Telemedicine and the Evaluation of Cognitive Impairment: The Additive Value of Neuropsychological Assessment

User Experience of a (Semi-) Automated Cognitive Phone-Based Assessment Within a Memory Clinic Population

OBJECTIVE

We examined the user experience in different modalities (face-to-face, semi-automated phone-based, and fully automated phone-based) of cognitive testing in people with subjective cognitive decline and mild cognitive impairment.

METHOD

A total of 67 participants from the memory clinic of the Maastricht University Medical Center+ participated in the study. The study consisted of cognitive tests in different modalities, namely, face-to-face, semi-automated phone-based guided by a researcher, and fully automated phone-based without the involvement of a researcher. After each assessment, a user experience questionnaire was administered, including questions about, for example, satisfaction, simplicity, and missing personal contact, on a seven-point Likert scale. Non-parametric tests were used to compare user experiences across different modalities.

RESULTS

In all modalities, user experiences were rated above average. The face-to-face ratings were comparable to the ratings of the semi-automated phone-based assessment, except for the satisfaction and recommendation items, which were rated higher for the face-to-face assessment. The face-to-face assessment was preferred above the fully automated phone-based assessment on all items. In general, the semi- and fully automated phone-based assessments were comparable (simplicity, conceivability, quality of sound, visiting the hospital, and missing personal contact), while on all the other items, the semi-automated phone-based assessment was preferred.

CONCLUSIONS

User experience was rated high within all modalities. Simplicity, conceivability, comfortability, and participation scores were comparable in the semi-automated phone-based and face-to-face assessment. Based on these findings and earlier research on validation of the semi-automated phone-based assessment, the semi-automated assessment could be useful for screening for clinical trials, and after more research, in clinical practice.

Remote neuropsychological evaluation of older adults

The use of technological means in the process of neuropsychological assessment has been proposed as a technique with promising results in the field of detection of neurocognitive disorders for community-dwelling older adults. Especially during the pandemic period due to COVID-19, telemedicine assumed to be vital in the field of early diagnosis of cognitive disorders and highlighted the clinical utility of remote methods of neuropsychological assessmentby video-conference. This descriptive study presents the development of a remote neuropsychological assessment protocol by selecting appropriate validated tests as part of a more comprehensive evaluation for older adults dwelling in the community. We recruited participants from the Athens Alzheimer's Association center in collaboration with the Hellenic Neuropsychological Society, in Athens, Greece, regarding the period between April 2020 and October 2021. 90 individuals, tested for the first time, were categorized into three groups according to their diagnosis which included: (a) Mild Cognitive Impairment (MCI), (b) Alzheimer's disease, (c) cognitively healthy older adults. The presented protocol outlines the main considerations of a framework about remote neuropsychological assessment, which can maximize the effectiveness of interventions and continuity regarding the care of older adults. The recommendations outlined in the presented protocol highlight strengths and limitations that should be taken into account in remote control procedures. Although the protocol was created in response to pandemic restrictions, tele-neuropsychology shows promise as a way to improve access opportunity to neurodiagnostic services for rural aging and underserved populations, which lack specialized healthcare services. Further application to different populations will add validity to the presented descriptive protocol.

Development of a self-administered online battery for remote assessment of executive functions and verbal memory: equivalence with face-to-face administration, preliminary norms, and acceptance

OBJECTIVES

Interest in teleneuropsychology services increased considerably after the COVID-19 pandemic. However, the utility of unsupervised administration of computerized tests remains largely unexplored. In the present study, we developed a brief computerized battery that assesses self-reported cognitive abilities and performances on executive functioning and verbal memory. We investigated the equivalence of the self-administration online (SAO) procedure and the face-to-face (FTF) administration. Preliminary normative data were developed and the acceptance of the SAO procedure was explored.

METHODS

A community sample of 169 Greek adults [94 women; mean age: 41.95 (SD = 13.40) years, mean years of education: 15.10 (SD = 2.65)] completed the SAO assessment. A subgroup of 40 participants was tested in a counterbalanced way both with SAO and FTF. Participants' performances were compared with paired sample t-tests and the agreement between the two methods was estimated with intraclass correlation coefficients (ICCs). Multiple linear regression analyses were applied to investigate the effect of demographic characteristics on SAO measures.

RESULTS

No difference between SAO and FTF scores was observed. ICCs indicated moderate to good agreement (.418-.848) for most measures. Age was positively associated with self-reported cognitive state and negatively with neuropsychological performances and the level of acceptance of the SAO procedure. Approximately 80% of participants reported satisfaction from the SAO assessment, 69% good compliance with the instructions, but less than 30% belief that the FTF assessment could be adequately replaced.

CONCLUSION

SAO testing is feasible and well accepted among Greek adults yielding equivalent results with FTF testing. Despite the wide satisfaction, though, notable reluctance was noted for the substitution of FTF with SAO procedures.

Acceptability of Tele-mental Health Services Among Users: A Systematic Review and Meta-analysis

BACKGROUND

Mental disorders are currently a global public health concern, particularly after the coronavirus disease 2019 (COVID-19) pandemic. Mental health services gradually transitioned to teleservices, employing various methods like texting and videoconferencing. This meta-analysis aimed mainly to quantify the acceptability of tele-mental health services among both beneficiaries and providers. Secondary objectives included quantifying the usability of and satisfaction with these services.

METHODS

We conducted a systematic search of the following databases PubMed Central, SAGE, Google Scholar, Scopus, Web of Science, PubMed Medline, and EBSCO according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines until December 2022.

RESULTS

Out of 3366 search results, 39 studies fully met the inclusion criteria. The pooled acceptability of tele-mental health services among beneficiaries was [71.0% with a 95% confidence interval (CI) of 63.0 - 78.5%, I2 = 98%]. Using meta-regression, four key factors contributed to this heterogeneity (R2 = 99.75%), namely, year of publication, type of mental disorder, participant category, and the quality of included studies. While acceptability among providers was [66.0% (95%CI, 52.0 - 78.0%), I2 = 95%]. The pooled usability of tele-mental health services among participants was [66.0% (95%CI, 50.0 - 80.0%), I2 = 83%]. Subgroup analysis revealed statistically significant results (p = 0.003), indicating that usability was higher among beneficiaries compared to providers.

CONCLUSIONS

The study highlighted a high acceptability of tele-mental health services. These findings suggest a promising outlook for the integration and adoption of tele-mental health services and emphasize the importance of considering user perspectives and addressing provider-specific challenges to enhance overall service delivery and effectiveness.

Continuity of care for patients with dementia during COVID-19 pandemic: flexibility and integration between in-person and remote visits

Introduction

During the pandemic, the Cognitive Disorders Unit of San Raffaele Hospital (Milan, Italy) offered patients the opportunity to undergo neuropsychological evaluations and cognitive training through telemedicine.

Method

We conducted an investigation to assess how patients responded to this option and to determine if telemedicine could ensure continuity of care.

Results

Between October 2019 and May 2022, a total of 5,768 telemedicine appointments and 8,190 in-person outpatient appointments were conducted, resulting in an increase in the rate of telemedicine activity from 16.81% in January 2020 to 23.21% in May 2022. Peaks in telemedicine activity reached 85.64% in May 2020 and 83.65% in February 2021, both representing a significant portion of the total activity. Interestingly, there was a notable positive correlation between telemedicine activity and the worsening of the Italian pandemic (r = 0.433, p = 0.027).

Discussion

During the peaks of contagion, the total number of visits remained stable, highlighting that telemedicine effectively served as a valuable and efficient tool to ensure continuity of care for vulnerable patients. This was evident from the integration of remote visits with in-person appointments.

Attitudes of Mental Health Professionals towards Telepsychology during the Pandemic: A Pilot Study

OBJECTIVE

This pilot study investigated mental health professionals' attitudes towards remote psychological consultations and internet-based interventions.

METHODS

An online survey in Italian and English was administered to a sample of 191 psychologists and psychotherapists to collect detailed information about their professional experience providing online psychological interventions a year and a half after the beginning of the SARS-CoV-2 pandemic.

RESULTS

The results did not reveal a statistically significant association between the participants' theoretical approaches and the number of patients treated via the online modality. Overall, most of the participants found advantages to the online setting but also noted critical issues regarding privacy and the ease of integrating new technology into their clinical practice.

CONCLUSIONS

According to the participants, despite the challenges that must be addressed, telehealth is a viable psychological therapeutic option that is destined to grow in importance in the near future.

Increasing Use of Telemedicine for Neurological Disorders During the COVID-19 Pandemic: A Mini-Review

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly contagious viral infection. In addition to its association with common pulmonary and gastrointestinal complications, COVID-19 is also associated with numerous neurological and neuropsychiatric conditions. This minireview aims to cover current literature addressing the application of telemedicine in neurological disorders and neuropsychiatric conditions, especially in response to the COVID-19 pandemic. This article revealed that quarantine, masking, and social distancing policies practiced during the COVID-19 pandemic involved restrictions and challenges to providing medical services, especially for patients with neurological disorders with or without COVID-19 infection. During the pandemic, both healthcare administrators and clinicians, including neurologists, have rapidly adapted or introduced telemedicine technologies for delivering specialty care. In some areas in the world, telemedicine has been successfully applied to reduce the impact imposed by COVID-19. Conclusively, this article supports the idea that telemedicine is an effective tool for providing specialized healthcare for patients with neurological conditions while adhering to social distancing or lockdown policies instituted during the COVID-19 pandemic. Government and medical/healthcare authorities, physicians and healthcare providers need to work together to expand the adoption of telemedicine applications, even after the COVID-19 crisis.

Tea, Technology and Me: a World Café approach to engage people with dementia and their carers about research priorities and policy development in digital technology and artificial intelligence

Digital technology and artificial intelligence (AI) use in health care is increasing, and it potentially offers significant patient benefit, such as independence, improved care and health care at home. Workforce benefits are apparent, for example, releasing time to see patients. However, are ethical and moral dilemmas of such technologies sufficiently unpacked by patients and understood by clinicians? A person living with dementia, and carers of people with dementia, alongside academics and clinicians, designed a public engagement World Café event for 20 people living with dementia and their carers. This process is described, as are reflections on a World Café approach to generate knowledge on a lesser explored topic. Working with a graphic recorder at the event proved a dynamic and engaging way of visually displaying feedback, served as an aide memoire and generated further discussion. Three feedback themes are highlighted: (1) trust; (2) continuity of care; and (3) support and independence. The event’s subsequent evaluation and impact, including a presentation to the House of Lords All-Party Parliamentary Group on Artificial Intelligence, are described. In conclusion, a suitable World Café approach enables people with dementia and their carers to voice exceptionally useful insights into a topic that already affects, or is very likely to, affect them.

Factors Influencing Barriers and Facilitators to In-home Video Telehealth for Dementia Management

OBJECTIVES

Quality dementia care, which recognizes caregivers as vital care partners, is a scarce resource. Innovative solutions like video telehealth may increase the reach of extant clinicians; however, little is known about perceived barriers and facilitators to in-home video telehealth for dementia management from the perspectives of caregivers.

METHODS

Twenty-four caregivers of community-dwelling Veterans with dementia participated in semi-structured interviews. Questions gathered perceived facilitators and barriers to in-home video telehealth for dementia management through experience with related technology. Transcripts were analyzed using directed content analysis which was guided by factors previously identified as influencing older adults' adoption of technology.

RESULTS

Caregiver experience with related technology was mostly facilitative to video telehealth, which was thought best suited for follow-up care. Increased access and decreased patient-caregiver stress were potential benefits. Barriers included perceived limitations of video and the belief that persons with dementia would have limited ability to manage technological aspects and to engage in video telehealth on their own.

CONCLUSIONS

This study improves our understanding of the factors that caregivers perceive as barriers and facilitators to in-home video telehealth for dementia management.

CLINICAL IMPLICATIONS

Strategies to optimize video telehealth include capitalizing on caregivers' social network and providing targeted training.

Using Telemedicine to Assess and Manage Psychosis in Neurodegenerative Diseases in Long-Term Care

The coronavirus disease 2019 (COVID-19) epidemic has forced a sudden global implementation of telemedicine strategies, including in long-term care (LTC) facilities where many people with dementia and Parkinson disease (PD) reside. Telemedicine offers a unique set of advantages for residents in LTC facilities if effectively supported and implemented, including expanded access to specialists in rural or underserved areas or for people with dementia who cannot travel for off-site visits. Many medical and psychiatric organizations have recently issued new or updated guidelines on the use of telemedicine. On October 22, 2020, a multidisciplinary consensus panel was convened to collate a list of best practices for LTC facilities and specialists when conducting telemedicine with residents with dementia-related psychosis or PD-related psychosis (PDP). A collaborative effort between specialists, facility administrators, and facility staff is essential for the success of telemedicine in the LTC setting. Telemedicine in LTC facilities comes with increased administrative and technical challenges that fall heavily on the shoulders of the LTC facility administrators and staff. Specialists can ease this burden by maintaining flexibility and ensuring expression of empathy and thanks to the staff who are facilitating the visits. LTC staff can provide specialists with valuable information about their patients to aid in evaluation and diagnosis. Specialists can facilitate this exchange of information by speaking to staff who work closely with the resident about any signs of hallucinations or delusions they may have observed. Educational efforts can increase staff understanding of dementia and PDP and empower them to engage with, and facilitate the resident's treatment plan. Using these strategies to take advantage of the benefits of telemedicine, specialists and LTC staff can together expand and improve care for LTC facility residents with dementia-related psychosis or PDP.

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults

The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access.

Objective

This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic.

Methods

We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile.

Results

To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm.

Conclusions

The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.

Comparison of Neuropsychological Assessment by Videoconference and Face to Face

OBJECTIVE

To compare the administration of neuropsychological tests by teleneuropsychology (TeleNP) and face to face (F-F) in order to determine the feasibility and reliability of TeleNP.

METHOD

At the inclusion visit, all participants underwent a traditional F-F neuropsychological assessment as part of their standard care. Four months after inclusion, they were randomized to undergo an additional neuropsychological assessment either by F-F administration or by TeleNP.

RESULTS

A total of 150 adults with cognitive complaints, but with no major cognitive or sensorial impairment were included. At 4 months, 69 participants were randomized in the F-F arm and 71 in TeleNP arm (10 lost in the follow-up). The overall satisfaction was high: 87.1% in the TeleNP arm were "very satisfied", and 82.9% indicated no preference between F-F and TeleNP. In agreement with previous data from the literature, neuropsychological assessments gave similar results across both administration conditions for a large majority of tests [Mini-Mental State Examination (MMSE), Free and Cued Selective Reminding Test (FCSRT) French version, Mahieux gestural praxis battery, Frontal Assessment Battery (FAB), time of completion of the Trail making Test (TMT) A and B, number of errors of the TMT B, Rey complex figure test, categorical et phonological verbal fluency tests] and minor differences for others [80-picture naming test (DO-80), FAB, Digit Span forward and backward and number of errors in the TMT A].

CONCLUSIONS

TeleNP is a promising method to be able to test patients as an alternative to F-F condition. Before this procedure can be generalized, it is now necessary to standardize the adaptation of certain tests and to test them in populations with more significant cognitive disorders.

Can the Rorschach be Administered Remotely? A Review of Options and a Pilot Study Using a Newly Developed R-PAS App

The ongoing COVID-19 pandemic has required psychologists to adopt measures like physical distancing and mask wearing, though other safety procedures such as travel restrictions or prohibitions on in-person practice and research have fostered the use of tele-health tools. In this article, we review options for using the Rorschach task via videoconference and provide preliminary data from using a new electronic app for remote R-PAS administration to determine whether the remote administration in an electronic form yields different information than in-person administration with the cards in hand. As a pilot study, our focus is on the "first factor" of all Rorschach scores, i.e., complexity. Data were collected from 60 adult Italian community volunteers, and statistical analyses evaluated the extent to which the average complexity score significantly departed from R-PAS normative expectations (SS = 100), accompanied by Bayesian likelihoods for supporting the null hypothesis. Results suggest that the general level of complexity shown by the test-takers when administered the Rorschach remotely with the new R-PAS app closely resembles that previously observed using "standard" in-person procedures. Tentative analyses of other R-PAS scores suggested normative departures that could be due to the effects of the app, testing at home, or responses to the pandemic. We offer recommendations for future research and discuss practical implications.

Mental Health Needs of Aging Veterans: Recent Evidence and Clinical Recommendations

Objectives: Large numbers of older Americans have a history of military service, which may be positively or negatively associated with mental health in late life. We reviewed literature with the aim of better understanding the mental health needs of older Veterans.Methods: Articles included those published in 2009-2018 and focused on prevalence/risk for mental illness and suicide among older Veterans; utilization of mental health services; effectiveness of evidence-based behavioral treatments; and pertinent care delivery models.Results: Older Veterans are generally resilient. A significant minority experience mental health concerns that are associated with poor outcomes including a substantial number of suicides. Most published research is based on the approximately one third of Veterans who use the Veterans Health Administration (VHA) for care. Older Veterans with mental health diagnoses are less likely to utilize mental health services compared to younger Veterans, but as likely to benefit once engaged. Integrated care models in primary and geriatric care settings are promising.Conclusions: Aging Veterans are a large subset of Americans whose mental health needs are complex and deserve attention.Clinical Implications: Clinicians should ask about history of military service (i.e., Veteran status) and utilize available resources when providing care for older Veterans.

Feasibility and Acceptance of Direct-to-Home Tele-neuropsychology Services during the COVID-19 Pandemic

OBJECTIVE

Neuropsychological assessment via video conferencing has been proposed during the COVID-19 pandemic. Existing literature has demonstrated feasibility and acceptance of neuropsychological measures administered by videoconference, although few studies have examined feasibility and patient acceptance of TNP visits directly to patients' homes (DTH-TNP).

METHODS

We modified a previously published patient satisfaction survey for DTH-TNP and developed a clinician feasibility survey to examine experiences during DTH-TNP.

RESULTS

Seventy-two patients (age range: preschool-geriatric) evaluated by DTH-TNP for cognitive problems at an academic medical center responded to voluntary surveys between April 20, 2020, and August 19, 2020, and 100% indicated satisfaction. Fifty-nine percent of patients reported limitations (e.g., technological concern) during the appointment. 134 clinician surveys were collected and indicated that clinicians achieved the goal of their appointment in 90% of encounters.

CONCLUSIONS

These qualitative data suggest that patients and clinicians found DTH-TNP to be satisfactory during the COVID-19 pandemic, while also recognizing limitations of the practice. These results are limited in that voluntary surveys are subject to bias. They support the growing body of literature suggesting that DTH-TNP provides a valuable service, though additional research to establish reliability and validity is needed.

Tele-neuropsychological assessment tools in Italy: a systematic review on psychometric properties and usability

Background

The current COVID-19 pandemic has abruptly catalysed a shift towards remote assessment in neuropsychological practice (tele-neuropsychology, t-NPs). Although the validity of t-NPs diagnostics is gaining recognition worldwide, little is known about its implementation in Italy. The present review by the Italian working group on tele-neuropsychology (TELA) aims at describing the availability, psychometric properties, and feasibility of t-NPs tools currently available in Italy.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. This work was pre-registered on the Prospective Register of Systematic Reviews (PROSPERO; CRD42021239687). Observational studies reporting telephone-, videoconference- or web-based assessment of cognition/behaviour in Italian both healthy participants (HPs) and patients were included. Bias assessment was performed through ad hoc scales.

Results

Fourteen studies were included from an initial N = 895 (4 databases searched). Studies were subdivided into those focused on psychometric properties and those characterized by a predominant applied nature. The majority of studies addressed either adult/elderly HPs or neurological/internal patients. Multi-domain screening tools for cognition, behaviour, mood/anxiety and quality of life were the most represented. Findings regarding validity, reliability, sensitivity, specificity and clinical usability were reported for cognitive screenings — the telephone- and videoconference-based Mini-Mental State Examination and the Telephone Interview for Cognitive Status.

Discussion

Positive albeit preliminary evidence regarding psychometric properties and feasibility in both clinical and non-clinical populations of Italian t-NPs brief screening tools are herewith provided. Further studies exploring clinical usability of t-NPs and psychometric properties/feasibility of tests for the in-depth assessment of specific cognitive domains are necessary.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10072-021-05719-9.

The development and implementation of teleneuropsychology in an academic lifespan neuropsychology center: Lessons learned from the COVID-19 pandemic

INTRODUCTION

Teleneuropsychology (TNP) became a critical means for providing care during the COVID-19 pandemic and may continue as an option for delivery of neuropsychological services. To understand how patient characteristics impact clinician decisions and service models, this study examines practice patterns within a lifespan outpatient neuropsychology center before, during and post-pandemic.

METHODS

Patient volume, demographics, and characteristics were compared across four, 3-month time intervals in 2019-2020. Two baseline intervals when the center was physically open (PO) were compared to one interval when the center was physically closed (PC) (all evaluations were conducted via direct-to-home TNP) and a fourth interval when the center was physically reopened (RO) and evaluations were conducted in one of the three modalities: in-person, virtual only or hybrid (both virtual/in-person).

RESULTS

A total of 1,459 total neuropsychological evaluations were conducted with a 64.6% reduction during PC. At RO, the number of evaluations returned to pre-COVID baseline during which in-person (72.4%) evaluations were conducted at a higher rate than hybrid (7.1%) or virtual only (20.4%). Across the lifespan, mean number of appointments to complete evaluations was significantly greater during PC (p< .001) than at other time intervals, and during RO, hybrid evaluations required significantly more appointments (p < .001) than in-person and virtual. The majority of evaluations were conducted with adult patients (71.4%). For adult patients, neurodegenerative/memory disorders received TNP evaluations at a higher rate during PC and RO. Pediatric patients were significantly older during PC (p < .001); neurodevelopmental referrals received more hybrid and virtual evaluations.

CONCLUSIONS

Results indicate that patient characteristics, especially age and referral categories, impact the feasibility of TNP. Data from the RO period suggest that in-person evaluations not surprisingly remain the mainstay; however, for adult patients, and especially older adults with neurodegenerative/memory disorders, TNP may provide an important option for delivery of neuropsychological evaluations.

Cancer, cognition, and COVID: delivering direct-to-home teleneuropsychology services to neuro-oncology patients

BACKGROUND

The COVID-19 pandemic induced rapid adoption of telemedicine services for neuro-oncology patients at an increased risk of infection. Neuropsychological assessment is important to neuro-oncology care yet challenging to complete outside of a structured testing environment. Teleneuropsychology (TNP) has been explored in limited populations and proven feasible and reliable. Conducting TNP visits directly to patients' home (DTH) had minimal prior study.

METHODS

We used two voluntary surveys to examine acceptance (patients) and feasibility (providers) of DTH-TNP at two regionally diverse medical institutions providing neuropsychological services to neuro-oncology patients from April to September 2020.

RESULTS

A total of 119 patients were scheduled during the study period, 79 of whom completed neuropsychological testing via DTH-TNP. Neuropsychology providers completed surveys on 68 of these encounters (86%). In 98% of cases, neuropsychologists were able to achieve or partially achieve the individually defined goals of their assessment. Common problems reported included patient dysregulation (16%) and slow/unreliable internet (15%). Of the 52 patients who responded, 98% were satisfied with the DTH-TNP experience, and 92% would recommend the virtual visit to others. All respondents felt understood by the examiner (100%) and the majority denied technical difficulties (90%), communication challenges (94%), or privacy concerns (98%). Patients reported reduced risk of infection and saved travel time as favorable aspects of DTH-TNP.

CONCLUSIONS

These preliminary results suggest neuro-oncology patients find DTH-TNP acceptable and neuropsychologists find it a feasible practice, while also recognizing its limitations. Results suggest that further study of DTH-TNP (eg, reliability, validity) for neuro-oncology patients is warranted.

Cross-cultural considerations for teleneuropsychology with Asian patients

OBJECTIVE

Recent teleneuropsychology (TeleNP) models provide some degree of guidance in the application of telecommunication technologies toward the practice of neuropsychology. However, there remains a paucity of peer-reviewed data on TeleNP practices with culturally diverse patients, including Asian patients. This manuscript describes the challenges related to TeleNP practices with Asian patients and offers practical recommendations to complement existing TeleNP guidelines.

METHOD

Based on extant literature on multicultural applications of neuropsychology, weprovide recommendations for TeleNP services with Asian patients that pertain to specific components of a TeleNP evaluation, such as a) pre-evaluation preparation, b) determining the appropriateness of the referral, c) determining language proficiency, d) working with interpreters, e) informed consent and confidentiality issues, f) conducting a culturally sensitive clinical interview, g) behavioral observations and communication, h) test selection, and i) interpreting data and writing reports.

CONCLUSIONS

Our recommendations for TeleNP services with Asian patients highlight the need for flexibility to accommodate cultural differences and commitment to the complex nature of working with patients requiring interpretation services, while also recognizing the importance of preserving the validity of neuropsychological methods. Moving forward, it is imperative that the field of neuropsychology increases the training and accessibility of neuropsychologists who are knowledgeable in providing TeleNP services to Asian patients, and promotes research on the validation of TeleNP for Asian and other ethnic minority groups.

Distance Assessment for Detecting Cognitive Impairment in Older Adults: A Systematic Review of Psychometric Evidence

INTRODUCTION

Distance or remote cognitive assessments, administered via phone or computer platforms, have emerged as possible alternatives to traditional assessments performed during office visits. Distance refers to any nontraditional assessment feature, not only or necessarily location. We conducted a systematic review to examine the psychometric soundness of these approaches.

METHOD

We searched PubMed, PsycINFO, AgeLine, and Academic Search Premier for articles published between January 2008 and June 2020. Studies were included if participants were over the age of 50, a structured assessment of cognitive function in older adults was evaluated, the assessment method was deemed distant, and validity and/or reliability data were reported. Assessment distance was defined as having any of the following features: use of an electronic test interface, nonroutine test location (e.g., home), test self-administered, and test unsupervised. Distance was categorized as low, intermediate, or high.

RESULTS/DISCUSSION

Twenty-six studies met inclusion criteria. Sample sizes ranged from n = 8 to 8,627, and the mean age ranged from 57 to 83. Assessments included screens, brief or full batteries, and were performed via videoconferencing, phone, smartphone, or tablet/computer. Ten studies reported on low distance, 11 on intermediate distance, and 5 studies for high distance assessments. Invalid performance data were observed with older age and cognitive impairment. Convergent validity data were reported consistently and suggested a decline with increasing distance: r = 0.52-0.80 for low, 0.49-0.75 for intermediate, and 0.41-0.53 for high distance. Diagnostic validity estimates presented a similar pattern. Reliability data were reported too inconsistently to allow evaluation.

CONCLUSION

The validity of cognitive assessments with older adults appears supported at lower but not higher distance. Less is known about the reliability of such assessments. Future research should delineate the person and procedure boundaries for valid and reliable test results.

From Face-to-Face to Home-to-Home: Validity of a Teleneuropsychological Battery

Background:

Over the last decade, teleneuropsychology has increased substantially. There is a need for valid neuropsychological batteries to be administered home-to-home. Since 2006, the neuropsychological battery of Fundació ACE (NBACE) has been administered face-to-face in our clinical settings. Recently, we adapted the NBACE for teleneuropsychology use to be administered home-to-home (NBACEtn).

Objective:

The aims of the present study are: 1) to determine the home-to-home NBACE equivalence compared to its original face-to-face version; and 2) to examine home-to-home NBACE discriminant capacity by differentiating among cognitively healthy, mild cognitive impairment, or mild dementia subjects and comparing it with the face-to-face version.

Methods:

Data from 338 individuals assessed home-to-home (NBACEtn) were contrasted with 7,990 participants assessed with its face-to-face version (NBACE). Exploratory and confirmatory factorial structure, and invariance analysis of the two versions of the battery were performed.

Results:

Exploratory and confirmatory factor analysis supported the four-factor model (attention, memory, executive, and visuospatial/constructional functions). Configural, metric, and scalar measurement invariance was found between home-to-home and face-to-face NBACE versions. Significant differences in most of the neuropsychological variables assessed were observed between the three clinical groups in both versions of administration. No differences were found between the technological devices used by participants (computer or tablet and mobile devices).

Conclusion:

For the first time, invariance analysis findings were addressed by determining a teleneuropsychological battery’s equivalence in comparison with its face-to-face version. This study amplifies the neuropsychological assessment’s applicability using a home-to-home format, maintaining the original measure’s structure, interpretability, and discriminant capacity.

How, when, and for whom: decisions regarding remote neuropsychological assessment during the 2020 COVID-19 pandemic

Neuropsychological assessment provides crucial information about cognitive, behavioral, and socioemotional functioning in medical, educational, legal, and social contexts. During the 2020 COVID-19 pandemic, the Israeli Ministry of Health initially mandated that all psychological assessments be postponed. However, as referrals to time-sensitive, high-need, and high-stakes assessments began to accumulate, it became necessary to consider remote solutions. In the current paper, we describe the considerations that affected the transition to remote activity in a prominent Israeli provider of neuropsychological assessment and rehabilitation services, referring to technological and environmental conditions, cognitive requirements, and tasks, as well as to legal, regulatory, and funding issues. After discussing how assessments should be conducted to maximize feasibility and validity while minimizing risks to clients and clinicians, we propose a preliminary model for deciding whether specific referrals warrant remote administration. The model delineates key factors in decisions regarding remote assessment, emphasizing the distinct roles of the referring clinician and the neuropsychologist who conducts the assessment, and highlighting the need for collaboration between them. The abrupt need for remote assessments during the pandemic required a quick response with little preparation. The lessons learned from this process can be applied in the future, so that the need for remote services can be met with greater certainty and uniformity.

Remote Forensic Psychological Assessment in Civil Cases: Considerations for Experts Assessing Harms from Early Life Abuse

The COVID-19 pandemic has brought to the fore the question of whether psycho-legal assessments can be executed remotely in a manner that adheres to the rigorous standards applied during in-person assessments. General guidelines have evolved, but to date, there are no explicit directives about whether and how to proceed. This paper reviews professional, ethical, and legal challenges that experts should consider before conducting such an evaluation remotely. Although the discussion is more widely applicable, remote forensic psychological assessment of adults alleging childhood abuse is used as an example throughout, due to the complexity of these cases, the ethical dilemmas they can present, and the need to carefully assess non-verbal trauma-related symptoms. The use of videoconferencing technology is considered in terms of potential benefits of this medium, as well as challenges this method could pose to aspects of interviewing and psychometric testing. The global pandemic is also considered with respect to its effects on functioning and mental health and the confounding impact such a crisis has on assessing the relationship between childhood abuse and current psychological functioning. Finally, for those evaluators who want to engage in remote assessment, practice considerations are discussed.

Patient Satisfaction with Telephone Neuropsychological Assessment

OBJECTIVE

Telephone-based neuropsychological assessment (TeleNP) has been shown to be a valid alternative to in-person or video-based assessment. However, there is limited information regarding patients' satisfaction with TeleNP. This report presents satisfaction survey data from a diverse, clinical sample who received TeleNP during the coronavirus disease pandemic.

METHOD

A total of 43 adult patients (30.2% Hispanic/Latinx, 32.6% Black), aged 24-75, who received TeleNP as part of routine clinical care participated in a postassessment satisfaction survey. Responses were analyzed qualitatively and via nonparametric comparisons based on demographic factors.

RESULTS

Given options of "Not Satisfied," "Somewhat Satisfied," "Satisfied," or "Very Satisfied," 97.7% of patients reported satisfaction with their visit as well as the visit length, and 80% felt the visit met their needs ("Good" + "Very Good"). There were no significant differences in responses based on age, race/ethnicity, sex, or education. Endorsed advantages of TeleNP included "Avoid potential exposure to illness" and "Flexibility/Convenience," and 20% reported difficulty communicating, concentrating, and/or connecting with their provider as potential disadvantages. Although 67.7% reported a preference for in-person visits, 83.7% expressed interest in another "virtual visit" (telephone or video conference) with their provider.

CONCLUSIONS

TeleNP was well received by the sample and demonstrated good patient satisfaction. These results in conjunction with other research supporting the validity of TeleNP support consideration of this assessment modality for patients who might not otherwise have access to in-person or video conference-based neuropsychological services. Based on these findings, a greater focus on rapport building may be warranted when utilizing TeleNP to enhance patients' sense of connection to their provider.

Teleneuropsychology for Monolingual and Bilingual Spanish-Speaking Adults in the Time of COVID-19: Rationale, Professional Considerations, and Resources

OBJECTIVE

Neuropsychological assessments with monolingual Spanish and bilingual Spanish/English-speaking adults present unique challenges. Barriers include, but are not limited to, the paucity of test norms, uncertainty about the equivalence of translated neuropsychological tests, and limited proficiency in the provision of culturally competent services. Similar issues generalize to telephone- and video-based administration of neuropsychological tests or teleneuropsychology (TeleNP) with Hispanics/Latinos (as), and few studies have examined its feasibility and validity in this group. The sudden onset of the COVID-19 pandemic prompted neuropsychologists to identify alternative ways to provide equitable care. Clinicians providing TeleNP to this population during (and after) the pandemic must consider safety, professional factors, and systemic barriers to accessing and benefitting from virtual modalities.

METHOD

This clinical process manuscript describes how cross-cultural neuropsychologists across five U.S. academic institutions serving Hispanics/Latinos (as) developed TeleNP models of care during the pandemic.

RESULTS

Workflows, test batteries, and resources for TeleNP assessment with monolingual and bilingual Spanish-speaking patients are included. Factors guiding model development and informing decisions to incorporate virtual administration of neuropsychological tests into their practice are also discussed.

CONCLUSIONS

Provision of TeleNP is a promising modality. Additional research in this area is warranted with focus on cultural and contextual factors that support or limit the use of TeleNP with this community.

Diagnosis of dementia in Australia: a narrative review of services and models of care

Objective There is an impetus for the timely diagnosis of dementia to enable optimal management of patients, carers and government resources. This is of growing importance in the setting of a rising prevalence of dementia in an aging population. The Australian Clinical Practice Guidelines and Principles of Care for People with Dementia advocate referral to comprehensive memory services for dementia diagnosis, but in practice many patients may be diagnosed in other settings. The aim of the present study was to obtain evidence of the roles, effectiveness, limitations and accessibility of current settings and services available for dementia diagnosis in Australia. Methods A literature review was performed by searching Ovid MEDLINE using the terms 'dementia' AND 'diagnosis OR detection'. In addition, articles from pertinent sources, such as Australian government reports and relevant websites (e.g. Dementia Australia) were included in the review. Results Literature was found for dementia diagnosis across general practice, hospitals, memory clinics, specialists, community, care institutions and new models. General practitioners are patients' preferred health professionals when dealing with dementia, but gaps in symptom recognition and initiation of cognitive testing lead to underdiagnosis. Hospitals are opportunistic places for dementia screening, but time constraints and acute medical issues hinder efficient dementia diagnosis. Memory clinics offer access to multidisciplinary skills, demonstrate earlier dementia diagnosis and potential cost-effectiveness, but are disadvantaged by organisational complexities. Specialists have increased confidence in diagnosing dementia than generalists, but drawbacks include long wait lists. Aged care assessment teams (ACAT) are a potential service for dementia diagnosis in the community. A multidisciplinary model for dementia diagnosis in care institutions is potentially beneficial, but is time and cost intensive. New models with technology allow dementia diagnosis in rural regions. Conclusion Memory clinics are most effective for formal dementia diagnosis, but healthcare professionals in other settings play vital roles in recognising patients with dementia and initiating investigations and referrals to appropriate services. What is known about this topic? Delays in dementia diagnosis are common, and it is unclear where majority of patients receive a diagnosis of dementia in Australia. While the Australian Clinical Practice Guidelines and Principles of Care for People with Dementia advocate referrals to services such as memory clinics for comprehensive assessment and diagnosis of dementia, such services may have limited capacity and may not be readily accessible to all. What does this paper add? This paper presents an overview of the various settings and services available for dementia diagnosis in Australia including evidence of the roles, accessibility, effectiveness and limitations of each setting. What are the implications for practitioners? This concerns a disease that is highly prevalent and escalating, and highlights the roles for practitioners in various settings including general practices, acute hospitals, specialist clinics, community and nursing homes. In particular, it discusses the potential roles, advantages and challenges of dementia diagnosis in each setting.

InterOrganizational practice committee recommendations/guidance for teleneuropsychology (TeleNP) in response to the COVID-19 pandemic

Objective: The Inter Organizational Practice Committee (IOPC) convened a workgroup to provide rapid guidance about teleneuropsychology (TeleNP) in response to the COVID-19 pandemic.Method: A collaborative panel of experts from major professional organizations developed provisional guidance for neuropsychological practice during the pandemic. The stakeholders included the American Academy of Clinical Neuropsychology/American Board of Clinical Neuropsychology, the National Academy of Neuropsychology, Division 40 of the American Psychological Association, the American Board of Professional Neuropsychology, and the American Psychological Association Services, Inc. The group reviewed literature, collated federal, regional and state regulations and information from insurers, and surveyed practitioners to identify best practices.Results: Literature indicates that TeleNP may offer reliable and valid assessments, but clinicians need to consider limitations, develop new informed consent procedures, report modifications of standard procedures, and state limitations to diagnostic conclusions and recommendations. Specific limitations affect TeleNP assessments of older adults, younger children, individuals with limited access to technology, and individuals with other individual, cultural, and/or linguistic differences. TeleNP may be contraindicated or infeasible given specific patient characteristics, circumstances, and referral questions. Considerations for billing TeleNP services are offered with reservations that clinicians must verify procedures independently. Guidance about technical issues and "tips" for TeleNP procedures are provided.Conclusion: This document provides provisional guidance with links to resources and established guidelines for telepsychology. Specific recommendations extend these practices to TeleNP. These recommendations may be revised as circumstances evolve, with updates posted continuously at OPC.online.

Health workers perception on telemedicine in management of neuropsychiatric symptoms in long-term care facilities: Two years follow-up

The management of neuropsychiatric symptoms is a challenge in long-term care facilities. Our objective was to assess the perception of telemedicine, as a useful tool to connect staff to specialized units. In this multicenter prospective study, 90 patients from ten facilities benefited from 180 sessions over two years. The primary outcome was the perception of telemedicine evaluated through semi-structured interviews at baseline and two years later. Our results revealed positive perceptions of telemedicine, confirmed after two years of real-life experience with its use. Not only do staff members believe that telemedicine is not a downgraded version of medicine, but they also believe that it could improve the quality of care. They expressed a very positive sense of recognition of their professional qualifications and indicated their need to be involved in change processes to ensure successful implementation and better adherence to telemedicine as a service.

Forensic mental telehealth assessment (FMTA) in the context of COVID-19

Due to the present COVID-19 pandemic, forensic mental telehealth assessment (FMTA) is an increasingly utilized means of conducting court-sanctioned psychiatric and psychological evaluations. FMTA is not a novel development, and studies have been published during the past two decades that opine on the positive and negative implications of conducting testing and interview procedures online, in forensic and traditionally clinical matters alike. The present article examines prospects for eventual legal challenges to FMTA, describes considerations for conducting FMTA in both institutional and residential settings, and concludes that FMTA is now-due to predicted accommodations on the part of courts, attorneys, institutions, and professional guilds-a permanent part of the forensic evaluation landscape, even once the present COVID-19 pandemic has subsided.

Assessing Cognition Outside of the Clinic: Smartphones and Sensors for Cognitive Assessment Across Diverse Psychiatric Disorders

Traditionally, the assessment of cognition and the administration of cognitive therapies has been performed in the clinic, but with modern technology, this clinic-centric view is changing. This article explores the landscape of digital devices used to measure cognition in settings outside the clinic. These devices range in mobility from user-friendly mobile devices to setting-specific devices able to provide powerful, robust cognitive therapy and living assistance in the comfort of a patient's home. Although these methods remain in early stages of developmental, initial studies suggest they may prove useful in treating patients with serious mental illnesses in a widespread clinical setting.

In-Home Video Telehealth for Dementia Management: Implications for Rehabilitation

PURPOSE OF REVIEW

The progressive nature of dementia requires ongoing care delivered by multidisciplinary teams, including rehabilitation professionals, that is individualized to patient and caregiver needs at various points on the disease trajectory. Video telehealth is a rapidly expanding model of care with the potential to expand dementia best practices by increasing the reach of dementia providers to flexible locations, including patients' homes. We review recent evidence for in-home video telehealth for patients with dementia and their caregivers with emphasis on implications for rehabilitation professionals.

RECENT FINDINGS

Eleven studies were identified that involved video visits into the home targeting patients with dementia and/or their family caregivers. The majority describe protocolized interventions targeting caregivers in a group format over a finite, pre-determined period. For most, the discipline of the interventionist was unclear, though two studies included rehabilitation interventions. While descriptions of utilized technology were often lacking, many reported that devices were issued to participants when needed, and that technical support was provided by study teams. Positive caregiver outcomes were noted but evidence for patient-level outcomes and cost data are mostly lacking.

SUMMARY

More research is needed to demonstrate implementation of dementia best care practices through in-home video telehealth. Though interventions delivered using in-home video telehealth appear to be effective at addressing caregivers' psychosocial concerns, the impact on patients and the implications for rehabilitation remain unclear. Larger, more systematic inquiries comparing in-home video telehealth to traditional visit formats are needed to better define best practices.

Geriatric Telepsychiatry: Systematic Review and Policy Considerations

Telemental health (TMH) for older patients has the potential to increase access to geriatric specialists, reduce travel times for patients and providers, and reduce ever growing healthcare costs. This systematic review article examines the literature regarding psychiatric assessment and treatment via telemedicine for geriatric patients. English language literature was searched using Ovid Medline, PubMed, and PsycINFO with search terms including telemedicine, telemental health, aging, and dementia. Abstracts were reviewed for relevance based on inclusion criteria. Multiple study types were reviewed, including open label, qualitative and randomized controlled trial study designs. Data was compiled regarding participants, study intervention, and outcomes. 76 articles were included. TMH was shown to be feasible and well accepted in the areas of inpatient and nursing home consultation, cognitive testing, dementia diagnosis and treatment, depression in integrated and collaborative care models, and psychotherapy. There is limited data on cost-effectiveness of TMH in the elderly. This article will discuss the current barriers to broader implementation of telemedicine for geriatric patients including reimbursement from the Medicare program. Medicare reimbursement for telemedicine is limited to rural areas, which does not allow for the widespread development of telemedicine programs. All Medicare beneficiaries would benefit from increased access to telemedicine services, not only those living in rural areas. As many elderly and disabled individuals have mobility problems, home-based telemedicine services should also be made available. There are efforts in Congress to expand the coverage of these services under Medicare, but strong advocacy will be needed to ensure these efforts are successful.

Validity of Teleneuropsychological Assessment in Older Patients with Cognitive Disorders

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.

Effectiveness of a Blended Care Self-Management Program for Caregivers of People With Early-Stage Dementia (Partner in Balance): Randomized Controlled Trial

BACKGROUND

The benefits of electronic health support for dementia caregivers are increasingly recognized. Reaching caregivers of people with early-stage dementia could prevent high levels of burden and psychological problems in the later stages.

OBJECTIVE

The current study evaluates the effectiveness of the blended care self-management program, Partner in Balance, compared to a control group.

METHODS

A single-blind randomized controlled trial with 81 family caregivers of community-dwelling people with mild dementia was conducted. Participants were randomly assigned to either the 8-week, blended care self-management Partner in Balance program (N=41) or a waiting-list control group (N=40) receiving usual care (low-frequent counseling). The program combines face-to-face coaching with tailored Web-based modules. Data were collected at baseline and after 8 weeks in writing by an independent research assistant who was blinded to the treatment. The primary proximal outcome was self-efficacy (Caregiver Self-Efficacy Scale) and the primary distal outcome was symptoms of depression (Center for Epidemiological Studies Depression Scale). Secondary outcomes included mastery (Pearlin Mastery Scale), quality of life (Investigation Choice Experiments for the Preferences of Older People), and psychological complaints (Hospital Anxiety and Depression Scale-Anxiety and Perceived Stress Scale).

RESULTS

A significant increase in favor of the intervention group was demonstrated for self-efficacy (care management, P=.002; service use P=.001), mastery (P=.001), and quality of life (P=.032). Effect sizes were medium for quality of life (d=0.58) and high for self-efficacy care management and service use (d=0.85 and d=0.93, respectively) and mastery (d=0.94). No significant differences between the groups were found on depressive symptoms, anxiety, and perceived stress.

CONCLUSIONS

This study evaluated the first blended-care intervention for caregivers of people with early-stage dementia and demonstrated a significant improvement in self-efficacy, mastery, and quality of life after receiving the Partner in Balance intervention, compared to a waiting-list control group receiving care as usual. Contrary to our expectations, the intervention did not decrease symptoms of depression, anxiety, or perceived stress. However, the levels of psychological complaints were relatively low in the study sample. Future studies including long-term follow up could clarify if an increase in self-efficacy results in a decrease or prevention of increased stress and depression. To conclude, the program can provide accessible preventative care to future generations of caregivers of people with early-stage dementia.

TRIAL REGISTRATION

Netherlands Trial Register NTR4748; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4748 (Archived by WebCite at http://www.webcitation.org/6vSb2t9Mg).

Agreement between telehealth and face-to-face assessment of intellectual ability in children with specific learning disorder

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.

Evaluating the Feasibility of a Play-Based Telehealth Intervention Program for Children with Prader-Willi Syndrome

Here we report the feasibility and acceptability of telehealth for direct intervention in children with Prader-Willi syndrome (PWS). Children with PWS have social-cognitive challenges that are similar to children with ASD. However, developing behavioral interventions for individuals with PWS is faced with the significant challenge of enrolling enough participants for local studies where multiple visits per week are indicated for effective intervention. This study delivered a 6-week play-based intervention via telehealth directly to eight children with PWS (6-12 years). Participants completed the program with minimal behavioral or technological difficulty (#sessions M = 11.875/12). Behavioral Intervention Rating Scale results indicate good acceptability (M = 5.54/6.00). These findings support using telehealth in rare disorders and delivering intervention directly to children with developmental delays through this modality.

Telehealth applications for outpatients with neuromuscular or musculoskeletal disorders

Telehealth describes the provision of medical services remotely through technology, and may enhance patient access to specialty care services. Although teleneurology has expanded widely since the introduction of telestroke in 1999, telehealth services for outpatients with neuromuscular or musculoskeletal disorders are less widespread. In this narrative review, we will describe the current technology, applications, outcomes, and limitations of this dynamically growing field. Evidence for telehealth applications related to neuromuscular diseases, palliative care, specialized multidisciplinary services, and musculoskeletal care are reviewed. With growing demand for specialized services and finite resources, telehealth provides a promising avenue to promote access to high-quality care, decrease the cost and burden of travel for patients, and with the expansion of software to personal computing and mobile devices, offer flexible, low-overhead practice opportunities for clinicians. Providers embarking on careers in telehealth should be aware of current legal restrictions impacting care to minimize risk and avoid liability. Muscle Nerve 58: 475-485, 2018.

Diagnosis of cognitive decline and dementia in rural areas - A scoping review

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.

The reliability of the Montreal Cognitive Assessment using telehealth in a rural setting with veterans

Background

Telehealth neuropsychological services can increase the availability of specialised care for individuals in rural areas where barriers to these services are faced. As this practice becomes more commonplace, the reliability and validity of neuropsychological assessment administered by telehealth continues to be established. The Montreal Cognitive Assessment, a screener for general neurocognitive dysfunction, may be particularly useful since this measure can be given by telehealth with minimal adaptation.

Methods

Veterans from a rural area of the country who were referred to an outpatient neuropsychology clinic were administered the Montreal Cognitive Assessment either in-person or by telehealth by a clinician. A second clinician observed the administration in-person or by telehealth and independently scored the each participant’s performance. The inter-rater reliabilities across conditions were compared to assess for differences between in-person and telehealth consultations.

Results

The inter-rater reliability of the Montreal Cognitive Assessment across the three conditions of interest was acceptably high and values ranged from r = 0.88 to r = 0.98. Reliability correlations were compared and no significant differences among the conditions were observed ( p’s > 0.10). Beyond reliability, univariate comparison of the absolute mean differences of clinician scores showed no significant differences among the actual raw scores of the three conditions tested, indicating good accuracy ( p = 0.56).

Conclusions

The inter-rater reliabilities of Montreal Cognitive Assessment scores across conditions were all acceptably high, and administration of the Montreal Cognitive Assessment using telehealth technology did not significantly alter the total scores. Overall, the lack of significant differences suggests that administering the Montreal Cognitive Assessment by telehealth is reliable, accurate and well received by participants.

Nursing Home Provider Perceptions of Telemedicine for Providing Specialty Consults

BACKGROUND

Nursing homes (NHs) provide care to a complex patient population and face the ongoing challenge of meeting resident needs for specialty care. A NH telemedicine care model could improve access to remote specialty providers.

INTRODUCTION

Little is known about provider interest in telemedicine for specialty consults in the NH setting. The goal of this study was to survey a national sample of NH physicians and advanced practice providers to document their views on telemedicine for providing specialty consults in the NH.

MATERIALS AND METHODS

We surveyed physician and advanced practice providers who attended the 2016 AMDA-The Society for Post-Acute and Long-Term Care Medicine Annual Conference about their likelihood of referral to and perceptions of a telemedicine program for providing specialty consults in the NH.

RESULTS

We received surveys from 524 of the 1,274 conference attendees for a 41.1% response rate. Respondents expressed confidence in the ability of telemedicine to fill existing service gaps and provide appropriate, timelier care. Providers showed the highest level of interest in telemedicine for dermatology, geriatric psychiatry, and infectious disease. Only 13% of respondents indicated that telemedicine was available for use in one of their facilities.

DISCUSSION

There appears to be unmet demand for telemedicine in NHs for providing specialty consults to residents.

CONCLUSIONS

The responses of NH providers suggest support for the concept of telemedicine as a modality of care that can be used to offer specialty consults to NH residents.