Telemedicine or Videoconferencing (VC) technology has been used successfully for psychiatric interviewing as a means of providing services to patients in rural and otherwise underserved settings. VC-based diagnostic interviewing has shown good agreement with conventional face-to-face diagnosis of dementia in several investigations, but extension of this technology to neurocognitive assessment techniques has received very little attention. Given the rapidly growing elderly segment of our population and the prevalence of Alzheimer's disease in this group, providing state of the art neurocognitive evaluations to elderly rural and underserved populations would represent a major step forward in the detection and diagnosis of dementia, with implications for treatment and monitoring over time.
Specific aims of this project are to assemble a brief battery of neurocognitive tests that can be administered using VC technology for the detection and quantification of cognitive impairment. Traditional face-to-face testing will be compared with VC-based testing among older healthy controls and patients with mild to moderate Alzheimer's disease (AD) seen through the UT Southwestern Memory Disorders Unit, and we will field test these procedures in a rural Native American population at our satellite clinic at the Choctaw Nation Healthcare Center in southeastern Oklahoma, where we presently conduct VC-based psychiatric interviews and face-to-face neurocognitive examinations. In addition to preliminary support from the literature, our pilot studies suggest the feasibility of using this technology in elderly patients with dementia. We will expand our AD samples and acquire data from healthy controls in order to explore the psychometric properties of the tests administered in this fashion and assess the ability of telecognitive evaluations to distinguish cognitively intact and impaired groups. Results from this investigation will determine whether telecognitive assessment is comparable to traditional in-person testing and therefore potentially available to provide more comprehensive dementia assessment services to elderly and underserved populations. Additional implications include future opportunities for large-scale telemedicine-based health care research.
The oldest segment of our population is the most rapidly growing age group, and with advancing age comes the increased risk of Alzheimer's disease and other forms of cognitive impairment. Roughly 25% of the U.S. population lives in rural areas, where access to medical specialties may be limited. Unlike other ethnic groups in the U.S., more than half of the 2.5 million Native Americans live outside of metropolitan areas, and the percentage of elderly Native Americans is predicted to more than double by the year 2050. Telemedicine or videoconferencing technology has been used to extend care in psychiatry and other specialties into rural areas, although long-distance assessment of dementia has received little attention. One of the goals of this project is to use modern telemedicine technology to conduct neurocognitive testing compared with traditional face-to-face examinations in older Native American and non-Native American adults with and without cognitive impairment. Providing state-of-the-art neurocognitive examinations to elderly rural and underserved populations would represent a major step in the detection, diagnosis, and treatment of dementia.
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