routine care. Though further advances in technology and research are expected to solve many of these problems, the way forward would be to promote telepsychiatry as an adjunct to conventional care, and to develop hybrid models, which incorporate both traditional and telepsychiatric forms of mental health-care.
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Vahia IV, Ng B, Camacho A, Cardenas V, Cherner M, Depp CA, Palmer BW, Jeste DV, Agha Z. Telepsychiatry for Neurocognitive Testing in Older Rural Latino Adults. Am J Geriatr Psychiatry 2015; 23:666-70. [PMID: 25708655 PMCID: PMC4363076 DOI: 10.1016/j.jagp.2014.08.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 01/17/2023]
Abstract
As the population of older Latinos in the U.S. increases, availability of culturally adapted geriatric psychiatry services is becoming a growing concern. This issue is exacerbated for rural Latino populations. In this study, we assessed whether neurocognitive assessment via telepsychiatry (TP) using a Spanish-language battery would be comparable to in-person (IP) testing using the same battery in a sample of Spanish-speaking older adults in a rural setting. Patients (N = 22) received IP and TP testing 2 weeks apart. The order of IP and TP test administrations in individual subjects was determined randomly. Comparison of scores indicated that there were no significant differences between IP and TP test performance though both groups scored non-significantly higher at the second visit. This study demonstrates feasibility and utility of neurocognitive testing in Spanish using TP among older rural Latinos.
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Affiliation(s)
- Ipsit V Vahia
- Department of Psychiatry, University of California, San Diego, CA; Sam and Rose Stein Institute for Research in Aging, University of California, San Diego, CA.
| | - Bernardo Ng
- Department of Psychiatry, University of California, San Diego, CA; Sun Valley Behavioral & Research Center, Imperial, CA; Department of Psychology, San Diego State University, San Diego, CA
| | - Alvaro Camacho
- Department of Psychiatry, University of California, San Diego, CA; Sun Valley Behavioral & Research Center, Imperial, CA; Department of Psychology, San Diego State University, San Diego, CA
| | - Veronica Cardenas
- Department of Psychiatry, University of California, San Diego, CA; Sam and Rose Stein Institute for Research in Aging, University of California, San Diego, CA
| | - Mariana Cherner
- Department of Psychiatry, University of California, San Diego, CA; HIV Neurobehavioral Research Program, University of California, San Diego, CA
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, CA; Sam and Rose Stein Institute for Research in Aging, University of California, San Diego, CA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, CA; Sam and Rose Stein Institute for Research in Aging, University of California, San Diego, CA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, CA; Sam and Rose Stein Institute for Research in Aging, University of California, San Diego, CA
| | - Zia Agha
- Department of Veterans Affairs, University of California, San Diego, CA; Department of Medicine, University of California, San Diego, CA
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Abstract
Naming or word-finding tasks are a mainstay of the typical neuropsychological evaluation, particularly with older adults. However, many older adults have significant visual impairment and there are currently no such word-finding tasks developed for use with older visually impaired populations. This study presents a verbal, non-visual measure of word-finding for use in the evaluation of older adults with possible dysnomia. Stimuli were chosen based on their frequency of usage in everyday spoken language. A 60-item scale was created and given to 131 older Veterans. Rasch analyses were conducted and differential item functioning assessed to eliminate poorly-performing items. The final 55-item scale had a coefficient alpha of 0.84 and correlated with the Neuropsychological Assessment Battery Naming test, r=0.84, p<.01, Delis-Kaplan Executive Function System (D-KEFS) Category Fluency, r=0.45, p<.01, and the D-KEFS Letter Fluency, r=0.40, p<.01. ROC analyses found the measure to have sensitivity of 79% and specificity of 85% for detecting dysnomia. Patients with dysnomia performed worse on the measure than patients with intact word-finding, t(84)=8.2, p<.001. Patients with no cognitive impairment performed significantly better than patients with mild cognitive impairment, who performed significantly better than patients with dementia. This new measure shows promise in the neuropsychological evaluation of word-finding ability in older adults with or without visual impairment. Future directions include the development of a shorter version and the generation of additional normative data.
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Grosch MC, Weiner MF, Hynan LS, Shore J, Cullum CM. Video teleconference-based neurocognitive screening in geropsychiatry. Psychiatry Res 2015; 225:734-5. [PMID: 25596957 PMCID: PMC4410696 DOI: 10.1016/j.psychres.2014.12.040] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 10/15/2014] [Accepted: 12/28/2014] [Indexed: 10/24/2022]
Abstract
Validation of remote video teleconference (VTC)-based procedures for geropsychiatry applications is essential to ensure validity and reliability of diagnostic procedures. The current study demonstrates the similarity of scores obtained from several brief neurocognitive screening measures in an outpatient VA geropsychiatry clinic population when participants were tested in-person and via VTC. Results revealed similar mean scores and moderate to good consistency among our mixed geropsychiatric sample on brief measures of global cognition, attention, and visuospatial function.
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Affiliation(s)
- Maria C Grosch
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Myron F Weiner
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda S Hynan
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Clinical Science, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jay Shore
- Department of Psychiatry, University of Colorado Denver School of Medicine, Denver, CO, USA
| | - C Munro Cullum
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Adjorlolo S. Can Teleneuropsychology Help Meet the Neuropsychological Needs of Western Africans? The Case of Ghana. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 22:388-98. [PMID: 25719559 DOI: 10.1080/23279095.2014.949718] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In Ghana, the services of psychologists, particularly clinical psychologists and neuropsychologists, remain largely inaccessible to a large proportion of those in need. Emphasis has been placed on "physical wellness" even among patients with cognitive and behavioral problems needing psychological attention. The small number of clinical psychologists and neuropsychologists, the deplorable nature of road networks and transport systems, geopolitical factors, and a reliance on the face-to-face method in providing neuropsychological services have further complicated the accessibility problem. One way of expanding and making neuropsychological services available and accessible is through the use of information communication technology to provide these services, and this is often termed teleneuropsychology. Drawing on relevant literature, this article discusses how computerized neurocognitive assessment and videoconferencing could help in rendering clinical neuropsychological services to patients, particularly those in rural, underserved, and disadvantaged areas in Ghana. The article further proposes recommendations on how teleneuropsychology could be made achievable and sustainable in Ghana.
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Affiliation(s)
- Samuel Adjorlolo
- a Department of Psychology, Faculty of Social Studies , University of Ghana , Legon , Accra , Ghana
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72
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Settle JR, Robinson SA, Kane R, Maloni HW, Wallin MT. Remote cognitive assessments for patients with multiple sclerosis: a feasibility study. Mult Scler 2015; 21:1072-9. [PMID: 25583842 DOI: 10.1177/1352458514559296] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/16/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND measuring cognitive function in patients with multiple sclerosis (MS) can be challenging given the obstacles faced when traveling to testing centers. OBJECTIVE the purpose of this study was to evaluate the feasibility of remote cognitive assessment in patients with MS using the automated neuropsychological assessment metrics (ANAM-MS) and the symbol digit modalities test (SDMT). METHODS patients meeting the McDonald criteria for MS (n = 24) were randomized to complete the live-in-office condition or a remote-in-office condition first, with all patients completing both sessions. Patients (n = 20) then completed a final remote-in-home testing session. Both remote sessions were proctored by a psychologist using a secure telehealth connection. RESULTS scores on the live SDMT differed from scores in the two remote settings F(2, 38) = 4.46, p = 0.018. However, summary scores on the ANAM-MS were similar across the three settings, F(2, 36) = 2.21, p = 0.124. Satisfaction with telehealth testing was high on the part of the examiner and patients. Each telehealth testing session saved more than $144.00 in travel costs and lost wages. CONCLUSION this study demonstrated that valid results can be obtained when evaluating patients remotely using ANAM-MS. Some differences were noted for the SDMT that suggest that either specific norms or a different implementation approach may be needed for telehealth.
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Affiliation(s)
- Jill R Settle
- Veterans Affairs Medical Center, Washington, DC/ Veterans Affairs Multiple Sclerosis Center of Excellence-East, USA
| | - Stephanie A Robinson
- Veterans Affairs Medical Center, Washington, DC/ Veterans Affairs Multiple Sclerosis Center of Excellence-East, USA
| | - Robert Kane
- Neurology Department, Georgetown University School of Medicine, USA
| | - Heidi W Maloni
- Veterans Affairs Medical Center, Washington, DC/ Veterans Affairs Multiple Sclerosis Center of Excellence-East, USA
| | - Mitchell T Wallin
- Department of Veterans Affairs MS Center of Excellence-East and Georgetown University School of Medicine
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Martin-Khan M, Salih SA, Rowland J, Wootton R, Gray LC. General Practitioners, Patients, and Care Givers Support the Use of a Telegeriatric Memory Disorder Consultation for Older Adults. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/aad.2015.41001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
The use of videoconference technology to deliver health care diagnostics and treatment continues to grow at a rapid pace. Telepsychiatry and telepsychology applications are well-accepted by patients and providers, and both diagnostic and treatment outcomes have generally been similar to traditional face-to-face interactions. Preliminary applications of videoconference-based neuropsychological assessment (teleneuropsychology) have yielded promising results in the feasibility and reliability of several standard tests, although large-scale studies are lacking. This investigation was conducted to determine the reliability of video teleconference (VTC) - based neuropsychological assessment using a brief battery of standard neuropsychological tests commonly used in the evaluation of known or suspected dementia. Tests included the Mini-Mental State Examination (MMSE), Hopkins Verbal Learning Test-Revised, Digit Span forward and backward, short form Boston Naming Test, Letter and Category Fluency, and Clock Drawing. Tests were administered via VTC and in-person to subjects, counterbalanced using alternate test forms and standard instructions. Two hundred two adult subjects were tested in both rural and urban settings, including 83 with cognitive impairment and 119 healthy controls. We found highly similar results across VTC and in-person conditions, with significant intraclass correlations (mean=.74; range: 0.55-0.91) between test scores. Findings remained consistent in subjects with or without cognitive impairment and in persons with MMSE scores as low as 15. VTC-based neuropsychological testing is a valid and reliable alternative to traditional face-to-face assessment using selected measures. More VTC-based studies using additional tests in different populations are needed to fully explore the utility of this new testing medium.
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75
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Teleneuropsychology: evidence for video teleconference-based neuropsychological assessment. J Int Neuropsychol Soc 2014. [PMID: 25343269 DOI: 10.1017/s135561771400873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The use of videoconference technology to deliver health care diagnostics and treatment continues to grow at a rapid pace. Telepsychiatry and telepsychology applications are well-accepted by patients and providers, and both diagnostic and treatment outcomes have generally been similar to traditional face-to-face interactions. Preliminary applications of videoconference-based neuropsychological assessment (teleneuropsychology) have yielded promising results in the feasibility and reliability of several standard tests, although large-scale studies are lacking. This investigation was conducted to determine the reliability of video teleconference (VTC) - based neuropsychological assessment using a brief battery of standard neuropsychological tests commonly used in the evaluation of known or suspected dementia. Tests included the Mini-Mental State Examination (MMSE), Hopkins Verbal Learning Test-Revised, Digit Span forward and backward, short form Boston Naming Test, Letter and Category Fluency, and Clock Drawing. Tests were administered via VTC and in-person to subjects, counterbalanced using alternate test forms and standard instructions. Two hundred two adult subjects were tested in both rural and urban settings, including 83 with cognitive impairment and 119 healthy controls. We found highly similar results across VTC and in-person conditions, with significant intraclass correlations (mean=.74; range: 0.55-0.91) between test scores. Findings remained consistent in subjects with or without cognitive impairment and in persons with MMSE scores as low as 15. VTC-based neuropsychological testing is a valid and reliable alternative to traditional face-to-face assessment using selected measures. More VTC-based studies using additional tests in different populations are needed to fully explore the utility of this new testing medium.
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Won H, Singh DKA, Din NC, Badrasawi M, Manaf ZA, Tan ST, Tai CC, Shahar S. Relationship between physical performance and cognitive performance measures among community-dwelling older adults. Clin Epidemiol 2014; 6:343-50. [PMID: 25328418 PMCID: PMC4198152 DOI: 10.2147/clep.s62392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose Cognitive impairment is correlated with physical function. However, the results in the literature are inconsistent with cognitive and physical performance measures. Thus, the aim of this study was to determine the association between cognitive performance and physical function among older adults. Methods A total of 164 older adults aged ≥60 years and residing in low-cost housing areas in Kuala Lumpur, Malaysia participated in this study. Cognitive performance was measured using the Mini Mental State Examination, clock drawing test, Rey auditory verbal learning test, digit symbol test, digit span test, matrix reasoning test, and block design test. Physical performance measures were assessed using the ten step test for agility, short physical performance battery test for an overall physical function, static balance test using a Pro.Balance board, and dynamic balance using the functional reach test. Results There was a negative and significant correlation between agility and the digit symbol test (r=−0.355), clock drawing test (r=−0.441), matrix reasoning test (r=−0.315), and block design test (r=−0.045). A significant positive correlation was found between dynamic balance, digit symbol test (r=0.301), and matrix reasoning test (r=0.251). The agility test appeared as a significant (R2=0.183, R2=0.407, R2=0.299, P<0.05) predictor of some cognitive performance measures, including the digit span test, clock drawing test, and Mini Mental State Examination. Conclusion These results suggest that a decline in most cognitive performance measures can be predicted by poor execution of a more demanding physical performance measure such as the ten step test for agility. It is imperative to use a more complex and cognitively demanding physical performance measure to identify the presence of an overall cognitive impairment among community-dwelling older adults. It may also be beneficial to promote more complex and cognitively challenging exercises and activities among older adults for optimal physical and cognitive function.
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Affiliation(s)
- Huiloo Won
- Nutrition Science Program, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Normah Che Din
- Health Psychology Program, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Manal Badrasawi
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Zahara Abdul Manaf
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sin Thien Tan
- Physiotherapy Program, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Chu Chiau Tai
- Physiotherapy Program, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Suzana Shahar
- Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Jelcic N, Agostini M, Meneghello F, Bussè C, Parise S, Galano A, Tonin P, Dam M, Cagnin A. Feasibility and efficacy of cognitive telerehabilitation in early Alzheimer's disease: a pilot study. Clin Interv Aging 2014; 9:1605-11. [PMID: 25284993 PMCID: PMC4181448 DOI: 10.2147/cia.s68145] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This pilot study compared the effects of lexical-semantic stimulation through telecommunication technology (LSS-tele) with in-person LSS (LSS-direct) and unstructured cognitive treatment (UCS) in patients with early Alzheimer's disease. METHODS Twenty-seven patients with Alzheimer's disease in the very early stage (Mini-Mental State Examination [MMSE] >26/30) were divided into three groups: seven patients received LSS-tele treatment, ten received standard LSS-direct intervention, and ten participants underwent UCS as control condition. Intervention treatments consisted of two weekly sessions of LSS (through teleconference or face to face depending on group assignment) or UCS exercises administered to small groups throughout a 3-month period. The main outcome measures were changes of global cognitive performance, language abilities, and memory function. Secondary outcome measures were changes in attention, working memory, executive functions, and visual-spatial abilities tests. RESULTS The mean MMSE score improved significantly in LSS-tele and LSS-direct treatments; LSS-tele improved language abilities, both phonemic and semantic, and stabilized delayed verbal episodic memory with respect to an improved performance after the LSS-direct intervention and to a memory decline observed in the control group. Improvement was not achieved in any neuropsychological test score after UCS. CONCLUSION Clinical application of telecommunication technology to cognitive rehabilitation of elderly patients with neurodegenerative cognitive impairment is feasible and may improve global cognitive performance. Technical aspects to ameliorate efficacy of delivery may further improve its impact on domain-specific cognitive abilities.
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Affiliation(s)
- Nela Jelcic
- Foundation IRCCS San Camillo Hospital, Laboratory of Kinematics and Robotics and Laboratory of Psychology, Neurorehabilitation Department, Venice, Italy
| | - Michela Agostini
- Foundation IRCCS San Camillo Hospital, Laboratory of Kinematics and Robotics and Laboratory of Psychology, Neurorehabilitation Department, Venice, Italy
| | - Francesca Meneghello
- Foundation IRCCS San Camillo Hospital, Laboratory of Kinematics and Robotics and Laboratory of Psychology, Neurorehabilitation Department, Venice, Italy
| | - Cinzia Bussè
- Department of Neurosciences: Sciences NPSRR, University of Padova, Padova, Italy
| | - Sara Parise
- Department of Neurosciences: Sciences NPSRR, University of Padova, Padova, Italy
| | - Antonietta Galano
- Department of Neurosciences: Sciences NPSRR, University of Padova, Padova, Italy
| | - Paolo Tonin
- Foundation IRCCS San Camillo Hospital, Laboratory of Kinematics and Robotics and Laboratory of Psychology, Neurorehabilitation Department, Venice, Italy
| | - Mauro Dam
- Foundation IRCCS San Camillo Hospital, Laboratory of Kinematics and Robotics and Laboratory of Psychology, Neurorehabilitation Department, Venice, Italy
| | - Annachiara Cagnin
- Foundation IRCCS San Camillo Hospital, Laboratory of Kinematics and Robotics and Laboratory of Psychology, Neurorehabilitation Department, Venice, Italy ; Department of Neurosciences: Sciences NPSRR, University of Padova, Padova, Italy
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Harrell KM, Wilkins SS, Connor MK, Chodosh J. Telemedicine and the Evaluation of Cognitive Impairment: The Additive Value of Neuropsychological Assessment. J Am Med Dir Assoc 2014; 15:600-6. [DOI: 10.1016/j.jamda.2014.04.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/15/2014] [Accepted: 04/16/2014] [Indexed: 01/18/2023]
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Lachman ME, Agrigoroaei S, Tun PA, Weaver SL. Monitoring cognitive functioning: psychometric properties of the brief test of adult cognition by telephone. Assessment 2013; 21:404-17. [PMID: 24322011 DOI: 10.1177/1073191113508807] [Citation(s) in RCA: 155] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Assessment of cognitive functioning is an important component of telephone surveys of health. Previous cognitive telephone batteries have been limited in scope with a primary focus on dementia screening. The Brief Test of Adult Cognition by Telephone (BTACT) assesses multiple dimensions central for effective functioning across adulthood: episodic memory, working memory, reasoning, verbal fluency, and executive function. The BTACT is the first instrument that includes measures of processing speed, reaction time, and task-switching/inhibitory control for use over the telephone. We administered the battery to a national sample (N = 4,268), age 32 to 84 years, from the study of Midlife in the United States (MIDUS) and examined age, education, and sex differences; reliability; and factor structure. We found good evidence for construct validity with a subsample tested in person. Implications of the findings are considered for efficient neuropsychological assessment and monitoring changes in cognitive aging, for clinical and research applications by telephone or in person.
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Timpano F, Pirrotta F, Bonanno L, Marino S, Marra A, Bramanti P, Lanzafame P. Videoconference-based mini mental state examination: a validation study. Telemed J E Health 2013; 19:931-7. [PMID: 24073900 DOI: 10.1089/tmj.2013.0035] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neuropsychological testing is a prime criterion of good practice to document cognitive deficits in a rapidly aging population. Telecommunication technologies may overcome limitations related to test administration. We compared performance of the Italian videoconference-based version of the Mini Mental State Examination (VMMSE) with performance of the standard MMSE administered face-to-face (F2F), to validate the Italian version of the 28-item VMMSE. MATERIALS AND METHODS To validate the Italian version of the VMMSE, we compared its performance with standard F2F. The sample (n=342) was administered three VMMSEs within 6 weeks after F2F testing. We identified the optimal cutoff through the receiver operating characteristic curve, as well as the VMMSE consistency through inter- and intrarater reliability (Inter/RR and Intra/RR) analysis. RESULTS We found high levels of sensitivity and specificity for the optimal VMMSE cutoff identification and an accuracy of 0.96 (95% confidence interval 0.94-0.98). Intra/RR and inter/RR were highly significant. CONCLUSIONS This study demonstrates that VMMSE is a valid instrument in clinical and research screening and monitoring of subjects affected by cognitive disorders. This study shows a significant correlation between videoconference assessment and the F2F one, providing an important impetus to expand studies and the knowledge about the usefulness of tele-assistance services. Our findings have important implications for both longitudinal assistance and clinical care of demented patients.
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Affiliation(s)
- Francesca Timpano
- Telemedicine and Bioengineering Group, IRCCS Neurolesi "Bonino-Pulejo" Center , Messina, Italy
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81
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Sugihara T, Fujinami T, Phaal R, Ikawa Y. A technology roadmap of assistive technologies for dementia care in Japan. DEMENTIA 2013; 14:80-103. [DOI: 10.1177/1471301213493798] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The number of elderly people in Japan is growing, which raises the issue of dementia, as the probability of becoming cognitively impaired increases with age. There is an increasing need for caregivers, who are well-trained, experienced and can pay special attention to the needs of people with dementia. Technology can play an important role in helping such people and their caregivers. A lack of mutual understanding between caregivers and researchers regarding the appropriate uses of assistive technologies is another problem. A vision of person-centred care based on the use of information and communication technology to maintain residents’ autonomy and continuity in their lives is presented. Based on this vision, a roadmap and a list of challenges to realizing assistive technologies have been developed. The roadmap facilitates mutual understanding between caregivers and researchers, resulting in appropriate technologies to enhance the quality of life of people with dementia.
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Affiliation(s)
- Taro Sugihara
- Okayama University, Japan
- Japan Advanced Institute of Science and Technology, Japan
| | - Tsutomu Fujinami
- Japan Advanced Institute of Science and Technology, Japan
- Japan Advanced Institute of Science and Technology, Japan
| | - Robert Phaal
- University of Cambridge, UK
- Japan Advanced Institute of Science and Technology, Japan
| | - Yasuo Ikawa
- Japan Advanced Institute of Science and Technology, Japan
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82
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In-person versus telehealth assessment of discourse ability in adults with traumatic brain injury. J Head Trauma Rehabil 2013; 27:424-32. [PMID: 22190010 DOI: 10.1097/htr.0b013e31823346fc] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To compare in-person versus telehealth (TH) assessment of discourse ability in adults with chronic traumatic brain injury (TBI). DESIGN Repeated-measures design with random order of conditions. PARTICIPANTS Twenty adults with moderate-to-severe TBI. METHOD Participants completed conversation, picture description, story-generation, and procedural description tasks. Sessions were video-recorded and transcribed. MEASURES Measures of productivity and quality of discourse. RESULTS Significant differences between conditions were not detected in this sample, and feedback from participants was positive. CONCLUSIONS These preliminary results support the use of TH for the assessment of discourse ability in adults with TBI, at least for individuals with sufficient cognitive skills to follow TH procedures.
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83
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Parikh M, Grosch MC, Graham LL, Hynan LS, Weiner M, Shore JH, Cullum CM. Consumer acceptability of brief videoconference-based neuropsychological assessment in older individuals with and without cognitive impairment. Clin Neuropsychol 2013; 27:808-17. [PMID: 23607729 DOI: 10.1080/13854046.2013.791723] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Growing evidence suggests that neuropsychological assessment via videoconference shows good agreement with traditional in-person assessment. However, there are few published studies regarding patient acceptability of this methodology, particularly in individuals with cognitive impairment. In this study we sought to evaluate patient preferences and acceptability of teleneuropsychology to further shed light on the viability of this cognitive assessment medium. We examined acceptability of videoconference-based neuropsychological assessment among healthy aging individuals and in subjects with mild cognitive impairment or early stage Alzheimer disease. We found that teleneuropsychology appears to be well accepted by consumers. Our results reflected 98% satisfaction, and roughly two-thirds of participants indicated no preference between traditional face-to-face testing and examination by teleneuropsychology. Furthermore, even participants with cognitive impairment showed good acceptability of teleneuropsychological assessment. In conjunction with the preliminary data on reliability and validity from this growing literature, these results support teleneuropsychology as a viable and acceptable method for assessing cognitive functioning, and show promise for the implementation and utilization of this cognitive assessment medium in clinical and research settings.
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Affiliation(s)
- Mili Parikh
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX 75390-9044, USA
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84
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Kitchen KA, McKibbin CL, Wykes TL, Lee AA, Carrico CP, McConnell KA. Depression Treatment Among Rural Older Adults: Preferences and Factors Influencing Future Service Use. Clin Gerontol 2013; 36:10.1080/07317115.2013.767872. [PMID: 24409008 PMCID: PMC3881270 DOI: 10.1080/07317115.2013.767872] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The purpose of this study was to investigate depression treatment preferences and anticipated service use in a sample of adults aged 55 years or older who reside in rural Wyoming. Sixteen participants (mean age = 59) completed 30- to 60-minute, semi-structured interviews. Qualitative methods were used to characterize common themes. Social/provider support and community gatekeepers were perceived by participants as important potential facilitators for seeking depression treatment. In contrast, perceived stigma and the value placed on self-sufficiency emerged as key barriers to seeking treatment for depression in this rural, young-old sample. Participants anticipated presenting for treatment in the primary care sector and preferred a combination of medication and psychotherapy for treatment. Participants were, however, more willing to see mental health professionals if they were first referred by a clergy member or primary care physician.
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Affiliation(s)
| | | | | | - Aaron A Lee
- University of Wyoming, Laramie, Wyoming, USA
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85
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Turner TH, Horner MD, VanKirk KK, Myrick H, Tuerk PW. A Pilot Trial of Neuropsychological Evaluations Conducted via Telemedicine in the Veterans Health Administration. Telemed J E Health 2012; 18:662-7. [DOI: 10.1089/tmj.2011.0272] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Travis H. Turner
- Mental Health Service Line, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
- Division of Neurology, Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina
| | - Michael D. Horner
- Mental Health Service Line, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Kathryn K. VanKirk
- Mental Health Service Line, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Hugh Myrick
- Mental Health Service Line, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Peter W. Tuerk
- Mental Health Service Line, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
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Abstract
BACKGROUND The use of telemedicine for the care of mental health problems has developed significantly over the last decade thanks to the emergence of a number of stable telepsychiatry programs in many countries. Parallel to this development, this care modality has also targeted specific populations with higher difficulty in gaining access to mental health services such as the elderly. Telepsychogeriatrics is expected to have an increasing role in providing care to geographically isolated rural communities, with a particular focus on long-term care facilities, in light of the high prevalence of psychiatric disorders in these centers and the lack of available specialized care. METHODS A thorough search of the literature was conducted using Medline, Web of Science, and PsychINFO databases in order to gather available evidence on the applicability of telepsychiatry, specifically the use of videoconferencing for remote consultation, in the elderly population with mental disorders. A succinct description of the selected studies is given along with a general reflection on the state-of-the-art in the field of psychogeriatric clinical practice and research. RESULTS Research on the use of telemedicine in this age group has taken into account their special characteristics, and has focused on demonstrating its applicability, the acceptance and satisfaction of elderly users and their healthcare providers, the possibility of carrying out cognitive and diagnostic assessments, and the efficiency of these programs. CONCLUSIONS Despite limited experience, telepsychogeriatrics appears to be a viable option, well accepted by patients, including those having dementia. More systematized studies are needed in this new field based on larger sample sizes, including comparison with traditional consultations and assessment of the clinical outcomes.
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87
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Martin-Khan M, Flicker L, Wootton R, Loh PK, Edwards H, Varghese P, Byrne GJ, Klein K, Gray LC. The diagnostic accuracy of telegeriatrics for the diagnosis of dementia via video conferencing. J Am Med Dir Assoc 2012; 13:487.e19-24. [PMID: 22572552 DOI: 10.1016/j.jamda.2012.03.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 03/05/2012] [Accepted: 03/06/2012] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The suitability of video conferencing (VC) technology for clinical purposes relevant to geriatric medicine is still being established. This project aimed to determine the validity of the diagnosis of dementia via VC. METHODS This was a multisite, noninferiority, prospective cohort study. Patients, aged 50 years and older, referred by their primary care physician for cognitive assessment, were assessed at 4 memory disorder clinics. All patients were assessed independently by 2 specialist physicians. They were allocated one face-to-face (FTF) assessment (Reference standard--usual clinical practice) and an additional assessment (either usual FTF assessment or a VC assessment) on the same day. Each specialist physician had access to the patient chart and the results of a battery of standardized cognitive assessments administered FTF by the clinic nurse. Percentage agreement (P(0)) and the weighted kappa statistic with linear weight (K(w)) were used to assess inter-rater reliability across the 2 study groups on the diagnosis of dementia (cognition normal, impaired, or demented). RESULTS The 205 patients were allocated to group: Videoconference (n = 100) or Standard practice (n = 105); 106 were men. The average age was 76 (SD 9, 51-95) and the average Standardized Mini-Mental State Examination Score was 23.9 (SD 4.7, 9-30). Agreement for the Videoconference group (P(0)= 0.71; K(w) = 0.52; P < .0001) and agreement for the Standard Practice group (P(0)= 0.70; K(w) = 0.50; P < .0001) were both statistically significant (P < .05). The summary kappa statistic of 0.51 (P = .84) indicated that VC was not inferior to FTF assessment. CONCLUSIONS Previous studies have shown that preliminary standardized assessment tools can be reliably administered and scored via VC. This study focused on the geriatric assessment component of the interview (interpretation of standardized assessments, taking a history and formulating a diagnosis by medical specialist) and identified high levels of agreement for diagnosing dementia. A model of service incorporating either local or remote administered standardized assessments, and remote specialist assessment, is a reliable process for enabling the diagnosis of dementia for isolated older adults.
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Affiliation(s)
- Melinda Martin-Khan
- Centre for Research in Geriatric Medicine, The University of Queensland, Brisbane, QLD, Australia.
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88
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Weiner MF, Rossetti HC, Harrah K. Videoconference diagnosis and management of Choctaw Indian dementia patients. Alzheimers Dement 2012; 7:562-6. [PMID: 22055972 DOI: 10.1016/j.jalz.2011.02.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 12/16/2010] [Accepted: 02/08/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study reports a 5-year experience using videoconference (VC) technology in diagnosing and treating adult members of the Choctaw Nation with symptoms or complaints of cognitive impairment. METHODS Patients were given the option of a VC session or a face-to-face evaluation in the clinic. Before their VC session, patients underwent neuropsychological testing, Clinical Dementia Rating, Geriatric Depression Scale and Neuropsychiatric Inventory, brain computed tomography, and routine blood tests. Physical observations made by VC included eyesight, hearing, facial expression, gait and station, coordination, tremor, rapid alternating movements, psychomotor activity, and motor tests of executive function. Cogwheeling and rigidity were tested by our on-site nurse, who also obtained vital signs as indicated. RESULTS Between January 2005 and March 2010, there were 47 clinics, 171 visits, and 85 unique patients. There were 52 new evaluations and 119 follow-up visits. The number of visits ranged from one to eight and the length of follow-up from 1 month to 4.5 years. The no-show rate for all VC sessions in 2009 was 3%, and only two subjects in 5 years refused further VC visits. CONCLUSION Once cultural barriers are dealt with, VC-based diagnosis and treatment of adults with cognitive disorders who live in remote areas is feasible and well accepted by patients and families.
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Affiliation(s)
- Myron F Weiner
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, USA.
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89
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Behavioral Activation Treatment for Depression in Older Adults Delivered via Videoconferencing: A Pilot Study. COGNITIVE AND BEHAVIORAL PRACTICE 2011. [DOI: 10.1016/j.cbpra.2010.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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90
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Barton C, Morris R, Rothlind J, Yaffe K. Video-telemedicine in a memory disorders clinic: evaluation and management of rural elders with cognitive impairment. Telemed J E Health 2011; 17:789-93. [PMID: 22023458 DOI: 10.1089/tmj.2011.0083] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Telemedicine is increasingly being used to provide consultation for healthcare in rural areas. Little work has been done with dementia although preliminary research suggests that clinical diagnosis performed via telemedicine consultation is valid. We implemented a program to provide multidisciplinary, state-of-the-art diagnosis of cognitive impairment by video-telemedicine (VTM) integrated into a clinical setting. METHODS Patients at a rural veteran's community clinic were referred by their local provider for evaluation of memory complaints by the multidisciplinary team of the San Francisco Veterans Administration (SFVA) Memory Disorders Clinic (MDC). The evaluation was integrated into the usual clinic structure and included a neurological evaluation and neuropsychological testing by the MDC team via video assisted by a remote clinician at the community clinic. RESULTS We evaluated 15 new patients referred to our multidisciplinary clinic. In each case, the VTM format permitted the MDC team to arrive at a working diagnosis; 12 patients with dementia, two with mild cognitive impairment, and one cognitively normal. Relevant treatment recommendations were made to the patients and caregivers. The evaluation results were discussed with providers who joined the MDC postclinic conference via VTM. In the majority of cases, recommendations were followed and there was satisfaction with VTM by providers and patients. CONCLUSIONS VTM is emerging as an effective way to provide consultation and care to rural residents who may not have access to specialty services and can be integrated into current clinical settings.
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Affiliation(s)
- Cynthia Barton
- Department of Neurology, University of California, San Francisco, San Francisco, California CA 94121, USA.
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91
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Grosch MC, Gottlieb MC, Cullum CM. Initial Practice Recommendations for Teleneuropsychology. Clin Neuropsychol 2011; 25:1119-33. [DOI: 10.1080/13854046.2011.609840] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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92
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Grady B, Myers KM, Nelson EL, Belz N, Bennett L, Carnahan L, Decker VB, Holden D, Perry G, Rosenthal L, Rowe N, Spaulding R, Turvey CL, White R, Voyles D. Evidence-based practice for telemental health. Telemed J E Health 2011; 17:131-48. [PMID: 21385026 DOI: 10.1089/tmj.2010.0158] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Brian Grady
- University of Maryland-Psychiatry , Baltimore, Maryland, USA
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Yellowlees P, Shore J, Roberts L. Practice guidelines for videoconferencing-based telemental health - October 2009. Telemed J E Health 2011; 16:1074-89. [PMID: 21186991 DOI: 10.1089/tmj.2010.0148] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Morgan D, Innes A, Kosteniuk J. Dementia care in rural and remote settings: a systematic review of formal or paid care. Maturitas 2010; 68:17-33. [PMID: 21041045 DOI: 10.1016/j.maturitas.2010.09.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 09/16/2010] [Accepted: 09/20/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The purpose of this review is to critically evaluate the available evidence from the published scientific literature on dementia care and service provision in rural and remote settings from the perspective of formal/paid caregiving, in order to assess the current state of knowledge, identify policy and practice implications, and make recommendations for future research. METHODS A systematic review of the literature indexed in ISI Web of Knowledge, PsychInfo, Medline, Healthstar, CINAHL, EMBASE, and Sociological Abstracts was conducted. Data were extracted from papers meeting inclusion criteria: peer-reviewed papers that focused on dementia or Alzheimer's disease (AD), examined care or service provision in relation to persons with AD or dementia, and relevant to rural or remote care or services. RESULTS The search identified 872 articles for review, reduced to 72 after removing duplicates and articles not meeting criteria. Of the 72 remaining, 46 are included in this current review focusing on formal or paid care. A future review will focus on the 26 studies on informal/unpaid care. Six themes that correspond to the current state of knowledge in rural dementia care in the 46 included studies were: diagnostic processes, service provision, service models and programs, staff education and support needs, use of technology, and long-term care. CONCLUSIONS Despite the growing body of evidence over the 20 years covered by this review, much of the research is descriptive and/or based on small sample sizes, and distributed across the care continuum. Hence the body of evidence on which to base policy and program decisions remains limited. More research is needed that would support the development of comprehensive rural dementia care models.
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Affiliation(s)
- Debra Morgan
- CIHR-SHRF Applied Chair in Health Services & Policy Research, Canadian Centre for Health & Safety in Agriculture, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8.
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Ciemins EL, Holloway B, Coon PJ, McClosky-Armstrong T, Min SJ. Telemedicine and the mini-mental state examination: assessment from a distance. Telemed J E Health 2009; 15:476-8. [PMID: 19548827 DOI: 10.1089/tmj.2008.0144] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The objective of this study was to determine the reliability of the Mini-Mental State Examination (MMSE) administration via telehealth with a focus on the auditory and visual test components. Reliability was assessed through use of an in-person collaborator and by assessment of faxed test copies. The MMSE was administered via telehealth with the assistance of a face-to-face collaborator. Patient responses were recorded by both the remote and in-person nurse and compared item by item; total scores for each subject were also compared. Visual items were assessed through a blinded separate scoring of a faxed copy. Percent agreement per item and total score were calculated and correlations between scores were determined by Pearson correlation coefficients. Mean score differences and associated 95% confidence intervals were calculated. Eighty percent of individual items demonstrated remote to in-person agreement of >95% and all items were >85.5% in agreement. Pearson correlation coefficients demonstrated high correlations (>0.86) between 80% of the items examined. Mean differences in scored test items were not significantly different from zero. This study demonstrates the utility of using telehealth for cognitive assessment by MMSE. It supports the use of telehealth to improve healthcare access among patients for whom distance, cost, and mobility are potential barriers to attending face-to-face clinical visits. Continued validation and reliability testing is warranted to ensure that all healthcare provided via telehealth maintains an equal quality level to that of in-person care.
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Affiliation(s)
- Elizabeth L Ciemins
- Billings Clinic-Center for Clinical Translational Research, Billings, MT 59107, USA.
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Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2009; 16:323-338. [PMID: 20161010 PMCID: PMC2758653 DOI: 10.1111/j.1468-2850.2009.01170.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
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Affiliation(s)
| | | | - Anouk L. Grubaugh
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
| | - Leonard Egede
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
- Medical University of South Carolina, Charleston, SC, USA
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Richardson LK, Frueh BC, Grubaugh AL, Egede L, Elhai JD. Current Directions in Videoconferencing Tele-Mental Health Research. CLINICAL PSYCHOLOGY : A PUBLICATION OF THE DIVISION OF CLINICAL PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION 2009. [PMID: 20161010 DOI: 10.1111/j.1468‐2850.2009.01170.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The provision of mental health services via videoconferencing tele-mental health has become an increasingly routine component of mental health service delivery throughout the world. Emphasizing the research literature since 2003, we examine: 1) the extent to which the field of tele-mental health has advanced the research agenda previously suggested; and 2) implications for tele-mental health care delivery for special clinical populations. Previous findings have demonstrated that tele-mental health services are satisfactory to patients, improve outcomes, and are probably cost effective. In the very small number of randomized controlled studies that have been conducted to date, tele-mental health has demonstrated equivalent efficacy compared to face-to-face care in a variety of clinical settings and with specific patient populations. However, methodologically flawed or limited research studies are the norm, and thus the research agenda for tele-mental health has not been fully maximized. Implications for future research and practice are discussed.
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Rationale and design: telepsychology service delivery for depressed elderly veterans. Trials 2009; 10:22. [PMID: 19379517 PMCID: PMC2681467 DOI: 10.1186/1745-6215-10-22] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 04/20/2009] [Indexed: 01/17/2023] Open
Abstract
Background Older adults who live in rural areas experience significant disparities in health status and access to mental health care. "Telepsychology," (also referred to as "telepsychiatry," or "telemental health") represents a potential strategy towards addressing this longstanding problem. Older adults may benefit from telepsychology due to its: (1) utility to address existing problematic access to care for rural residents; (2) capacity to reduce stigma associated with traditional mental health care; and (3) utility to overcome significant age-related problems in ambulation and transportation. Moreover, preliminary evidence indicates that telepsychiatry programs are often less expensive for patients, and reduce travel time, travel costs, and time off from work. Thus, telepsychology may provide a cost-efficient solution to access-to-care problems in rural areas. Methods We describe an ongoing four-year prospective, randomized clinical trial comparing the effectiveness of an empirically supported treatment for major depressive disorder, Behavioral Activation, delivered either via in-home videoconferencing technology ("Telepsychology") or traditional face-to-face services ("Same-Room"). Our hypothesis is that in-homeTelepsychology service delivery will be equally effective as the traditional mode (Same-Room). Two-hundred twenty-four (224) male and female elderly participants will be administered protocol-driven individual Behavioral Activation therapy for depression over an 8-week period; and subjects will be followed for 12-months to ascertain longer-term effects of the treatment on three outcomes domains: (1) clinical outcomes (symptom severity, social functioning); (2) process variables (patient satisfaction, treatment credibility, attendance, adherence, dropout); and (3) economic outcomes (cost and resource use). Discussion Results from the proposed study will provide important insight into whether telepsychology service delivery is as effective as the traditional mode of service delivery, defined in terms of clinical, process, and economic outcomes, for elderly patients with depression residing in rural areas without adequate access to mental health services. Trial registration National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier# NCT00324701).
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Loh PPK. Telemedicine and Alzheimer's disease from studio-based videoconferencing to mobile handheld cell phones. J Brain Dis 2009; 1:39-43. [PMID: 23818808 PMCID: PMC3676370 DOI: 10.4137/jcnsd.s2296] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The use of Telemedicine in the assessment of cognitive impairment and Alzheimer’s Disease is evolving with advances in Information and Communication Technology. This article outlines the course of evolution in Western Australia, a large state with a sparse population outside of the capital city. The starting point of the evolution, video-conferencing in Telehealth studios, is reviewed as well as the next stage, use of desktop technology, which enables the physician to consult from the office or clinic. A pilot study currently being undertaken to assess the validity of the latest stage in evolution of Telehealth—the use of handheld mobile cell phone video calling that allows the physician and patient to interact at locations convenient to both parties. The pitfalls and implications of the use of this stage, should it prove to be a valid approach, are discussed.
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Affiliation(s)
- Pk Poh-Kooi Loh
- Department of Geriatric Medicine, Royal Perth Hospital, Wellington Street, Perth, Western Australia 6000
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Alverson DC, Holtz B, D'Iorio J, DeVany M, Simmons S, Poropatich RK. One size doesn't fit all: bringing telehealth services to special populations. Telemed J E Health 2009; 14:957-63. [PMID: 19035807 DOI: 10.1089/tmj.2008.0115] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Telehealth applications and information communication technologies can be customized and scaled to meet the healthcare service needs of a wide variety of special populations. Categorization of those special groups can be viewed from a spectrum of perspectives such as by gender, age, culture, families, communities, chronic conditions, or particular types of locations, as well as when addressing a specific or unique health need. The emergence of innovations in the use of a range of technologies and connectivity offers exciting new approaches to the integration of telehealth aimed at improving quality and continuity of care to better meet the needs of special populations.
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Affiliation(s)
- Dale C Alverson
- Center for Telehealth and Cybermedicine Research, University of New Mexico, Albuquerque, New Mexico 87106, USA.
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