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Cited by 127Telemedicine and Telehealth ImplementationDementia and Cognitive Impairment ResearchDental Research and COVID-19

Remote cognitive and behavioral assessment: Report of the Alzheimer Society of Canada Task Force on dementia care best practices for COVID‐19

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Geddes, Maiya R., O'Connell, Megan E., Fisk, John D., Gauthier, Serge, Camicioli, Richard, Ismail, Zahinoor, for the Alzheimer Society of Canada Task Force on Dementia Care Best Practices for COVID‐19·2020·Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring
DOI 10.1002/dad2.12111PMC PMC7507991
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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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  • Technology is helping to improve access to care for people living with dementia, especially for those in rural areas and those with mobility limitations.

    “Technology is also helping to improve access to care for people living with dementia, especially for those in rural areas and those with mobility limitations. 855”

    From 2024 Alzheimer's disease facts and figures (2024) · cites this paper as [855]

    The Ethical Considerations section says telemedicine has the potential to improve specialist access for patients with reduced mobility or geographical constraints. But Future Directions and Conclusion says whether people in rural areas benefit from telehealth still needs study, so the claim overstates an established benefit for that group. (LLM, conf=0.88)

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  1. [1]Knopman DS, Gottesman RF, Sharrett AR, et al. Mild cognitive impairment and dementia prevalence: the Atherosclerosis Risk in Communities Neurocognitive Study. Alzheimers Dement. 2016; 2: 1‐ 11. PMC4772876 26949733
  2. [3]Wimo A, Winblad B, Aguero‐Torres H, von Strauss E. The magnitude of dementia occurrence in the world. Alzheimer Dis Assoc Disord. 2003; 17(2): 63‐ 67. 12794381
  3. [4]Wang H, Li T, Barbarino P, et al. Dementia care during COVID‐19. Lancet. 2020; 395(10231): 1190‐ 1191. 32240625 PMC7146671
  4. [5]Atkins JL, Masoli JAH, Delgado J, et al. Preexisting comobidities predicting severe covid‐19 in older adults in the UK biobank community cohort. medRxiv. 2020. 2020.05.06.20092700.
  5. [6]Agha Z, Schapira RM, Laud PW, McNutt G, Roter DL. Patient satisfaction with physician–patient communication during telemedicine. Telemed J E Health. 2009; 15(9): 830‐ 839. 19919189
  6. [7]Gillespie SM, Wasserman EB, Wood NE, et al. High‐intensity telemedicine reduces emergency department use by older adults with dementia in senior living communities. J Am Med Dir Assoc. 2019; 20(8): 942‐ 946. 31315813 PMC7213053
  7. [8]Robillard JM, Cleland I, Hoey J, Nugent C. Ethical adoption: a new imperative in the development of technology for dementia. Alzheimers Dement. 2018; 14(9): 1104‐ 1113. 29937247
  8. [9]Chaet D, Clearfield R, Sabin JE, Skimming K, Skimming K. Ethical practice in telehealth and telemedicine. J Gen Intern Med. 2017; 32(10): 1136‐ 1140. 28653233 PMC5602756
  9. [10]Miller EA. Telemedicine and doctor‐patient communication: an analytical survey of the literature. J Telemed Telecare. 2001; 7(1): 1‐ 17. 11265933
  10. [11]Cheshire WP, Barrett KM, Eidelman BH, et al. Patient perception of physician empathy in stroke telemedicine. J Telemed Telecare. 2020. 1357633X19899237. 31986965
  11. [12]Terry C, Cain J. The emerging issue of digital empathy. Am J Pharm Educ. 2016; 80(4): 58. 27293225 PMC4891856
  12. [13]Christensen KD, Uhlmann WR, Roberts JS, et al. A randomized controlled trial of disclosing genetic risk information for Alzheimer disease via telephone. Genet Med. 2018; 20(1): 132‐ 141. 28726810 PMC5897910
  13. [14]Barton C, Morris R, Rothlind J, Yaffe K. Video‐Telemedicine in a memory disorders clinic: evaluation and management of rural elders with cognitive impairment. Telemed J E Health. 2011; 17(10): 789‐ 793. 22023458
  14. [16]Ismail Zahinoor, Black Sandra E., Camicioli Richard, Chertkow Howard, Herrmann Nathan, Laforce Robert, Montero‐Odasso Manuel, Rockwood Kenneth, Rosa‐Neto Pedro, Seitz Dallas, Sivananthan Saskia, Smith Eric E., Soucy Jean‐Paul, Vedel Isabelle, Gauthier Serge,. Recommendations of the 5th Canadian Consensus Conference on the diagnosis and treatment of dementia. Alzheimer's & Dementia. 2020; 16: 8: 1182– 1195. 10.1002/alz.12105. PMC7984031 32725777 · DOI · Paper page
  15. [17]Allen DT, Caldwell P, Komesaroff PA, et al. Practical aspects of telehealth: set‐up and preparation for video consultations. Intern Med J. 2013; 43(10): 1133‐ 1136. 24134169
  16. [18]O'Connell ME, Crossley M, Cammer A, et al. Development and evaluation of a telehealth videoconferenced support group for rural spouses of individuals diagnosed with atypical early‐onset dementias. Dementia. 2014; 13(3): 382‐ 395. 24339063
  17. [19]Nickerson RS, Null hypothesis significance testing: a review of an old and continuing controversy. 2000(1082‐989X (Print)). 10937333
  18. [20]Ismail Z, Mortby ME. Cognitive and neuropsychiatric screening tests in older adults. Mental health and illness of the elderly. Springer Sci. 2017: 343‐ 368.
  19. [21]Daffner KR, Gale SA, Barrett AM, et al. Improving clinical cognitive testing: report of the AAN Behavioral Neurology Section Workgroup. Neurology. 2015; 85(10): 910‐ 918. 26163433 PMC4560060
  20. [22]Castanho TC, Amorim L, Zihl J, Palha JA, Sousa N, Santos NC. Telephone‐based screening tools for mild cognitive impairment and dementia in aging studies: a review of validated instruments. Front Aging Neurosci. 2014; 6: 16. 24611046 PMC3933813
  21. [24]Grady B, Myers Km, Nelson E‐L, et al. Evidence‐based practice for telemental health. Telemed J E Health. 2011; 17(2): 131‐ 148. 21385026
  22. [25]Cohen RA, Alexander GE. Using TICS and T‐MoCA for telephone assessments of vascular cognitive impairment: promising call or put on hold? Stroke. 2017; 48(11): 2919. 29042491 PMC5803098
  23. [26]Brandt J, Spencer M, Folstein M. The telephone interview for cognitive status. Neuropsych Neuropsychol Behav Neurol. 1988; 1(2): 111‐ 117.
  24. [27]Knopman DS, Roberts RO, Geda YE, et al. Validation of the telephone interview for cognitive status‐modified in subjects with normal cognition, mild cognitive impairment, or dementia. Neuroepidemiology. 2010; 34(1): 34‐ 42. 19893327 PMC2857622
  25. [28]Seo EH, Lee DY, Kim SG, et al. Validity of the telephone interview for cognitive status (TICS) and modified TICS (TICSm) for mild cognitive imparment (MCI) and dementia screening. Arch Gerontol Geriatr. 2011; 52(1): e26‐ e30. 20471701
  26. [29]Lindgren N, Rinne JO, Palviainen T, Kaprio J, Vuoksimaa E. Prevalence and correlates of dementia and mild cognitive impairment classified with different versions of the modified Telephone Interview for Cognitive Status (TICS‐m). Int J Geriatr Psychiatry. 2019; 34(12): 1883‐ 1891. 31469194
  27. [30]Wittich W, Phillips N, Nasreddine ZS, Chertkow H. Sensitivity and specificity of the Montreal Cognitive Assessment Modified for individuals who are visually impaired. J Vis Impair Blind. 2010; 104(6): 360‐ 368.
  28. [32]Pendlebury ST, Welch SJ, Cuthbertson FC, Mariz J, Mehta Z, Rothwell PM. Telephone assessment of cognition after transient ischemic attack and stroke: modified telephone interview of cognitive status and telephone Montreal Cognitive Assessment versus face‐to‐face Montreal Cognitive Assessment and neuropsychological battery. Stroke. 2013; 44(1): 227‐ 229. 23138443 PMC5593099
  29. [33]Wong A, Nyenhuis D, Black SE, et al. Montreal Cognitive Assessment 5‐minute protocol is a brief, valid, reliable, and feasible cognitive screen for telephone administration. Stroke. 2015; 46(4): 1059‐ 1064. 25700290 PMC4373962
  30. [34]Roccaforte WH, Burke WJ, Bayer BL, Wengel SP. Reliability and validity of the Short Portable Mental Status Questionnaire administered by telephone. J Geriatr Psychiatry Neurol. 1994; 7(1): 33‐ 38. 8192828
  31. [35]Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short Orientation‐Memory‐Concentration Test of cognitive impairment. Am J Psychiatry. 1983; 140(6): 734‐ 739. 6846631
  32. [36]Meagher J, Leonard M, Donoghue L, et al. Months backward test: a review of its use in clinical studies. World J Psych. 2015; 5(3): 305. PMC4582306 26425444
  33. [37]Salib E, McCarthy J. Mental Alternation Test (MAT): a rapid and valid screening tool for dementia in primary care. Int J Geriatr Psych. 2002; 17(12): 1157‐ 1161. 12461766
  34. [38]Bunker L, Hshieh TT, Wong B, et al. The SAGES telephone neuropsychological battery: correlation with in‐person measures. Int J Geriatr Psychiatry. 2017; 32(9): 991‐ 999. 27507320 PMC5299071
  35. [39]Hamberger MJ, Seidel WT. Auditory and visual naming tests: normative and patient data for accuracy, response time, and tip‐of‐the‐tongue. J Int Neuropsychol Soc. 2003; 9(3): 479‐ 489. 12666772
  36. [40]Miller KM, Finney GR, Meador KJ, Loring DW. Auditory responsive naming versus visual confrontation naming in dementia. Clin Neuropsychol. 2010; 24(1): 103‐ 118. 19626564
  37. [41]Wadsworth HE, Galusha‐Glasscock JM, Womack KB, et al. Remote neuropsychological assessment in rural American Indians with and without cognitive impairment. Arch Clin Neuropsychol. 2016; 31(5): 420‐ 425. 27246957 PMC4954610
  38. [43]Cullum CM, Hynan LS, Grosch M, Parikh M, Weiner MF. Teleneuropsychology: evidence for Video Teleconference‐Based Neuropsychological Assessment. J Int Neuropsychol So. 2014; 20(10): 1028‐ 1033. PMC4410096 25343269
  39. [44]Wadsworth HE, Dhima K, Womack KB, et al. Validity of teleneuropsychological assessment in older patients with cognitive disorders. Arch Clin Neuropsychol. 2018; 33(8): 1040‐ 1045. 29329363 PMC6887729
  40. [45]Vahia IV, Ng B, Camacho A, et al. Telepsychiatry for neurocognitive testing in older rural latino adults. Am J Geriatr Psychiatry. 2015; 23(7): 666‐ 670. 25708655 PMC4363076
  41. [46]Grosch MC, Weiner MF, Hynan LS, Shore J, Cullum CM. Video teleconference‐based neurocognitive screening in geropsychiatry. Psychiatry Res. 2015; 225(3): 734‐ 735. 25596957 PMC4410696
  42. [47]Ball LJ, Bisher GB, Birge SJ. A simple test of central processing speed: an extension of the Short Blessed Test. J Am Geriatr Soc. 1999; 47(11): 1359‐ 1363. 10573448
  43. [49]Jacobsen S, Sprenger T, Andersson S, Krogstad J‐M. Neuropsychological assessment and telemedicine: a preliminary study examining the reliability of neuropsychology services performed via telecommunication. J Int Neuropsychol So. 2003; 9: 472‐ 478. 12666771
  44. [50]Allain P, Foloppe DA, Besnard J, et al. Detecting Everyday Action Deficits in Alzheimer's Disease Using a Nonimmersive Virtual Reality Kitchen. J Int Neuropsychol Soc. 2014; 20(5): 468‐ 477. 24785240
  45. [51]Allard M, Husky M, Catheline G, et al. Mobile technologies in the early detection of cognitive decline. PLoS One. 2014; 9(12): e112197. 25536290 PMC4275158
  46. [52]Randolph C, Tierney MC, Mohr E, Chase TN. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): preliminary clinical validity. J Clin Exp Neuropsychol. 1998; 20(3): 310‐ 319. 9845158
  47. [53]Goodglass H, Kaplan E, Barresi B. BDAE‐3: Boston Diagnostic Aphasia Examination. 3rd ed Philadelphia, PA: Lippincott Williams & Wilkins; 2001.
  48. [55]Hildebrand R, Chow H, Williams C, Nelson M, Wass P. Feasibility of neuropsychological testing of older adults via videoconference: implications for assessing the capacity for independent living. J Telemed Telecare. 2004; 10(3): 130‐ 134. 15165437
  49. [56]Zygouris S, Giakoumis D, Votis K, et al. Can a virtual reality cognitive training application fulfill a dual role? using the virtual supermarket cognitive training application as a screening tool for mild cognitive impairment. JAD. 2015; 44(4): 1333‐ 1347. 25428251
  50. [57]Diaz‐Orueta U, Etxaniz A, Gonzalez MF, Buiza C, Urdaneta E, Yanguas J. Role of cognitive and functional performance in the interactions between elderly people with cognitive decline and an avatar on TV. Univ Access Inf Soc. 2014; 13(1): 89‐ 97.
  51. [59]Galusha‐Glasscock JM, Horton DK, Weiner MF, Cullum CM. Video Teleconference Administration of the repeatable battery for the assessment of neuropsychological status. Arch Clin Neuropsychol. 2016; 31(1): 8‐ 11. 26446834 PMC4718188
  52. [60]Ekman P. Pictures of facial affect. Consulting Psychologists Press; 1976.
  53. [61]Costanzo MC, Arcidiacono C, Rodolico A, Panebianco M, Aguglia E, Signorelli MS. Diagnostic and interventional implications of telemedicine in Alzheimer's disease and mild cognitive impairment: a literature review. Int J Geriatr Psychiatry. 2020; 35(1): 12‐ 28. 31617247
  54. [62]DeYoung N, Shenal BV. The reliability of the Montreal Cognitive Assessment using telehealth in a rural setting with veterans. J Telemed Telecare. 2019; 25(4): 197‐ 203. 29320916
  55. [63]Rowland JT, Basic D, Storey JE, Conforti DA. The Rowland Universal Dementia Assessment Scale (RUDAS) and the Folstein MMSE in a multicultural cohort of elderly persons. Int Psychogeriatr. 2006; 18(1): 111‐ 120. 16466591
  56. [65]Wong L, Martin‐Khan M, Rowland J, Varghese P, Gray LC. The Rowland Universal Dementia Assessment Scale (RUDAS) as a reliable screening tool for dementia when administered via videoconferencing in elderly post‐acute hospital patients. J Telemed Telecare. 2012; 18(3): 176‐ 179. 22362836
  57. [66]Gates NJ, Kochan NA. Computerized and on‐line neuropsychological testing for late‐life cognition and neurocognitive disorders: are we there yet? Curr Opin Psychiatry. 2015; 28(2): 165‐ 172. 25602241
  58. [68]Ismail Z, Elbayoumi H, Smith EE, et al. A systematic review and meta‐analysis for the prevalence of depression in mild cognitive impairment. JAMA Psychiatry. 2017; 74(1): 58‐ 67. 27893026
  59. [69]Sheikh J, Yesavage J. Geriatric Depression Scale (GDS): recent findings and development of a shorter version In: Brink T, ed. Clinical Gerontology: A Guide to Assessment and Intervention. New York: Howarth Press; 1986.
  60. [70]Goodarzi ZS, Mele BS, Roberts DJ, Holroyd‐Leduc J. Depression Case Finding in Individuals with Dementia: a Systematic Review and Meta‐Analysis. J Am Geriatr Soc. 2017; 65(5): 937‐ 948. 28152174
  61. [71]Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell scale for depression in dementia. Biol Psychiatry. 1988; 23(3): 271‐ 284. 3337862
  62. [73]Hancock P, Larner A. Clinical utility of Patient Health Questionnaire‐9 (PHQ‐9) in memory clinics. Int J Psychiatry. 2009; 13(3): 188‐ 191. 24916819
  63. [74]Shankar K, Walker M, Frost D, Orrell M. The development of a valid and reliable scale for rating anxiety in dementia (RAID). Aging Ment Health. 1999; 3(1): 39‐ 49.
  64. [76]McKhann GM, Knopman DS, Chertkow H, et al. The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging‐Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement. 2011; 7(3): 263‐ 269. 21514250 PMC3312024
  65. [77]Kaufer DI, Cummings JL, Ketchel P, et al. Validation of the NPI‐Q, a brief clinical form of the neuropsychiatric inventory. J Neuropsychiatry Clin Neurosci. 2000; 12(2): 233‐ 239. 11001602
  66. [78]Reisberg B, Auer SR, Monteiro IM. Behavioral pathology in Alzheimer's disease (BEHAVE‐AD) rating scale. Int Psychogeriatr. 1997; 8(S3): 301‐ 308. 9154579
  67. [79]Boeve BF, Molano JR, Ferman TJ, et al. Validation of the Mayo Sleep Questionnaire to screen for REM sleep behavior disorder in an aging and dementia cohort. Sleep Med. 2011; 12(5): 445‐ 453. 21349763 PMC3083495
  68. [80]Wise EA, Rosenberg PB, Lyketsos CG, Leoutsakos J‐M. Time course of neuropsychiatric symptoms and cognitive diagnosis in National Alzheimer's Coordinating Centers volunteers. Alzheimer's & Dementia: Diagnosis. 2019; 11: 333‐ 339. PMC6476801 31024987
  69. [81]Ismail Z, Smith EE, Geda Y, et al. Neuropsychiatric symptoms as early manifestations of emergent dementia: provisional diagnostic criteria for mild behavioral impairment. Alzheimers Dement. 2016; 12(2): 195‐ 202. 26096665 PMC4684483
  70. [82]Ismail Z, Aguera‐Ortiz L, Brodaty H, et al. The Mild Behavioral Impairment Checklist (MBI‐C): a rating scale for neuropsychiatric symptoms in pre‐dementia populations. J Alzheimers Dis. 2017; 56(3): 929‐ 938. 28059789 PMC5652315
  71. [83]Lussier FZ, Pascoal TA, Chamoun M, et al. Mild behavioral impairment is associated with β‐amyloid but not tau or neurodegeneration in cognitively intact elderly individuals. Alzheimers Dement. 2020; 16: 192‐ 199. 31914223 PMC7041633
  72. [84]Yoon EJ, Ismail Z, Hanganu A, et al. Mild behavioral impairment is linked to worse cognition and brain atrophy in Parkinson disease. Neurology. 2019; 93(8): e766. 31320470 PMC6711660
  73. [85]Roehr S, Riedel‐Heller SG, Kaduszkiewicz H, et al. Is function in instrumental activities of daily living a useful feature in predicting A lzheimer's disease dementia in subjective cognitive decline? Int J Geriatr Psychiatry. 2019; 34(1): 193‐ 203. 30353573
  74. [86]Marshall GA‐O, Aghjayan SL, Dekhtyar M, et al. Measuring instrumental activities of daily living in non‐demented elderly: a comparison of the new performance‐based Harvard Automated Phone Task with other functional assessments. Alzheimers Res Ther. 2019; 11(1): 4. 30630529 PMC6329044
  75. [88]Emory university telehealth neuropsychology development and implementation in response to the COVID‐19 pandemic. The Clinical Neuropsychologist. 2020. 32660335

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Authors
Geddes, M. R., O'Connell, M. E., Fisk, J. D., Gauthier, S., Camicioli, R., Ismail, Z., & for the Alzheimer Society of Canada Task Force on Dementia Care Best Practices for COVID‐19
Affiliations
  • Brigham and Women's Hospital (US)
  • Department of Psychology University of Saskatchewan Saskatoon Canada
  • Dalhousie University (CA)
  • McGill University Research Centre for Studies in Aging (CA)
  • University of Alberta (CA)
  • University of Calgary (CA)
Corresponding author
Geddes, Maiya R.
ORCID
Venue
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring
Publisher
Wiley
Published
2020-01
Volume
12
Issue
1
Pages
e12111-e12111
ISSN
2352-8729 (ISSN-L)
DOI
10.1002/dad2.12111
PMC
PMC7507991
OpenAlex
W3089035976
Cited by
127
References
9
Citations by year
2026: 3 · 2025: 18 · 2024: 25 · 2023: 27 · 2022: 32 · 2021: 21 · 2020: 1
FWCI
3.38
Type
journal article
Language
en
Open access
Licence
Locations
  • Alzheimer s & Dementia Diagnosis Assessment & Disease Monitoring (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • Canadian Institutes of Health Research
  • National Institutes of Health
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
Keywords
remote cognitive assessment, telemedicine, dementia, COVID-19 pandemic, behavioral assessment, functional assessment, telephone assessment, videoconferencing, neuropsychological assessment, informed consent, privacy and autonomy, screening tool

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