Using Telemedicine to Assess and Manage Psychosis Among Outpatients with Neurodegenerative Disease

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 televisit 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.

Smartphone-Based Remote Monitoring for Chronic Heart Failure: Mixed Methods Analysis of User Experience From Patient and Nurse Perspectives

“…This led to frustration from patient users and inefficiency for HFSNs. Although the inevitability of some technical issues is appreciated by previous work [ 31 , 32 ], there is a dearth of studies evaluating their impact on the user experience. This study highlights that these issues can have substantial negative impact on user experience for both patients and nurses.…”

Neurological Examination via Telemedicine: An Updated Review Focusing on Movement Disorders

“…The opportunity of multidisciplinary care is an important advantage of telemedicine, as various healthcare specialists can be invited and participate during the videoconferencing, thereby contributing to optimal management. For the assessment of patients with movement disorders, an ideal care team could include a primary care physician, a neurologist, a geriatric psychiatrist, a neuropsychologist, a nurse, a physical therapist, a speech pathologist, and a social worker, depending on the situation [ 22 , 28 ].…”

“…Alternatively, a trained registered nurse, physician assistant, or other healthcare professional could perform these parts of the neurological examination under the supervision of the remote neurologist specialist in front of the camera [ 24 , 29 ]. If the examination is performed at home, a family member or caregiver could facilitate the physician–patient communication, give insight into the patient’s answers, and assist with specific parts of the remote examination, such as holding or moving the camera [ 18 , 28 ]. Furthermore, the body language of the caregiver/family member might also guide the clinician for specific questions and give deeper clinical insights [ 28 ].…”

“…If the examination is performed at home, a family member or caregiver could facilitate the physician–patient communication, give insight into the patient’s answers, and assist with specific parts of the remote examination, such as holding or moving the camera [ 18 , 28 ]. Furthermore, the body language of the caregiver/family member might also guide the clinician for specific questions and give deeper clinical insights [ 28 ]. If possible, after the obtainment of consent from the patient, the physician could arrange a phone call with the caregiver/family member before and after the telemedicine visit in order to gather useful information [ 28 ].…”

“…Furthermore, the body language of the caregiver/family member might also guide the clinician for specific questions and give deeper clinical insights [ 28 ]. If possible, after the obtainment of consent from the patient, the physician could arrange a phone call with the caregiver/family member before and after the telemedicine visit in order to gather useful information [ 28 ]. The presence of a third party is even more important in case of cognitive impairment or psychiatric manifestations ( Table 1 ) [ 28 ].…”