Implementing Remote Memory Clinics to Enhance Clinical Care During and After COVID-19

Abstract

Social isolation is likely to be recommended for older adults due to COVID-19, with ongoing reduced clinical contact suggested for this population. This has increased the need for remote memory clinics, we therefore review the literature, current practices and guidelines on organizing such remote memory clinics, focusing on assessment of cognition, function and other relevant measurements, proposing a novel pathway based on three levels of complexity: simple telephone or video-based interviews and testing using available tests (Level 1), digitized and validated methods based on standard pen-and-paper tests and scales (Level 2), and finally fully digitized cognitive batteries and remote measurement technologies (RMTs, Level 3). Pros and cons of these strategies are discussed. Remotely collected data negates the need for frail patients or carers to commute to clinic and offers valuable insights into progression over time, as well as treatment responses to therapeutic interventions, providing a more realistic and contextualized environment for data-collection. Notwithstanding several challenges related to internet access, computer skills, limited evidence base and regulatory and data protection issues, digital biomarkers collected remotely have significant potential for diagnosis and symptom management in older adults and we propose a framework and pathway for how technologies can be implemented to support remote memory clinics. These platforms are also well-placed for administration of digital cognitive training and other interventions. The individual, societal and public/private costs of COVID-19 are high and will continue to rise for some time but the challenges the pandemic has placed on memory services also provides an opportunity to embrace novel approaches. Remote memory clinics' financial, logistical, clinical and practical benefits have been highlighted by COVID-19, supporting their use to not only be maintained when social distancing legislation is lifted but to be devoted extra resources and attention to fully potentiate this valuable arm of clinical assessment and care.

Perceptions, Experiences, and Challenges of Physicians Involved in Dementia Care During the COVID-19 Lockdown in India: A Qualitative Study

“…Soares et al ( 20 ) while discussing telecare for BPSD during COVID-19, describe it as a “viable tool” for monitoring clinical stability, however, cautions about cost, resistance to change, age of the patient, and technical challenges. Implementing remote memory clinics has also been recommended to help screening, digital cognitive training, pragmatic benefits of which can outlast the pandemic ( 21 ). HCP in this study rather admitted technical ease in consultations but were worried about the virtual assessments.…”

Effects of COVID-19 Infection Control Measures on Appointment Cancelation in an Italian Outpatient Memory Clinic

“…In general, the use of Information and Communications Technology (ICT) by people with NCD is well-tolerated if devices are specifically designed to be easy to use for the target users and if they receive adequate training in order to learn how to use the technology and avoid issues due to their cognitive problems (34). Thus, one priority area for preparing Italy for potential future outbreaks of COVID-19 is to design and develop telemedicine solutions for individuals with cognitive impairment [i.e., remote memory clinics (35)], and to prepare adequate training for both healthcare professionals and patients.…”

Opportunities for the advanced practice nurse in improving the wellbeing of older adults during the COVID-19 pandemic

“… 32 Flexible mobilization of memory care services to telehealth platforms using geriatric-trained clinicians is essential for reducing disease and caregiver burden during periods of social isolation. 33 , 34 …”