Remote assessments with SMMSE and GDS using Telehealth methods yielded similar results to direct assessments. However, there was a moderate difference between face-to-face and Telehealth assessments in some subjects, which could influence clinical decision-making.
We developed a telemedicine protocol for diagnosis of Alzheimer's Disease (AD). Assessments by video-conferencing (remote) were compared with face to face (direct) assessments. Eight physicians performed direct assessments and two physicians conducted remote assessments. There was alternate allocation of direct or remote initial assessment. The participants were 20 subjects over 65 years living in a rural area and referred by general practitioners (GPs) because of cognitive impairment. Each assessment included a Standardised Mini Mental State Examination, Geriatric Depression Scale, Katz assessment of Activities of Daily Living, Instrumental ADL assessment, and the Informant Questionnaire for Cognitive Decline in the Elderly. Laboratory results and radiological imaging were available from referring GPs. There was good agreement for diagnosing Alzheimer's disease between telemedicine and direct assessment, kappa = 0.8 (P<0.0001). However, because of the small sample size, the presence of systematic bias could not be completely excluded. We conclude that it is possible to diagnose AD at a distance using telemedicine, but this requires validation with a larger study.
Abstract:Objective: Polypharmacy and adverse drug reactions are frequent and important among older people. Few clinical trials have evaluated systematic withdrawal of medications among older people. This small, open, study was conducted to determine the feasibility of a randomized controlled deprescribing trial. Methods: Ten volunteers living in the community (recruited by media advertising) and 25 volunteers living in residential aged-care facilities (RCFs) were randomized to intervention or control groups. The intervention was gradual withdrawal of one target medication. The primary outcome was the number of intervention participants in whom medication withdrawal could be achieved. Other outcomes measures were quality of life, medication adherence, sleep quality, and cognitive impairment. Results: Participants were aged 80±11 years and were taking 9±2 medications. Fifteen participants commenced medication withdrawal and all ceased or reduced the dose of their target medication. Two subjects withdrew; one was referred for clinical review, and one participant declined further dose reductions. Conclusions: A randomized controlled trial of deprescribing was acceptable to participants. Recruitment in RCFs is feasible. Definitive trials of deprescribing are required.
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