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Ter Huurne D, Ramakers I, Possemis N, König A, Linz N, Tröger J, Langel K, Verhey F, de Vugt M. User Experience of a (Semi-) Automated Cognitive Phone-Based Assessment Within a Memory Clinic Population. Arch Clin Neuropsychol 2024:acae063. [PMID: 39221892 DOI: 10.1093/arclin/acae063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 06/13/2024] [Accepted: 07/15/2024] [Indexed: 09/04/2024] Open
Abstract
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.
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Affiliation(s)
- Daphne Ter Huurne
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Dr. Tanslaan 12, Maastricht University, 6200 MD Maastricht, the Netherlands
| | - Inez Ramakers
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Dr. Tanslaan 12, Maastricht University, 6200 MD Maastricht, the Netherlands
| | - Nina Possemis
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Dr. Tanslaan 12, Maastricht University, 6200 MD Maastricht, the Netherlands
| | - Alexandra König
- National Institute for Research in Computer Science and Automation (INRIA), Stars team, route des Lucioles 06902 Sophia Antipolis, France
| | - Nicklas Linz
- ki elements, Bleichstrasse 27, 66121 Saarbrücken, Germany
| | | | - Kai Langel
- Janssen Clinical Innovation, Turnhoutseweg 30, B-2340 Beerse, Belgium
| | - Frans Verhey
- Department of Psychiatry and psychology, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and psychology, Maastricht University Medical Center+ (MUMC+), P. Debyelaan 25, 6202 AZ Maastricht, the Netherlands
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Sachs BC, Latham LA, Bateman JR, Cleveland MJ, Espeland MA, Fischer E, Gaussoin SA, Leng I, Rapp SR, Rogers S, Shappell HM, Williams BJ, Yang M, Craft S. Feasibility of Remote Administration of the Uniform Data Set-Version 3 for Assessment of Older Adults With Mild Cognitive Impairment and Alzheimer's Disease. Arch Clin Neuropsychol 2024; 39:635-643. [PMID: 38291734 PMCID: PMC11447737 DOI: 10.1093/arclin/acae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE Assess the feasibility and concurrent validity of a modified Uniform Data Set version 3 (UDSv3) for remote administration for individuals with normal cognition (NC), mild cognitive impairment (MCI), and early dementia. METHOD Participants (N = 93) (age: 72.8 [8.9] years; education: 15.6 [2.5] years; 72% female; 84% White) were enrolled from the Wake Forest ADRC. Portions of the UDSv3 cognitive battery, plus the Rey Auditory Verbal Learning Test, were completed by telephone or video within ~6 months of participant's in-person visit. Adaptations for phone administration (e.g., Oral Trails for Trail Making Test [TMT] and Blind Montreal Cognitive Assessment [MoCA] for MoCA) were made. Participants reported on the pleasantness, difficulty, and preference for each modality. Staff provided validity ratings for assessments. Participants' remote data were adjudicated by cognitive experts blinded to the in person-diagnosis (NC [N = 44], MCI [N = 35], Dementia [N = 11], or other [N = 3]). RESULTS Remote assessments were rated as pleasant as in-person assessments by 74% of participants and equally difficult by 75%. Staff validity rating (video = 92%; phone = 87.5%) was good. Concordance between remote/in-person scores was generally moderate to good (r = .3 -.8; p < .05) except for TMT-A/OTMT-A (r = .3; p > .05). Agreement between remote/in-person adjudicated cognitive status was good (k = .61-.64). CONCLUSIONS We found preliminary evidence that older adults, including those with cognitive impairment, can be assessed remotely using a modified UDSv3 research battery. Adjudication of cognitive status that relies on remotely collected data is comparable to classifications using in-person assessments.
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Affiliation(s)
- Bonnie C Sachs
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Lauren A Latham
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - James R Bateman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mary Jo Cleveland
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mark A Espeland
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eric Fischer
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sarah A Gaussoin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Iris Leng
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Samantha Rogers
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Heather M Shappell
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Benjamin J Williams
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Mia Yang
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Suzanne Craft
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Sperling SA, Acheson SK, Fox-Fuller J, Colvin MK, Harder L, Cullum CM, Randolph JJ, Carter KR, Espe-Pfeifer P, Lacritz LH, Arnett PA, Gillaspy SR. Tele-Neuropsychology: From Science to Policy to Practice. Arch Clin Neuropsychol 2024; 39:227-248. [PMID: 37715508 DOI: 10.1093/arclin/acad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The primary aim of this paper is to accelerate the number of randomized experimental studies of the reliability and validity in-home tele-neuropsychological testing (tele-np-t). METHOD We conducted a critical review of the tele-neuropsychology literature. We discuss this research in the context of the United States' public and private healthcare payer systems, including the Centers for Medicare & Medicaid Services (CMS) and Current Procedural Terminology (CPT) coding system's telehealth lists, and existing disparities in healthcare access. RESULTS The number of tele-np publications has been stagnant since the onset of the COVID-19 pandemic. There are less published experimental studies of tele-neuropsychology (tele-np), and particularly in-home tele-np-t, than other tele-np publications. There is strong foundational evidence of the acceptability, feasibility, and reliability of tele-np-t, but relatively few studies of the reliability and validity of in-home tele-np-t using randomization methodology. CONCLUSIONS More studies of the reliability and validity of in-home tele-np-t using randomization methodology are necessary to support inclusion of tele-np-t codes on the CMS and CPT telehealth lists, and subsequently, the integration and delivery of in-home tele-np-t services across providers and institutions. These actions are needed to maintain equitable reimbursement of in-home tele-np-t services and address the widespread disparities in healthcare access.
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Affiliation(s)
- Scott A Sperling
- Department of Neurology, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA
| | | | - Joshua Fox-Fuller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Mary K Colvin
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lana Harder
- Children's Health, Children's Medical Center, Dallas, TX, USA
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, 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, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John J Randolph
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Randolph Neuropsychology Associates, PLLC, Lebanon, NH, USA
| | | | - Patricia Espe-Pfeifer
- Department of Psychiatry and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Laura H Lacritz
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter A Arnett
- Department of Psychology, The Pennsylvania State University, State College, PA, USA
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Dawson R, Gilchrist H, Pinheiro M, Nelson K, Bowes N, Sherrington C, Haynes A. Experiences of Older Adults, Physiotherapists, and Aged Care Staff in the TOP UP Telephysiotherapy Program: Interview Study of the TOP UP Interventions. JMIR Aging 2024; 7:e53010. [PMID: 38324369 PMCID: PMC10882472 DOI: 10.2196/53010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/19/2023] [Accepted: 12/18/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Telehealth provides opportunities for older adults to access health care. However, limited research exists on the use of telehealth within aged care services, particularly regarding physiotherapy-led fall prevention and mobility programs. Understanding the experiences and interactions of older adults, physiotherapists, and aged care service providers is crucial for the scale-up and sustainability of such essential programs. The TOP UP study, a hybrid type 1 effectiveness-implementation randomized controlled trial in aged care, used a supported multidisciplinary telephysiotherapy model to motivate older adults to engage in exercises to improve mobility and reduce falls. OBJECTIVE This qualitative substudy aims to achieve 2 primary objectives: to describe the experiences and acceptability of the TOP UP intervention for older people, physiotherapists, and aged care support workers and managers and to gain an in-depth understanding of program implementation. METHODS A purposive recruitment strategy was used to select 18 older adults who participated in the TOP UP intervention, ensuring variation in age, gender, residential status (home or residential aged care), geographic location, and cognitive levels. In addition, 7 physiotherapists, 8 aged care support workers, and 6 managers from 7 different aged care provider partners participated in this study. Semistructured interviews were conducted to explore stakeholders' experiences with the TOP UP program, gather suggestions for improvement, and obtain insights for the future implementation of similar telephysiotherapy programs. The interview framework and coding processes were informed by behavior changes and implementation frameworks. Data were analyzed using an abductive approach, informed by 2 behavioral change theories (Capability, Opportunity, Motivation, and Behavior Model and Self-Determination Theory) and the Nonadoption, Abandonment and Challenges to the Scale-Up, Spread and Sustainability of Health and Care Technologies framework. RESULTS All participants (n=39) reported high levels of acceptability for the TOP UP program and cited multiple perceived benefits. The thematic analysis generated 6 main themes: telephysiotherapy expands opportunity; tailored physiotherapy care with local support enhances motivation; engaging, older adult-friendly educational resources build capability; flexible reablement approach fosters autonomy; telephysiotherapy is safe, effective, and acceptable for many; and organizational commitment is required to embed telehealth. The motivation to exercise was enhanced by Zoom's convenience, use of tailored web-based exercise resources, and companionable local support. CONCLUSIONS This study highlights the inherent value of telephysiotherapy in aged care, emphasizing the need for investment in staff training, local support, and older adult-friendly resources in future telephysiotherapy iterations. TOP UP represents a convenient and flexible web-based care model that empowers many older adults to receive sustainable, high-quality care precisely when and where they need it. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN 1261000734864; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12621000734864.
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Affiliation(s)
- Rik Dawson
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, Sydney Local Health District, The University of Sydney, Camperdown, Australia
| | - Heidi Gilchrist
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, Sydney Local Health District, The University of Sydney, Camperdown, Australia
| | - Marina Pinheiro
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, Sydney Local Health District, The University of Sydney, Camperdown, Australia
| | | | | | - Cathie Sherrington
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, Sydney Local Health District, The University of Sydney, Camperdown, Australia
| | - Abby Haynes
- Institute for Musculoskeletal Health, Sydney Musculoskeletal Health, Sydney Local Health District, The University of Sydney, Camperdown, Australia
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Angelopoulou E, Kontaxopoulou D, Fragkiadaki S, Stanitsa E, Pavlou D, Papatriantafyllou J, Koros C, Dimovski V, Šemrov D, Papageorgiou SG. Perceptions of Patients, Caregivers, and Healthcare Professionals toward Telemedicine Use for Cognitive and Movement Disorders in the Aegean Islands, Greece: A Pilot Study of the SI4CARE European Project. Geriatrics (Basel) 2023; 9:3. [PMID: 38247978 PMCID: PMC10801565 DOI: 10.3390/geriatrics9010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Patients with neurodegenerative diseases who live in remote areas often have limited access to specialized healthcare, and telemedicine represents a useful solution. The aim of this study was to investigate the perceptions toward the use of a specialized-tertiary telemedicine service of patients with cognitive and movement disorders, caregivers, and local healthcare professionals (HPs) in the Aegean Islands. METHODS Data were derived from the "Specialized Outpatient Clinic of Memory, Dementia and Parkinson's disease through the National Telemedicine Network", March 2021-March 2023. The survey included 10 questions (5-point Likert scale). RESULTS We received 64 questionnaires (25 patients, 18 caregivers, 21 HPs). Most participants positively perceived all aspects of telemedicine, including comfort (mean ± standard deviation: patients 4.5 ± 0.9, caregivers: 4.8 ± 0.5, HPs: 4.6 ± 0.7), access to specialized care (4.7 ± 0.6, 4.7 ± 0.5, 4.9 ± 0.4), number of transportations (4.6 ± 0.8, 4.6 ± 0.9, 4.8 ± 0.5), adequacy of follow-up (4.6 ± 0.7, 4.4 ± 0.8, 4.2 ± 0.7), future telemedicine selection (4.8 ± 0.4, 4.8 ± 0.4, 4.6 ± 0.6), perceived reliable medical assessment (4.7 ± 0.5, 4.6 ± 0.6, 4.3 ± 0.6), information delivery (4.7 ± 0.6, 4.6 ± 0.5, 4.4 ± 0.9), health status improvement (4.6 ± 0.7, 4.6 ± 0.6, 4.0 ± 0.7), cost (4.6 ± 1, 4.6 ± 1, 5.0 ± 0.2), and general satisfaction (4.8 ± 0.4, 4.7 ± 0.5, 4.5 ± 0.6). The commonest recommendations were more frequent visits, medical specialties, and dissemination of information. CONCLUSIONS The positive perception of participants highlights the value of telemedicine for specialized healthcare for neurodegenerative disorders, especially in remote areas.
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Affiliation(s)
- Efthalia Angelopoulou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Dionysia Kontaxopoulou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Stella Fragkiadaki
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Evangelia Stanitsa
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Dimosthenis Pavlou
- School of Topography and Geoinformatics, University of West Attica, Ag. Spyridonos Str., 12243 Aigalew, Greece;
| | - John Papatriantafyllou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Christos Koros
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
| | - Vlado Dimovski
- School of Economics and Business, University of Ljubljana, Kardeljeva ploščad 17, 1000 Ljubljana, Slovenia
| | - Darja Šemrov
- Faculty of Civic and Geodetic Engineering, University of Ljubljana, Jamova Cesta 2, 1000 Ljubljana, Slovenia
| | - Sokratis G. Papageorgiou
- 1st Department of Neurology, Aiginition University Hospital, Vasilissis Sofias Street 72-74, 11528 Athens, Greece; (D.K.); (S.F.); (E.S.); (J.P.); (C.K.); (S.G.P.)
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Brodoehl S, Wagner F, Klingner C, Srowig A, Finke K. [Telemedicine Care of Dementia Patients During the COVID-19 Pandemic]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:444-454. [PMID: 37494147 PMCID: PMC10635742 DOI: 10.1055/a-2073-3947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 03/23/2023] [Indexed: 07/28/2023]
Abstract
In our multidisciplinary memory center at Jena University Hospital, we initiated a regular video consultation for patients at risk of developing dementia or with dementia disease and their relatives at the beginning of the SARS-CoV2 pandemic in spring 2020.Over a 12-month period, we conducted a systematic survey of satisfaction among patients in regular face-to-face contact (F2F) and video consultations (VC).The aim of this study was to evaluate the potential use of telemedicine in older people with incipient cognitive deficits in the context of dementia. In particular, we aimed to evaluate patient satisfaction and feasibility.Initial presentations to our memory center for suspected dementia were evaluated in a standardized regular on-site setting (n=50) and in a standardized video consultation (n=40). In both settings, a neuropsychologist's and a physician's consultation were performed consecutively. Both groups were similarly distributed in terms of age and sex (71.4 vs. 72.3 years, 52 vs. 50% female (F2F vs. VC)). Cognitive status was slightly better in the VC group (ACE III significant, MMST not significant).In the survey of the patients using a 12-question inventory (patient satisfaction, rated 1 to 5), there was no significant difference between the two groups overall. However, the F2F tended to be rated slightly better here in terms of advice. More than 80% of the physicians and neuropsychologists rated the technical process of VC as good/very good.A general assessment of the cognitive deficits by physicians and neuropsychologists correlated extremely highly with the results of the subsequent specific testing (MMST and ACE) in F2F and VC. With a tendency to better agreement in VC, the difference between the correlations was not significant.Overall, we could not find any significant differences in patients' satisfaction between VC and classical F2F presentation. Technical aspects in the preparation of a VC and during a VC were less problematic than initially anticipated.
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Affiliation(s)
| | | | | | - Annie Srowig
- Gedächtniszentrum/Neurologie, Jena University Hospital,
Jena, Germany
| | - Kathrin Finke
- Gedächtniszentrum/Neurologie, Jena University Hospital,
Jena, Germany
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Muili AO, Mustapha MJ, Offor MC, Oladipo HJ. Emerging roles of telemedicine in dementia treatment and care. Dement Neuropsychol 2023; 17:e20220066. [PMID: 37261258 PMCID: PMC10229090 DOI: 10.1590/1980-5764-dn-2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/20/2022] [Accepted: 01/20/2023] [Indexed: 06/02/2023] Open
Abstract
Dementia is a neurological disorder that affects memory, thinking, orientation, and other important functions of the brain; telemedicine is a part of the healthcare delivery system involving diagnosis and consultation over telecommunications devices such as mobile phones and computers. In this review, we assessed the impact, accessibility, and possible improvements in telemedicine in dementia treatment. Regarding the use of telemedicine in the treatment, we evaluated its impact on the management of the disease (i.e., diagnosis and follow-up). We also evaluated studies on the current improvements and accessibility of telemedicine in dementia treatment. The review findings showed that it is effective in diagnosing patients, monitoring their progress during treatment, and providing caregiver support. However, studies have revealed a lack of accessibility and improvement in telemedicine among the elderly, particularly in West African countries. Finally, lasting solutions were provided to address the problems in the review permanently.
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Tu CC, Weng SY, Hsieh NC, Cheng WC, Alizargar J, Chang KS. Increasing Use of Telemedicine for Neurological Disorders During the COVID-19 Pandemic: A Mini-Review. J Multidiscip Healthc 2023; 16:411-418. [PMID: 36820220 PMCID: PMC9938664 DOI: 10.2147/jmdh.s390013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/02/2022] [Indexed: 02/17/2023] Open
Abstract
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.
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Affiliation(s)
- Chuan-Chou Tu
- Department of Internal Medicine, Yuan Rung Hospital, Changhua, 510, Taiwan, Republic of China
| | - Shih-Yen Weng
- College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei City, 112, Taiwan, Republic of China,Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, Taipei City, 112, Taiwan, Republic of China,Smart Healthcare Interdisciplinary College, National Taipei University of Nursing and Health Sciences, Taipei City, 112, Taiwan, Republic of China
| | - Nan-Chen Hsieh
- College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei City, 112, Taiwan, Republic of China,Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, Taipei City, 112, Taiwan, Republic of China
| | - Wen-Chang Cheng
- Hyperbaric Oxygen Therapy and Wound Treatment Centre, Yuan Rung Hospital, Changhua, 510, Taiwan, Republic of China
| | - Javad Alizargar
- Research Center for Healthcare Industry Innovation, National Taipei University of Nursing and Health Sciences, Taipei City, 112, Taiwan, Republic of China,College of Nursing, School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, 112, Taiwan, Republic of China
| | - Ko-Shih Chang
- Department of Cardiology, Yuan Rung Hospital, Changhua, 510, Taiwan, Republic of China,Correspondence: Ko-Shih Chang, Department of Cardiology, Yuan Rung Hospital, No. 201, Zhongzheng Road, Yuanlin, Changhua, 510, Taiwan, Republic of China, Tel +886 4 8326161 ext 2702, Fax +886 4 8317776, Email
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Rini JF, Tsoy E, Peet B, Best J, Tanner JA, Asken BM, Sanchez A, Apple AC, VandeVrede L, Stephens ML, Erkkinen M, Kramer JH, Miller BL. Feasibility and Acceptability of a Multidisciplinary Academic Telemedicine System for Memory Care in Response to COVID-19. Neurol Clin Pract 2022; 12:e199-e209. [PMID: 36540141 PMCID: PMC9757120 DOI: 10.1212/cpj.0000000000200099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/26/2022] [Indexed: 01/30/2023]
Abstract
Background and Objectives In response to the restrictions imposed by the COVID-19 pandemic, the University of California San Francisco Memory and Aging Center (UCSF MAC) has deployed a comprehensive telemedicine model for the diagnosis and management of Alzheimer disease and related dementias. This review summarizes a large academic behavioral neurology clinic's experience transitioning to telemedicine services, including the impact on clinic care indicators, access metrics, and provider's experience. We compared these outcomes from 3 years before COVID-19 to 12 months after the transition to video teleconferencing (VTC) encounters. Methods Patient demographics and appointment data (dates, visit types, and departments) were extracted from our institution's electronic health record database from January 1, 2017, to May 1, 2021. We present data as descriptive statistics and comparisons using Wilcoxon rank-sum tests and Fisher exact tests. The results of anonymous surveys conducted among the clinic's providers are reported as descriptive findings. Results After the implementation of telemedicine services, the proportion of clinic encounters completed via VTC increased from 1.9% to 86.4%. There was a statistically significant decline in both the percentage of scheduled appointments that were canceled (32.9% vs 27.9%; p < 0.01) and total cancelations per month (mean 240.3 vs 179.4/mo; p < 0.01). There was an increase in the percentage of completed scheduled appointments (60.2% vs 64.8%; p < 0.01) and an increase in the average estimated commuting distance patients would need to drive for follow-up appointments (mean 49.8 vs 54.7 miles; p < 0.01). The transition to telemedicine services did not significantly affect the clinic's patient population as measured by age, gender, estimated income, area deprivation index, or self-reported racial/ethnic identity. The results of the provider survey revealed that physicians reported a more positive experience relative to neuropsychologists. Both types of providers reported telemedicine services as a reasonable equivalent and acceptable alternative to in-person evaluations with notable caveats. Discussion UCSF MAC's comprehensive integration of telemedicine services maintained critical ambulatory care to patients living with dementia during the COVID-19 pandemic. The recognized benefits of our care model suggest dementia telemedicine may be used as a feasible and equivalent alternative to in-person ambulatory care in the after COVID-19 era.
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Affiliation(s)
- James Fraser Rini
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Elena Tsoy
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Bradley Peet
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - John Best
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Jeremy A Tanner
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Breton M Asken
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Alejandra Sanchez
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Alexandra C Apple
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Lawren VandeVrede
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Melanie L Stephens
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Michael Erkkinen
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Joel H Kramer
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
| | - Bruce L Miller
- Ochsner Health (JFR, BP), New Orleans, LA; University of California (ET, JB, JAT, BMA, AS, ACA, LV, MLS, ME, JHK, BLM), San Francisco, Memory and Aging Center; Global Brain Health Institute (BLM), University of California, San Francisco and Trinity College Dublin, Ireland; and Weill Neurosciences Institute and Department of Neurology (BLM)
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10
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Gonzalez JA, Clark US, Byrd D, Clarke Y, Greenwood K, Tell E, Carrion-Park C, Pizzirusso M, Burgess R, Morgello S. Preliminary Findings from a Telephone-Based Cognitive Screening of an Adult HIV Research Cohort during the COVID-19 Pandemic. Arch Clin Neuropsychol 2022; 37:1710-1719. [PMID: 35780306 PMCID: PMC9278200 DOI: 10.1093/arclin/acac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Few publications have documented the utility of in-home telephone-based cognitive screeners during COVID-19. This manuscript describes the adaptation of select face-to-face (FTF) neuropsychological tests to telephonic administration in a longitudinal cohort of people with HIV (PWH). Using the cohort's pre-pandemic neuropsychological data, we explore the utility of telephonic administration in this population. METHODS Of a longitudinal cohort of 170 adult PWH, 59 completed telephonic medical and cognitive screenings with comparable pre-pandemic FTF data. Telephone screeners and FTF evaluations were compared using repeated measures ANCOVAs to examine whether test performance differed between administration types and levels of pre-pandemic cognitive performance. Individuals with pre-pandemic test scores more than a standard deviation below the demographically-corrected mean were categorized as "below average" cognitive performance (n = 23), and the remainder as "average" (n = 36). RESULTS Over 90% of participants gave positive feedback about the telephone encounter. The average cognitive performance group scored higher than the below average group on all measures across both administration types. Telephone and FTF test scores did not differ significantly for measures of category fluency, letter fluency, and verbal learning. However, the below average group scored higher on a verbal memory measure administered via telephone compared with FTF. CONCLUSIONS Support for telephonic adaptation of select FTF measures in longitudinal research is mixed, with verbal fluency tasks showing the strongest equivalency. When employed carefully with a clear understanding of their limitations, telephone adaptations can provide an opportunity to continue study objectives, promote equity, and monitor participant well-being during times of duress.
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Affiliation(s)
- Jairo A Gonzalez
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Uraina S Clark
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Desiree Byrd
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Psychology, Queens College & The Graduate Center, The City University of New York, New York City, NY, USA
| | - Yusuf Clarke
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Kaitlyn Greenwood
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Elizabeth Tell
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Cira Carrion-Park
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Maria Pizzirusso
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Rhonda Burgess
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Susan Morgello
- Department of Neurology, The Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Neuroscience, The Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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11
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Hoff T, Lee DR. Physician Satisfaction With Telehealth: A Systematic Review and Agenda for Future Research. Qual Manag Health Care 2022; 31:160-169. [PMID: 35132008 DOI: 10.1097/qmh.0000000000000359] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES The use of telehealth has risen dramatically due to the Covid-19 pandemic and is expected to be a regular part of patient care moving forward. We know little currently about how satisfied physicians are with this type of patient care. The present systematic review examines physician satisfaction with telehealth, as physician acceptance remains vital to telehealth gaining wider and more permanent adoption. METHODS A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-guided systematic review of empirical articles published between 2010 and 2020 that contain a finding examining physician satisfaction with using telehealth, using 4 article databases (PubMed, Web of Science, COCHRANE, and CINAHL), to identify relevant studies. A standardized data abstraction Excel sheet was used to extract relevant information from each of the included studies. Relevant study findings related to physician satisfaction with telehealth were reviewed for each of the 37 studies by the coauthors. RESULTS A total of 37 published studies were included in the review. Thirty-three of the 37 (89%) studies reviewed were classified as having findings showing moderate to high levels of physician satisfaction with telehealth. Just under 60% of the studies focused on physician satisfaction with providing telemedicine to patients (21/37). Twelve other studies focused on physician satisfaction with teleconsultations with other providers. Four studies examined physician satisfaction with both. The type of patient telemedicine or provider teleconsultation performed varied greatly across the 37 studies, with several different diagnoses or care situations included. Research designs used in the studies were less robust, with all studies using primary data for assessing physician satisfaction but only one study providing any type of multivariate analysis of physician satisfaction with telehealth. CONCLUSION The results of this review support the observation that physicians across different specialties, geographic locations, practice locations, and care situations appear satisfied with engaging in telehealth for both patient care and consultations with other physicians. The research on telehealth should be enhanced, given how ubiquitous telehealth has become due to the Covid-19 pandemic. This enhancement should include larger physician sample sizes in studies of telehealth satisfaction; more research focused on telehealth in the primary care setting; and the types of virtual modalities that have become more commonplace for physicians to use due to the Covid-19 pandemic.
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Affiliation(s)
- Timothy Hoff
- Management, Healthcare Systems, and Health Policy (Dr Hoff), and School of Pharmacy (Dr Lee), Northeastern University, Boston, Massachusetts
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12
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Hewitt KC, Block C, Bellone JA, Dawson EL, Garcia P, Gerstenecker A, Grabyan JM, Howard C, Kamath V, LeMonda BC, Margolis SA, McBride WF, Salinas CM, Tam DM, Walker KA, Del Bene VA. Diverse experiences and approaches to tele neuropsychology: Commentary and reflections over the past year of COVID-19. Clin Neuropsychol 2022; 36:790-805. [DOI: 10.1080/13854046.2022.2027022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Kelsey C. Hewitt
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cady Block
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John A. Bellone
- Perspectives Psychological Services, Fullerton, California, USA
| | - Erica L. Dawson
- Department of Neurology, The Ohio State University, Columbus, Ohio, USA
| | - Patricia Garcia
- Department of Rehabilitation Neuropsychology, Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Adam Gerstenecker
- Department of Neurology, University of Alabama at Birmingham, UAB Heersink School of Medicine, Birmingham, Alabama, USA
| | - Jonathan M. Grabyan
- Michael E. DeBakey VA Medical Center, Behavioral Health Program, Houston, Texas, USA
| | - Christopher Howard
- Psychology Department, Utah State Hospital, Provo, Utah, USA
- Department of Psychology, Brigham Young University, Provo, Utah, USA
| | - Vidyulata Kamath
- Perspectives Psychological Services, Fullerton, California, USA
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brittany C. LeMonda
- Perspectives Psychological Services, Fullerton, California, USA
- Department of Psychiatry, NYU Langone, NYU Psychiatry Associates, New York, New York, USA
| | - Seth A. Margolis
- Perspectives Psychological Services, Fullerton, California, USA
- Department of Psychiatry & Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Willie F. McBride
- Perspectives Psychological Services, Fullerton, California, USA
- Department of Neurology, University of Virginia Health, Charlottesville, Virginia, USA
| | - Christine M. Salinas
- Perspectives Psychological Services, Fullerton, California, USA
- Neuropsychology Concierge®, Indialantic, Florida, USA
| | - Danny M. Tam
- VA NY Harbor Healthcare System, Division of Psychology, Mental Health Service, New York, New York, USA
| | - Keenan A. Walker
- Perspectives Psychological Services, Fullerton, California, USA
- National Institute on Aging, Laboratory of Behavioral Neuroscience, Baltimore, Maryland, USA
| | - Victor A. Del Bene
- Department of Neurology, University of Alabama at Birmingham, UAB Heersink School of Medicine, Birmingham, Alabama, USA
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13
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Riedl R. On the stress potential of videoconferencing: definition and root causes of Zoom fatigue. ELECTRONIC MARKETS 2021; 32:153-177. [PMID: 35600914 PMCID: PMC8645680 DOI: 10.1007/s12525-021-00501-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/15/2021] [Indexed: 05/05/2023]
Abstract
As a consequence of lockdowns due to the coronavirus disease (COVID-19) and the resulting restricted social mobility, several billion people worldwide have recently had to replace physical face-to-face communication with computer-mediated interaction. Notably, the adoption rates of videoconferencing increased significantly in 2020, predominantly because videoconferencing resembles face-to-face interaction. Tools such as Zoom, Microsoft Teams, and Cisco Webex are used by hundreds of millions of people today. Videoconferencing may bring benefits (e.g., saving of travel costs, preservation of environment). However, prolonged and inappropriate use of videoconferencing may also have an enormous stress potential. A new phenomenon and term emerged, Zoom fatigue, a synonym for videoconference fatigue. This paper develops a definition for Zoom fatigue and presents a conceptual framework that explores the major root causes of videoconferencing fatigue and stress. The development of the framework draws upon media naturalness theory and its underlying theorizing is based on research published across various scientific fields, including the disciplines of both behavioral science and neuroscience. Based on this theoretical foundation, hypotheses are outlined. Moreover, implications for research and practice are discussed.
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Affiliation(s)
- René Riedl
- School of Business and Management, Digital Business, University of Applied Sciences Upper Austria, Wehrgrabengasse 1-3, 4400 Steyr, Austria
- Institute of Business Informatics – Information Engineering, Johannes Kepler University Linz, Altenberger Strasse 69, Linz, 4040 Austria
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14
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Chepke C, Shaughnessy LW, Brunton S, Farmer JG, Rosenzweig AS, Grossberg GT, Wright WL. Using Telemedicine to Assess and Manage Psychosis Among Outpatients with Neurodegenerative Disease. Int J Gen Med 2021; 14:10271-10280. [PMID: 34992442 PMCID: PMC8711560 DOI: 10.2147/ijgm.s335739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/03/2021] [Indexed: 11/23/2022] Open
Abstract
The presence of hallucinations and delusions in patients with neurodegenerative disease correlates negatively with function, cognition, quality of life, and survival. When these patients still have insight, the treatment of mild hallucinations may reduce the risk of progression to more severe symptoms, specifically hallucinations without insight or delusions. On October 22, 2020, a multidisciplinary consensus panel comprising United States-based experts in geriatric psychiatry, geriatric medicine, family medicine, movement disorders, and neuropsychology was convened remotely to discuss best practices for using telemedicine to evaluate, diagnose, and treat psychosis in patients with neurodegenerative diseases. This review reflects the opinions and recommendations discussed at this meeting. Despite drawbacks, telemedicine can offer several advantages over in-person care, particularly for older adults, and may be a unique opportunity for care of patients with neuropsychiatric symptoms. While telemedicine may not be suitable for all patients, it allows the involvement of specialists from multiple geographic locations and the extension of care to homebound individuals. Patients with neurodegenerative diseases who are likely to become homebound as the disease advances may benefit greatly from telemedicine as a standard of care. Healthcare provided via telemedicine should be nothing less than what would be offered to the patient in person. Telemedicine may present some difficulties, including technological issues and inherent constraints of remote care, but with proper planning many problems could be diminished. Technical issues associated with telemedicine are inevitable but may be partially offset by providing clear directions ahead of any tele-visit to ensure connectivity and access to the videoconferencing platform. Alternative procedures to communicate should be established in the eventuality of technological issues. Using these strategies, telemedicine can serve as a valuable complement to traditional in-person practices for the diagnosis and management of hallucinations and delusions associated with Parkinson’s disease psychosis or dementia-related psychosis.
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Affiliation(s)
- Craig Chepke
- Excel Psychiatric Associates, Huntersville, NC, USA
- Atrium Health, Charlotte, NC, USA
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Correspondence: Craig Chepke Email
| | - Lynn W Shaughnessy
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Brunton
- Primary Care Education Consortium, Winnsboro, SC, USA
- Department of Family Medicine, Touro University, Vallejo, CA, USA
| | - Jill G Farmer
- Parkinson’s Disease and Movement Disorder Program, Center for Neurosciences, Robert Wood Johnson University Hospital Hamilton, Lawrenceville, NJ, USA
- Department of Emergency Medicine, Drexel College of Medicine, Philadelphia, PA, USA
| | | | - George T Grossberg
- Department of Psychiatry, St. Louis University School of Medicine, St. Louis, MO, USA
| | - Wendy L Wright
- Wright & Associates Family Health Care, Concord and Amherst, NH, USA
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15
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Collins JT, Mohamed B, Bayer A. Feasibility of remote Memory Clinics using the plan, do, study, act (PDSA) cycle. Age Ageing 2021; 50:2259-2263. [PMID: 34510177 PMCID: PMC8499871 DOI: 10.1093/ageing/afab173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/11/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction A timely diagnosis of dementia is crucial for initiating and maintaining support for people living with dementia. The coronavirus disease (COVID) pandemic temporarily halted Memory Clinics, where this is organised, and rate of dementia diagnosis has fallen. Despite increasing use of alternatives to face-to-face (F2F) consultations in other departments, it is unclear whether this is feasible within the traditional Memory Clinic model. Aims The main aim of this service improvement project performed during the pandemic was to explore feasibility of telephone (TC) and videoconference (VC) Memory Clinic consultations. Methods Consecutive patients on the Memory Clinic waiting list were telephoned and offered an initial appointment by VC or TC. Data extracted included: age, internet-enabled device ownership, reason for and choice of Memory Clinic assessment. We noted Montreal Cognitive Assessment-Blind (TC) and Addenbrooke’s Cognitive Examination-III (VC via Attend Anywhere) scores, and feasibility of consultation. Results Out of 100 patients, 12 had a home assessment, moved away, been hospitalised, or died. 45, 21 and 6 preferred F2F, VC and TC assessments respectively. 16 were not contactable and offered a F2F appointment. The main reason for preferring F2F was non-ownership, or inability to use an internet-enabled device (80%). VC and TC preference reasons were unwillingness to come to hospital (59%), and convenience (41%). Attendance rate was 100% for VC and TC, but 77% for F2F. Feasibility (successful consultations) was seen in 90% (VC) and 67% (TC) patients. Conclusion For able and willing patients, remote Memory Consultations can be both feasible and beneficial. This has implications for future planning in dementia services.
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Affiliation(s)
- Jemima T Collins
- Memory Team, Cardiff and Vale University Health Board, Routledge Academic Centre, University Hospital Llandough, Penarth CF64 2XX, UK
| | - Biju Mohamed
- Memory Team, Cardiff and Vale University Health Board, Routledge Academic Centre, University Hospital Llandough, Penarth CF64 2XX, UK
| | - Antony Bayer
- Memory Team, Cardiff and Vale University Health Board, Routledge Academic Centre, University Hospital Llandough, Penarth CF64 2XX, UK
- Cardiff University School of Medicine, Heath Park, University Hospital of Wales, CF14 4XW, UK
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McCleery J, Laverty J, Quinn TJ. Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment. Cochrane Database Syst Rev 2021; 7:CD013786. [PMID: 34282852 PMCID: PMC8406800 DOI: 10.1002/14651858.cd013786.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many millions of people living with dementia around the world are not diagnosed, which has a negative impact both on their access to care and treatment and on rational service planning. Telehealth - the use of information and communication technology (ICT) to provide health services at a distance - may be a way to increase access to specialist assessment for people with suspected dementia, especially those living in remote or rural areas. It has also been much used during the COVID-19 pandemic. It is important to know whether diagnoses made using telehealth assessment are as accurate as those made in conventional, face-to-face clinical settings. OBJECTIVES Primary objective: to assess the diagnostic accuracy of telehealth assessment for dementia and mild cognitive impairment. Secondary objectives: to identify the quality and quantity of the relevant research evidence; to identify sources of heterogeneity in the test accuracy data; to identify and synthesise any data on patient or clinician satisfaction, resource use, costs or feasibility of the telehealth assessment models in the included studies. SEARCH METHODS We searched multiple databases and clinical trial registers on 4 November 2020 for published and 'grey' literature and registered trials. We applied no search filters and no language restrictions. We screened the retrieved citations in duplicate and assessed in duplicate the full texts of papers considered potentially relevant. SELECTION CRITERIA We included in the review cross-sectional studies with 10 or more participants who had been referred to a specialist service for assessment of a suspected cognitive disorder. Within a period of one month or less, each participant had to undergo two clinical assessments designed to diagnose dementia or mild cognitive impairment (MCI): a telehealth assessment (the index test) and a conventional face-to-face assessment (the reference standard). The telehealth assessment could be informed by some data collected face-to-face, e.g. by nurses working in primary care, but all contact between the patient and the specialist clinician responsible for synthesising the information and making the diagnosis had to take place remotely using ICT. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from included studies. Data extracted covered study design, setting, participants, details of index test and reference standard, and results in the form of numbers of participants given diagnoses of dementia or MCI. Data were also sought on dementia subtype diagnoses and on quantitative measures of patient or clinician satisfaction, resource use, costs and feasibility. We assessed risk of bias and applicability of each included study using QUADAS-2. We entered the results into 2x2 tables in order to calculate the sensitivity and specificity of telehealth assessment for the diagnosis of all-cause dementia, MCI, and any cognitive syndrome (combining dementia and MCI). We presented the results of included studies narratively because there were too few studies to derive summary estimates of sensitivity and specificity. MAIN RESULTS Three studies with 136 participants were eligible for inclusion. Two studies (20 and 100 participants) took place in community settings in Australia and one study (16 participants) was conducted in veterans' homes in the USA. Participants were referred from primary care with undiagnosed cognitive symptoms or were identified as being at high risk of having dementia on a screening test in the care homes. Dementia and MCI were target conditions in the larger study; the other studies targeted dementia diagnosis only. Only one small study used a 'pure' telehealth model, i.e. not involving any elements of face-to-face assessment. The studies were generally well-conducted. We considered two studies to be at high risk of incorporation bias because a substantial amount of information collected face-to-face by nurses was used to inform both index test and reference standard assessments. One study was at unclear risk of selection bias. For the diagnosis of all-cause dementia, sensitivity of telehealth assessment ranged from 0.80 to 1.00 and specificity from 0.80 to 1.00. We considered this to be very low-certainty evidence due to imprecision, inconsistency between studies and risk of bias. For the diagnosis of MCI, data were available from only one study (100 participants) giving a sensitivity of 0.71 (95% CI 0.54 to 0.84) and a specificity of 0.73 (95% CI 0.60 to 0.84). We considered this to be low-certainty evidence due to imprecision and risk of bias. For diagnosis of any cognitive syndrome (dementia or MCI), data from the same study gave a sensitivity of 0.97 (95% CI 0.91 to 0.99) and a specificity of 0.22 (95% CI 0.03 to 0.60). The majority of diagnostic disagreements concerned the distinction between MCI and dementia, occurring approximately equally in either direction. There was also a tendency for patients identified as cognitively healthy at face-to-face assessment to be diagnosed with MCI at telehealth assessment (but numbers were small). There were insufficient data to make any assessment of the accuracy of dementia subtype diagnosis. One study provided a small amount of data indicating a good level of clinician and especially patient satisfaction with the telehealth model. There were no data on resource use, costs or feasibility. AUTHORS' CONCLUSIONS We found only very few eligible studies with a small number of participants. An important difference between the studies providing data for the analyses was whether the target condition was dementia only (two studies) or dementia and MCI (one study). The data suggest that telehealth assessment may be highly sensitive and specific for the diagnosis of all-cause dementia when assessed against a reference standard of conventional face-to-face assessment, but the estimates are imprecise due to small sample sizes and between-study heterogeneity, and may apply mainly to telehealth models which incorporate a considerable amount of face-to-face contact with healthcare professionals other than the doctor responsible for making the diagnosis. For the diagnosis of MCI by telehealth assessment, best estimates of both sensitivity and specificity were somewhat lower, but were based on a single study. Errors occurred at the cognitively healthy/MCI and the MCI/dementia boundaries. However, there is no evidence that diagnostic disagreements were more frequent than would be expected due to the known variation between clinicians' opinions when assigning a dementia diagnosis.
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Affiliation(s)
| | | | - Terry J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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17
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Yi JS, Pittman CA, Price CL, Nieman CL, Oh ES. Telemedicine and Dementia Care: A Systematic Review of Barriers and Facilitators. J Am Med Dir Assoc 2021; 22:1396-1402.e18. [PMID: 33887231 PMCID: PMC8292189 DOI: 10.1016/j.jamda.2021.03.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES An increasing reliance on telemedicine for older adults with cognitive impairment requires a better understanding of the barriers and facilitators for this unique patient population. DESIGN The study team queried PubMed, Embase, the Cochrane Library, PsycINFO, CINAHL, Scopus, and ClinicalTrials.gov on May 1, 2020, for studies in English published from January 2010 to May 2020. SETTING AND PARTICIPANTS We conducted a systematic review of articles investigating the use of telemedicine among older adults with Alzheimer's disease and related dementia (ADRD) or mild cognitive impairment (MCI) that focused on the patient and care partner perspectives. METHODS Telemedicine encounter purpose, technological requirements, and findings regarding sensory needs were extracted. The Cochrane Collaboration's Risk of Bias Tool was applied for quality assessment. RESULTS The search yielded 3551 abstracts, from which 90 articles were reviewed and 17 were included. The purpose of telemedicine encounters included routine care, cognitive assessment, and telerehabilitation. All studies reported successful implementation of telemedicine, supported by patient and care partner satisfaction, similar results on cognitive assessment and diagnosis compared to in-person visits, and improvement in outcome measures following rehabilitation. Sixteen studies relied on staff and care partners to navigate technologies. Six studies reported participants reporting difficulty hearing the provider during the telemedicine visits. Five studies excluded participants with visual or hearing impairment because of the potential difficulty of using telemedicine technology. No studies reported technological adaptations to account for sensory impairment. CONCLUSIONS AND IMPLICATIONS Telemedicine is well received among patients and care partners, but successful delivery incorporates support staff and the care partners to navigate technologies. The exclusion of older adults with sensory impairment, especially given that it is highly prevalent, in developing telemedicine systems may further exacerbate access to care in this population. Adapting technologies for sensory needs is critical to the advancement of accessible dementia care through telemedicine.
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Affiliation(s)
- Julie S Yi
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Corinne A Pittman
- Howard University College of Medicine, Washington, DC, USA; Cochlear Center for Hearing & Public Health-Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Carrie L Price
- Albert S. Cook Library, Towson University, Towson, MD, USA
| | - Carrie L Nieman
- Cochlear Center for Hearing & Public Health-Johns Hopkins University School of Public Health, Baltimore, MD, USA; Division of Otology, Neurotology & Skull Base Surgery, Department of Otolaryngology-HNS, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Esther S Oh
- Cochlear Center for Hearing & Public Health-Johns Hopkins University School of Public Health, Baltimore, MD, USA; Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Alegret M, Espinosa A, Ortega G, Pérez-Cordón A, Sanabria Á, Hernández I, Marquié M, Rosende-Roca M, Mauleón A, Abdelnour C, Vargas L, de Antonio EE, López-Cuevas R, Tartari JP, Alarcón-Martín E, Tárraga L, Ruiz A, Boada M, Valero S. From Face-to-Face to Home-to-Home: Validity of a Teleneuropsychological Battery. J Alzheimers Dis 2021; 81:1541-1553. [PMID: 33935075 PMCID: PMC8293645 DOI: 10.3233/jad-201389] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
- Montserrat Alegret
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Espinosa
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Gemma Ortega
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Pérez-Cordón
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain
| | - Ángela Sanabria
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Isabel Hernández
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Marquié
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Maitée Rosende-Roca
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain
| | - Ana Mauleón
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain
| | - Carla Abdelnour
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Liliana Vargas
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain
| | - Ester Esteban de Antonio
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain
| | - Rogelio López-Cuevas
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain
| | - Juan Pablo Tartari
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain
| | - Emilio Alarcón-Martín
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain
| | - Lluís Tárraga
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Agustín Ruiz
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Sergi Valero
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya - Barcelona, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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19
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Kitaigorodsky M, Loewenstein D, Curiel Cid R, Crocco E, Gorman K, González-Jiménez C. A Teleneuropsychology Protocol for the Cognitive Assessment of Older Adults During COVID-19. Front Psychol 2021; 12:651136. [PMID: 34054655 PMCID: PMC8155705 DOI: 10.3389/fpsyg.2021.651136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/16/2021] [Indexed: 12/21/2022] Open
Abstract
The Coronavirus Disease 2019 (COVID-19) pandemic prompted the need for a teleneuropsychology protocol for the cognitive assessment of older adults, who are at increased risk for both COVID-19 and dementia. Prior recommendations for teleneuropsychological assessment did not consider many of the unique challenges posed by COVID-19. The field is still in need of clear guidelines and standards of care for the assessment of older adults under the current circumstances. Advantages of teleneuropsychological assessment during the COVID-19 pandemic include reduced risk of contracting the virus, eliminating travel time and reducing cost, and more rapid access to needed services. Challenges include disparities in technology access among patients, reduced control over the testing environment, impeded ability to make behavioral observations, and limited research on valid and reliable cognitive assessment measures. The aim of this perspective review is to propose a teleneuropsychological protocol to facilitate neuropsychological assessment utilizing a virtual platform. The proposed protocol has been successful with our clinical and research populations and may help neuropsychologists implement teleneuropsychology services without compromising validity or reliability. However, there is increasing need for research on teleneuropsychological assessment options for both clinical and research purposes.
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Affiliation(s)
- Marcela Kitaigorodsky
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - David Loewenstein
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Rosie Curiel Cid
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Elizabeth Crocco
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Katherine Gorman
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
| | - Christian González-Jiménez
- Department of Psychiatry and Behavioral Sciences, Center for Cognitive Neuroscience and Aging, University of Miami, Miami, FL, United States
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20
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Abstract
With the evolution of the COVID-19 pandemic in the United States in March 2020, most ambulatory care environments rapidly pivoted to extensive use to telehealth to protect patients and providers while continuing to provide care. This shift resulted in the expansion of telehealth platforms and workflows. Many behavioral health services can be provided in a telehealth format. The case example in this article illustrates that transition to telehealth is feasible and sustainable. Limitations include preoperative psychological assessments and certain neuropsychological tests requiring material manipulation. Careful consideration of risk factors should be exerted for more vulnerable patient populations.
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Affiliation(s)
- Mary J Wells
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health System, PO Box 980677, Richmond, VA 23298, USA.
| | - Paul Dukarm
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health System, PO Box 980677, Richmond, VA 23298, USA
| | - Ana Mills
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, PO Box 980206, Richmond, VA 23298-0206, USA
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21
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Scott TM, Marton KM, Madore MR. A detailed analysis of ethical considerations for three specific models of teleneuropsychology during and beyond the COVID-19 pandemic. Clin Neuropsychol 2021; 36:24-44. [DOI: 10.1080/13854046.2021.1889678] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Travis M. Scott
- VA Palo Alto Health Care System Sierra Pacific Mental Illness Research Education Clinical Center, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
| | - Kacey M. Marton
- Psychology Service, VA Palo Alto Health Care System, San Jose, CA, USA
| | - Michelle R. Madore
- VA Palo Alto Health Care System Sierra Pacific Mental Illness Research Education Clinical Center, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford School of Medicine, Stanford, CA, USA
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22
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Telehealth in Neurodegenerative Diseases: Opportunities and Challenges for Patients and Physicians. Brain Sci 2021; 11:brainsci11020237. [PMID: 33668641 PMCID: PMC7917616 DOI: 10.3390/brainsci11020237] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
Telehealth, by definition, is distributing health-related services while using electronic technologies. This narrative Review describes the technological health services (telemedicine and telemonitoring) for delivering care in neurodegenerative diseases, Alzheimer's disease, Parkinson's Disease, and amyotrophic lateral Sclerosis, among others. This paper aims to illustrate this approach's primary experience and application, highlighting the strengths and weaknesses, with the goal of understanding which could be the most useful application for each one, in order to facilitate telehealth improvement and use in standard clinical practice. We also described the potential role of the COVID-19 pandemic to speed up this service's use, avoiding a sudden interruption of medical care.
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23
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Domingues RB, Mantese CE, Aquino EDS, Fantini FGMM, Prado GFD, Nitrini R. Telemedicine in neurology: current evidence. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:818-826. [PMID: 33295422 DOI: 10.1590/0004-282x20200131] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Telemedicine was first introduced in Neurology as a tool to facilitate access to acute stroke treatment. More recently, evidence has emerged of the use of telemedicine in several other areas of Neurology. With the advent of the COVID-19 pandemic and the need for social isolation, Brazilian authorities have expanded the regulation of the use of telemedicine, thus allowing the treatment of many patients with neurological diseases to be conducted with less risk of SARS-CoV-2 contamination. OBJECTIVE This study aimed to critically review the current evidence of the use, efficacy, safety, and usefulness of telemedicine in Neurology. METHODS A review of PubMed indexed articles was carried out by searching for the terms "telemedicine AND": "headache", "multiple sclerosis", "vestibular disorders", "cerebrovascular diseases", "epilepsy", "neuromuscular diseases", "dementia", and "movement disorders". The more relevant studies in each of these areas were critically analyzed. RESULTS Several articles were found and analyzed in each of these areas of Neurology. The main described contributions of telemedicine in the diagnosis and treatment of such neurological conditions were presented, indicating a great potential of use of this type of assistance in all these fields. CONCLUSION Current evidence supports that teleneurology can be a tool to increase care for patients suffering from neurological diseases.
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Affiliation(s)
- Renan Barros Domingues
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Santa Casa de Misericórdia de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Carlos Eduardo Mantese
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Hospital Sírio Libanês, Telemedicina, São Paulo SP, Brazil.,Hospital Mãe de Deus, Porto Alegre RS, Brazil
| | - Emanuelle da Silva Aquino
- Comissão Aberta de Telemedicina, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Hospital Sírio Libanês, Telemedicina, São Paulo SP, Brazil.,Universidade de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | | | - Gilmar Fernandes do Prado
- Diretoria Executiva, Academia Brasileira de Neurologia, São Paulo SP, Brazil.,Universidade Federal de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Universidade de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.,Diretoria Científica, Academia Brasileira de Neurologia, São Paulo SP, Brazil
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24
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Lacritz LH, Carlew AR, Livingstone J, Bailey KC, Parker A, Diaz A. Patient Satisfaction with Telephone Neuropsychological Assessment. Arch Clin Neuropsychol 2020; 35:1240-1248. [PMID: 33124648 PMCID: PMC7665292 DOI: 10.1093/arclin/acaa097] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 01/18/2023] Open
Abstract
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.
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Affiliation(s)
- Laura H Lacritz
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Anne R Carlew
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Julia Livingstone
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - K Chase Bailey
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Allison Parker
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Aislinn Diaz
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
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25
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Pike KE, Chong MS, Hume CH, Keech BJ, Konjarski M, Landolt KA, Leslie BE, Russo A, Thai C, Vilsten JS, Kinsella GJ. Providing Online Memory Interventions for Older Adults: A Critical Review and Recommendations for Development. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12339] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
| | - Mei San Chong
- School of Psychology and Public Health, La Trobe University,
| | | | | | | | | | | | - Adrian Russo
- School of Psychology and Public Health, La Trobe University,
| | - Christine Thai
- School of Psychology and Public Health, La Trobe University,
| | | | - Glynda Jane Kinsella
- School of Psychology and Public Health, La Trobe University,
- Department of Psychology, Caulfield Hospital,
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26
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Diagnostic test accuracy of telehealth assessment for dementia and mild cognitive impairment. Hippokratia 2020. [DOI: 10.1002/14651858.cd013786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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27
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Pritchard AE, Sweeney K, Salorio CF, Jacobson LA. Pediatric neuropsychological evaluation via telehealth: Novel models of care. Clin Neuropsychol 2020; 34:1367-1379. [PMID: 32787508 PMCID: PMC8106922 DOI: 10.1080/13854046.2020.1806359] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 10/23/2022]
Abstract
Objective: As the coronavirus pandemic extends across the globe, the impacts have been felt across domains of industry. Neuropsychology services are no exception. Methods for neuropsychological assessments, which typically require an in-person visit, must be modified in order to adhere to social distancing and isolation standards enacted in an effort to slow the pandemic. How can providers continue to meet the needs of patients referred for neuropsychology evaluations, while respecting federal and state guidelines for safety and ethical mandates? We offer a novel, tiered model of care, successfully implemented in response to mandated social distancing, in a large, pediatric neuropsychology program.Method: We describe the considerations and challenges to be addressed in transitioning a large neuropsychology department to a new model of care, including triaging referrals, developing -or rediscovering - types of services to meet the needs of a virtual patient population, and helping patients, parents, and providers to adjust to these new models.Conclusions: Lessons learned as a function of rapid changes in care models have implications for the field of neuropsychology as a whole as well as for future flexibility in meeting the needs of pediatric patients and their families.
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Affiliation(s)
- Alison E. Pritchard
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kristie Sweeney
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Cynthia F. Salorio
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lisa A. Jacobson
- Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
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28
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Bilder RM, Postal KS, Barisa M, Aase DM, Cullum CM, Gillaspy SR, Harder L, Kanter G, Lanca M, Lechuga DM, Morgan JM, Most R, Puente AE, Salinas CM, Woodhouse J. InterOrganizational practice committee recommendations/guidance for teleneuropsychology (TeleNP) in response to the COVID-19 pandemic. Clin Neuropsychol 2020; 34:1314-1334. [PMID: 32673163 PMCID: PMC7767580 DOI: 10.1080/13854046.2020.1767214] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 12/18/2022]
Abstract
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.
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Affiliation(s)
- Robert M. Bilder
- Psychiatry & Biobehavioral Sciences and Psychology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Karen S. Postal
- Department of Psychiatry, Harvard Medical School, Andover, MA, USA
| | - Mark Barisa
- Performance Neuropsychology, University of North Texas, Denton, TX, USA
| | - Darrin M. Aase
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - C. Munro Cullum
- Psychology Division, Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Lana Harder
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Margaret Lanca
- Department of Psychiatry, Harvard Medical School, Cambridge, MA, USA
| | - David M. Lechuga
- Neurobehavioral Clinic and Counseling Center, Lake Forest, IL, USA
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Sekhon H, Sekhon K, Launay C, Afililo M, Innocente N, Vahia I, Rej S, Beauchet O. Telemedicine and the rural dementia population: A systematic review. Maturitas 2020; 143:105-114. [PMID: 33308615 DOI: 10.1016/j.maturitas.2020.09.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Telemedicine is a timely solution for the restrictions that COVID-19 social distancing places upon conventional modalities of healthcare provision. Geriatric populations affected by dementia require greater access to healthcare services, particularly in rural areas. As such, the aim of this systematic review is to examine the impact of telemedicine on health outcomes in elderly individuals with dementia living in rural areas. METHODS A systematic review was completed using Ovid Medline, Web of Science and ACM Digital Libraries. The keywords for the selection of articles were: (telemedicine OR Telehealth) AND (Rural) AND (Age* OR Eld*) AND (Dementia) and (Telemedicine) AND (Rural Health OR Rural Population OR Hospitals, Rural OR Rural Health Services) AND (Aged OR Aging) AND (Dementia OR Multi-Infarct Dementia OR Vascular Dementia OR Frontotemporal Dementia). Among the 94 articles identified, 79 (84.0 %) were screened, 58 (61.7 %) were assessed and 12 (12.8 %) were included. RESULTS The studies had diverse populations. Two were conducted in Australia, five in Canada, one in Korea, and four in the United States of America. The studies used a variety of cognitive tests and reported mixed results regarding the differences in patient performance when assessed in-person as compared to telemedicine consultation. Overall, both patients and physicians reported satisfaction with telemedicine; however, there were mixed results regarding the reliability of cognitive tests and the infrastructure required. Convenience, satisfaction, comfort and recommending telemedicine were reported to be high in the telemedicine group and physicians reported they would use telemedicine again. CONCLUSION The testing conditions and the accessibility of telemedicine yield inconclusive results as to whether telemedicine can improve the management of dementia in geriatric individuals.
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Affiliation(s)
- Harmehr Sekhon
- Postdoctoral Research Fellow, Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; GeriPARTy Research Group, Jewish General Hospital, Montreal, Canada
| | - Kerman Sekhon
- Division of Experimental Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Cyrille Launay
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Marc Afililo
- Emergency Department, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | | | - Ipsit Vahia
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, 02215, USA
| | - Soham Rej
- GeriPARTy Research Group, Jewish General Hospital, Montreal, Canada; Department of Psychiatry, McGill University, 1033 Avenue des Pins, Montreal, H3A 1A1, Canada; McGill Meditation and Mind-Body Medicine Research Clinic (MMMM-RC), Canada
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; Department of Medicine, Faculty of Medicine, University of Montreal, Quebec, Canada; Centre of Research of "Institut Universitaire de Montreal", Quebec, Canada; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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Geddes MR, O'Connell ME, Fisk JD, Gauthier S, Camicioli R, Ismail Z. Remote cognitive and behavioral assessment: Report of the Alzheimer Society of Canada Task Force on dementia care best practices for COVID-19. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2020; 12:e12111. [PMID: 32999916 PMCID: PMC7507991 DOI: 10.1002/dad2.12111] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/26/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Despite the urgent need for remote neurobehavioral assessment of individuals with cognitive impairment, guidance is lacking. Our goal is to provide a multi-dimensional framework for remotely assessing cognitive, functional, behavioral, and physical aspects of people with cognitive impairment, along with ethical and technical considerations. METHODS Literature review on remote cognitive assessment and multidisciplinary expert opinion from behavioral neurologists, neuropsychiatrists, neuropsychologists, and geriatricians was integrated under the auspices of the Alzheimer Society of Canada Task Force on Dementia Care Best Practices for COVID-19. Telephone and video approaches to assessments were considered. RESULTS Remote assessment is shown to be acceptable to patients and caregivers. Informed consent, informant history, and attention to privacy and autonomy are paramount. A range of screening and domain-specific instruments are available for telephone or video assessment of cognition, function, and behavior. Some neuropsychological tests administered by videoconferencing show good agreement with in-person assessment but still lack validation and norms. Aspects of the remote dementia-focused neurological examination can be performed reliably. DISCUSSION Despite challenges, current literature and practice support implementation of telemedicine assessments for patients with cognitive impairment. Convergence of data across the clinical interview, reliable and brief remote cognitive tests, and remote neurological exam increase confidence in clinical interpretation and diagnosis.
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Affiliation(s)
- Maiya R. Geddes
- Department of Neurology and NeurosurgeryMontreal Neurological InstituteMcGill UniversityMontrealCanada
- McGill Center for Studies in AgingMcGill UniversityVerdunCanada
- Departments of Psychiatry and NeurologyBrigham and Women's HospitalHarvard Medical SchoolBostonUSA
| | - Megan E. O'Connell
- Department of PsychologyUniversity of SaskatchewanSaskatoonCanada
- Canadian Center for Health & Safety in AgricultureMedicineUniversity of SaskatchewanSaskatoonCanada
| | - John D. Fisk
- Department of PsychiatryDalhousie UniversityHalifaxCanada
- Department of Psychology and NeuroscienceDalhousie UniversityHalifaxCanada
- Department of MedicineDalhousie UniversityHalifaxCanada
| | - Serge Gauthier
- McGill Center for Studies in AgingMcGill UniversityVerdunCanada
| | - Richard Camicioli
- Neuroscience and Mental Health Institute and Department of MedicineDivision of NeurologyUniversity of AlbertaEdmontonCanada
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health SciencesCumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain InstituteO'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
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Capozzo R, Zoccolella S, Frisullo ME, Barone R, Dell'Abate MT, Barulli MR, Musio M, Accogli M, Logroscino G. Telemedicine for Delivery of Care in Frontotemporal Lobar Degeneration During COVID-19 Pandemic: Results from Southern Italy. J Alzheimers Dis 2020; 76:481-489. [PMID: 32651328 DOI: 10.3233/jad-200589] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The COVID-19 pandemic is changing clinical practice in neurology, after the governments decided the introduction of social distancing and interruption of medical non-emergency services in many countries. Teleneurology is an effective tool for the remote evaluation of patients but its adoption for frontotemporal lobar dementia (FTD) is in a preliminary stage. OBJECTIVE We evaluated multidisciplinary assessment of patients with FTD using telehealth during the COVID-19 pandemic. METHODS All patients received a diagnosis of FTD during 2018-2019 according to international criteria. A structured questionnaire and Clinical Dementia Rating Scale (CDR)-FTD were used by the neurologist with patients and/or caregivers. Index symptoms of COVID-19 infection were searched. RESULTS Twenty-eight clinical interviews were completed with caregivers and four with both patients/caregivers. Most patients and caregivers were satisfied with the neurological interview and expressed their willingness to continue to be included in remote evaluation programs (90%). Fifty percent of patients experienced significant worsening of clinical picture and quality of life since the start of social distancing. The CDR-FTD scale revealed a significant worsening of behavior (p = 0.01) and language functions (p = 0.009), compared to the last in-person evaluation at the center. One patient presented index symptoms of COVID-19 infection and was confirmed to be positive for COVID-19 with pharyngeal swab. CONCLUSION The study was conducted in Italy, one of the countries hit particularly hard by the COVID-19 pandemic, with interruption of all non-emergency medical services. Our study indicates that telemedicine is a valid tool to triage patients with FTD to increase practice outreach and efficiency.
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Affiliation(s)
- Rosa Capozzo
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital Pia Fondazione "Card. G. Panico"/University of Bari, Tricase, Italy
| | | | - Maria Elisa Frisullo
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital Pia Fondazione "Card. G. Panico"/University of Bari, Tricase, Italy
| | - Roberta Barone
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital Pia Fondazione "Card. G. Panico"/University of Bari, Tricase, Italy
| | - Maria Teresa Dell'Abate
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital Pia Fondazione "Card. G. Panico"/University of Bari, Tricase, Italy
| | - Maria Rosaria Barulli
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital Pia Fondazione "Card. G. Panico"/University of Bari, Tricase, Italy
| | - Marco Musio
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital Pia Fondazione "Card. G. Panico"/University of Bari, Tricase, Italy
| | - Miriam Accogli
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital Pia Fondazione "Card. G. Panico"/University of Bari, Tricase, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital Pia Fondazione "Card. G. Panico"/University of Bari, Tricase, Italy.,Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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Marra DE, Hamlet KM, Bauer RM, Bowers D. Validity of teleneuropsychology for older adults in response to COVID-19: A systematic and critical review. Clin Neuropsychol 2020; 34:1411-1452. [DOI: 10.1080/13854046.2020.1769192] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- David E. Marra
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Kristin M. Hamlet
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Russell M. Bauer
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcolm Randall VAMC, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
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Abstract
Purpose of Review The prevalence of neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD), is rising as the global population ages. Access to specialist care, which improves outcomes, is insufficient and disease-related disability makes in-person physician visits burdensome. Telehealth is one potential means for improving access to care. The purpose of this manuscript is to review recent publications on telemedicine in AD and PD. Recent Findings Telemedicine is feasible in AD and PD and acceptable to patients and their caregivers. Compared with in-person visits, telemedicine reduces visit-associated travel and time. Telemedicine can be used for rehabilitative therapies, to administer cognitive tests, and to support caregivers. Access to telemedicine results in changes in patient care including medication adjustments and referrals for therapies and supports. Summary The use of telemedicine in AD and PD stands to decrease burden on patients and increase access to specialty care. Barriers to the expansion of telemedicine care include lack of widespread broadband access, state licensure requirements, and inconsistent reimbursement. More outcomes-based prospective telemedicine studies are needed.
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Charalambous AP, Pye A, Yeung WK, Leroi I, Neil M, Thodi C, Dawes P. Tools for App- and Web-Based Self-Testing of Cognitive Impairment: Systematic Search and Evaluation. J Med Internet Res 2020; 22:e14551. [PMID: 31951218 PMCID: PMC6996724 DOI: 10.2196/14551] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/16/2019] [Accepted: 09/24/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tools for app- and Web-based self-testing for identification of cognitive impairment are widely available but are of uncertain quality. OBJECTIVE The objective of this study was to undertake a scoping review of app- and Web-based self-tests for cognitive impairment and determine the validity of these tests. METHODS We conducted systematic searches in electronic databases, including Google search, Google Play Store, and iPhone Operating System App Store, using the search terms "Online OR Internet-based AND Memory OR Brain OR Dementia OR mild cognitive impairment OR MCI AND Test OR Screen OR Check." RESULTS We identified 3057 tools, of which 25 were included in the review. Most tools meeting the inclusion criteria assessed multiple cognitive domains. The most frequently assessed domains were memory, attention, and executive function. We then conducted an electronic survey with the developers of the tools to identify data relating to development and validation of each tool. If no response to the survey was received, Google (to identify gray literature), Google Scholar, and Medical Literature Analysis and Retrieval System Online were searched using key terms "(name of developer, if available)" AND "(the name of the tool)" to identify any additional data. Only 7 tools had any information concerning psychometric quality, and only 1 tool reported data on performance norms, reliability, validity, sensitivity, and specificity for the detection of cognitive impairment. CONCLUSIONS The number of cognitive self-assessment electronic health tools for cognitive impairment is increasing, but most are of uncertain quality. There is a need for well-validated tools and guidance for users concerning which tools provide reliable information about possible cognitive impairment that could warrant further investigation.
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Affiliation(s)
| | - Annie Pye
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Wai Kent Yeung
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Iracema Leroi
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | | | | | - Piers Dawes
- Manchester Centre for Audiology and Deafness, University of Manchester and the Manchester Academic Health Sciences Centre, Manchester, United Kingdom
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Hatcher-Martin JM, Adams JL, Anderson ER, Bove R, Burrus TM, Chehrenama M, Dolan O'Brien M, Eliashiv DS, Erten-Lyons D, Giesser BS, Moo LR, Narayanaswami P, Rossi MA, Soni M, Tariq N, Tsao JW, Vargas BB, Vota SA, Wessels SR, Planalp H, Govindarajan R. Telemedicine in neurology. Neurology 2019; 94:30-38. [DOI: 10.1212/wnl.0000000000008708] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/06/2019] [Indexed: 11/15/2022] Open
Abstract
PurposeWhile there is strong evidence supporting the importance of telemedicine in stroke, its role in other areas of neurology is not as clear. The goal of this review is to provide an overview of evidence-based data on the role of teleneurology in the care of patients with neurologic disorders other than stroke.Recent findingsStudies across multiple specialties report noninferiority of evaluations by telemedicine compared with traditional, in-person evaluations in terms of patient and caregiver satisfaction. Evidence reports benefits in expediting care, increasing access, reducing cost, and improving diagnostic accuracy and health outcomes. However, many studies are limited, and gaps in knowledge remain.SummaryTelemedicine use is expanding across the vast array of neurologic disorders. More studies are needed to validate and support its use.
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Haralambous B, Subramaniam S, Hwang K, Dow B, LoGiudice D. A narrative review of the evidence regarding the use of telemedicine to deliver video-interpreting during dementia assessments for older people. Asia Pac Psychiatry 2019; 11:e12355. [PMID: 31025506 DOI: 10.1111/appy.12355] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/21/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION As Australia's aging population increases and diversifies, there will be a growing need to address the burden of dementia among culturally and linguistically diverse (CALD) communities. Due to a lack of CALD-appropriate services and bilingual health professionals, older people from CALD backgrounds often receive a delayed diagnosis of dementia. The use of telemedicine (TM) to deliver video-interpreting services may overcome the barriers of interpreter availability when diagnosing and assessing dementia in older people from CALD backgrounds. METHODS This paper aims to present a review of the literature on the use of TM to deliver video-interpreting during dementia assessments. Factors affecting the reliability and agreement, feasibility, and satisfaction and acceptability when using TM or video-interpreting have been described. RESULTS The review found evidence that dementia assessments conducted via TM are as reliable as face-to-face (FTF) assessments and that participants are satisfied and find TM acceptable. There was less evidence about the feasibility of TM from the health care perspective, particularly regarding the acceptability and potential financial cost-savings. Only five studies investigated the use of video-interpreting during clinical assessments with CALD patients. Although video-interpreting was found to be satisfactory among CALD patients and clinicians, a common finding was the preference for FTF interpreting. DISCUSSION More research is needed to examine the financial feasibility and the health care perspective on the implementation and adoption of TM for dementia assessments. The use of TM to deliver video-interpreting for dementia assessments has never been investigated and represents a significant gap in the literature.
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Affiliation(s)
- Betty Haralambous
- Social Gerontology Division, National Ageing Research Institute, Parkville, Victoria, Australia
| | - Santini Subramaniam
- Social Gerontology Division, National Ageing Research Institute, Parkville, Victoria, Australia
| | - Kerry Hwang
- Social Gerontology Division, National Ageing Research Institute, Parkville, Victoria, Australia
| | - Briony Dow
- Social Gerontology Division, National Ageing Research Institute, Parkville, Victoria, Australia
| | - Dina LoGiudice
- Social Gerontology Division, National Ageing Research Institute, Parkville, Victoria, Australia
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Gately ME, Trudeau SA, Moo LR. In-Home Video Telehealth for Dementia Management: Implications for Rehabilitation. CURRENT GERIATRICS REPORTS 2019; 8:239-249. [PMID: 32015957 PMCID: PMC6996201 DOI: 10.1007/s13670-019-00297-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
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Collaborative Approaches to Team-Based Primary Health Care for Individuals with Dementia in Rural/Remote Settings. Can J Aging 2019; 38:367-383. [PMID: 30846013 DOI: 10.1017/s0714980818000727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACTApplying primary health care (PHC) team-based approaches to diagnosing and treating dementia is considered best practice. Unfortunately, those living in rural and remote areas often have limited access to dementia-specific PHC services. The purpose of this scoping review was to identify and understand PHC team-based approaches for dementia care in rural settings. A search strategy was employed which included only peer-reviewed journal articles that were published from 1997 to 2017. Four databases (Embase, Medline, PsycInfo, and CINAHL) were searched from March 2017 to May 2017. Among the 10 studies included there was a variation in the degree of collaboration and interaction among the care teams. Limited information existed about collaboration strategies among care teams. An adaptation of the socio-ecological model enabled us to categorize key factors influencing collaborative team-based approaches. Combined, these findings can be used to inform both future research and the development of a rural PHC dementia model.
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Dial HR, Hinshelwood HA, Grasso SM, Hubbard HI, Gorno-Tempini ML, Henry ML. Investigating the utility of teletherapy in individuals with primary progressive aphasia. Clin Interv Aging 2019; 14:453-471. [PMID: 30880927 PMCID: PMC6394239 DOI: 10.2147/cia.s178878] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Primary progressive aphasia (PPA) is a neurodegenerative disorder characterized by progressive deterioration of speech and language. A growing body of research supports the utility of speech and language intervention in individuals with PPA, although access to these services remains limited. One potential means of increasing treatment accessibility is the delivery of treatment via telemedicine. Evidence supports the use of teletherapy in stroke-induced aphasia, but research examining the application of teletherapy in PPA is limited. In the current study, a non-randomized group comparison design was used to evaluate the feasibility and utility of treatment delivered via teletherapy relative to treatment administered in person for individuals with PPA. METHODS Two treatment protocols were administered as part of a larger study investigating treatment for speech and language deficits in PPA. Participants with semantic (n=10) and logopenic (n=11) PPA received lexical retrieval treatment and individuals with nonfluent/agrammatic PPA (n=10) received video-implemented script training for aphasia designed to promote speech production and fluency. Treatment was administered via teletherapy for approximately half of the participants receiving each intervention. Treatment outcomes and performance on standardized tests were assessed at pre-treatment and post-treatment, as well as 3, 6, and 12 months post-treatment. RESULTS Overall, both treatment approaches resulted in significant gains for primary outcome measures. Critically, comparison of in-person and teletherapy groups revealed comparable outcomes. Generalization to untrained targets and tasks and maintenance of treatment-induced gains were also comparable for traditional vs teletherapy participants. CONCLUSION Overall, treatment outcomes were largely equivalent for individuals receiving treatment via teletherapy vs traditional, in-person delivery. Results support the application of teletherapy for administering restitutive interventions to individuals with mild-to-moderate PPA. Potential implications for using teletherapy in the treatment of cognitive-linguistic and motoric impairments in other disorders and suggestions for administering treatment via telemedicine are discussed.
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Affiliation(s)
- Heather R Dial
- Communication Sciences and Disorders, University of Texas at Austin, Austin, TX, USA,
| | | | - Stephanie M Grasso
- Communication Sciences and Disorders, University of Texas at Austin, Austin, TX, USA,
| | - H Isabel Hubbard
- Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
| | | | - Maya L Henry
- Communication Sciences and Disorders, University of Texas at Austin, Austin, TX, USA,
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Gentry MT, Lapid MI, Rummans TA. Geriatric Telepsychiatry: Systematic Review and Policy Considerations. Am J Geriatr Psychiatry 2019; 27:109-127. [PMID: 30416025 DOI: 10.1016/j.jagp.2018.10.009] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 01/02/2023]
Abstract
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.
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Affiliation(s)
- Melanie T Gentry
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
| | - Maria I Lapid
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Teresa A Rummans
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
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Zucchella C, Sinforiani E, Tamburin S, Federico A, Mantovani E, Bernini S, Casale R, Bartolo M. The Multidisciplinary Approach to Alzheimer's Disease and Dementia. A Narrative Review of Non-Pharmacological Treatment. Front Neurol 2018; 9:1058. [PMID: 30619031 PMCID: PMC6300511 DOI: 10.3389/fneur.2018.01058] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 11/21/2018] [Indexed: 12/22/2022] Open
Abstract
Background: Alzheimer's disease (AD) and dementia are chronic diseases with progressive deterioration of cognition, function, and behavior leading to severe disability and death. The prevalence of AD and dementia is constantly increasing because of the progressive aging of the population. These conditions represent a considerable challenge to patients, their family and caregivers, and the health system, because of the considerable need for resources allocation. There is no disease modifying intervention for AD and dementia, and the symptomatic pharmacological treatments has limited efficacy and considerable side effects. Non-pharmacological treatment (NPT), which includes a wide range of approaches and techniques, may play a role in the treatment of AD and dementia. Aim: To review, with a narrative approach, current evidence on main NPTs for AD and dementia. Methods: PubMed and the Cochrane database of systematic reviews were searched for studies written in English and published from 2000 to 2018. The bibliography of the main articles was checked to detect other relevant papers. Results: The role of NPT has been largely explored in AD and dementia. The main NPT types, which were reviewed here, include exercise and motor rehabilitation, cognitive rehabilitation, NPT for behavioral and psychological symptoms of dementia, occupational therapy, psychological therapy, complementary and alternative medicine, and new technologies, including information and communication technologies, assistive technology and domotics, virtual reality, gaming, and telemedicine. We also summarized the role of NPT to address caregivers' burden. Conclusions: Although NPT is often applied in the multidisciplinary approach to AD and dementia, supporting evidence for their use is still preliminary. Some studies showed statistically significant effect of NPT on some outcomes, but their clinical significance is uncertain. Well-designed randomized controlled trials with innovative designs are needed to explore the efficacy of NPT in AD and dementia. Further studies are required to offer robust neurobiological grounds for the effect of NPT, and to examine its cost-efficacy profile in patients with dementia.
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Affiliation(s)
| | - Elena Sinforiani
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Stefano Tamburin
- Neurology Unit, University Hospital of Verona, Verona, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Bernini
- Alzheimer's Disease Assessment Unit, Laboratory of Neuropsychology, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto Casale
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
| | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA, Bergamo, Italy
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Piau A, Nourhashemi F, De Mauléon A, Tchalla A, Vautier C, Vellas B, Duboue M, Costa N, Rumeau P, Lepage B, Soto Martin M. Telemedicine for the management of neuropsychiatric symptoms in long-term care facilities: the DETECT study, methods of a cluster randomised controlled trial to assess feasibility. BMJ Open 2018; 8:e020982. [PMID: 29895651 PMCID: PMC6009473 DOI: 10.1136/bmjopen-2017-020982] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPSs) in elderly patients with dementia are frequent in long-term care facilities (LTCFs) and are associated with adverse events. Telemedicine is an emerging way to provide consultation and care to dependent LTCF residents who may not have easy access to specialty services. Several studies have evaluated telemedicine for dementia care but to date, no study has evaluated its impact in the management of NPS in patients with dementia living in LTCF. METHODS AND ANALYSIS The Dementia in long-term care facilities: Telemedicine for the management of neuropsychiatric symptoms (DETECT) study is a 24-month multicentre prospective cluster randomised controlled study with two arms: a control arm (usual care) and an intervention arm (telemedicine consultation) for NPSs management. DETECT enrolled 20 LTCFs. The primary outcome is based on the acceptability of the telemedicine among the LTCF staff which will be assessed in the intervention group by quantitative and qualitative indicators. The rate of unscheduled hospitalisations and/or consultations due to disruptive NPSs, psychotropic drug use and health costs will be described in both groups. Approximately, 200 patients are expected to be recruited. ETHICS AND DISSEMINATION The study protocol was approved and sponsored by the French Ministry of Health. The study received ethical approval from the Toulouse University Hospital Institutional Review Board. We will communicate the final results to the public via conferences and results will also be submitted for publication in international peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT02472015.
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Affiliation(s)
| | - Fati Nourhashemi
- Gérontopôle, CHU Toulouse, Toulouse, France
- UMR 1027, INSERM, Toulouse, France
| | | | | | - Claude Vautier
- Manufacture des Tabacs, Université des Sciences Sociales-Toulouse 1, Toulouse, France
| | - Bruno Vellas
- Gérontopôle, CHU Toulouse, Toulouse, France
- UMR 1027, INSERM, Toulouse, France
| | | | - Nadège Costa
- Medical Information Department, CHU Toulouse, Toulouse, France
| | | | - Benoit Lepage
- Department of Epidemiology, CHU Toulouse, USMR, Toulouse, France
| | - Maria Soto Martin
- Gérontopôle, CHU Toulouse, Toulouse, France
- UMR 1027, INSERM, Toulouse, France
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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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Burton RL, O'Connell ME. Telehealth Rehabilitation for Cognitive Impairment: Randomized Controlled Feasibility Trial. JMIR Res Protoc 2018; 7:e43. [PMID: 29422453 PMCID: PMC5824099 DOI: 10.2196/resprot.9420] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/14/2017] [Accepted: 01/01/2018] [Indexed: 11/29/2022] Open
Abstract
Background Nonpharmacological interventions are needed to support the function of older adults struggling with subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and dementia due to Alzheimer disease (AD). Telerehabilitation aims to provide rehabilitation at a distance, but cognitive rehabilitation by videoconferencing has not been explored. Objective The objective of this study was to compare goal-oriented cognitive rehabilitation delivered in-person with videoconferencing to determine whether telehealth cognitive rehabilitation appears feasible. Methods Random assignment to in-person or telehealth videoconferencing cognitive rehabilitation with a combined between-subjects, multiple baseline single-case experimental design, cognitive rehabilitation was delivered by a therapist to 6 participants with SCI (n=4), MCI (n=1), or dementia due to AD (n=1). Results Two of the 6 participants randomly assigned to the telehealth condition withdrew before beginning the intervention. For those who participated in the intervention, 6 out of 6 goals measured with the Canadian Occupational Performance Measure improved for those in the in-person group, and 7 out of 9 goals improved for those in the telehealth group. Conclusions Delivery of cognitive rehabilitation by telehealth appeared feasible but required modifications such as greater reliance on caregivers and clients for manipulating materials.
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Affiliation(s)
- Rachel L Burton
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, Canada
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Schneider RB, Biglan KM. The promise of telemedicine for chronic neurological disorders: the example of Parkinson's disease. Lancet Neurol 2017; 16:541-551. [DOI: 10.1016/s1474-4422(17)30167-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/02/2017] [Accepted: 05/03/2017] [Indexed: 10/19/2022]
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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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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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