Tele-neuropsychological evaluation in Alzheimer's disease: an experimental study

BACKGROUND: Telemedicine consists in the use of telecommunication technologies to provide healthcare services overcoming geographic, temporal, social, and cultural barriers. Today telemedicine is a developed field, which includes about 50 different subspecialties: neuropsychology is one of them. Its main application consists in the early diagnosis of cognitive disorders of adult onset ,and particularly in the assessment of individuals potentially affected by degenerative conditions, such as Alzheimer disease (AD). These individuals would benefit significantly by an assessment by telemedicine. This study was aimed to assess the feasibility by telemedicine of two widely used neuropsychological test: the MMSE and the ADAS_COG test. While for the first some data are available in the literature, no study has investigated, to our knowledge, the ADAS_COG administration by videoconference in subjects with AD. We aimed thus to compare the results obtained by the ''face to face'' condition to those obtained by videoconference. MATERIALS AND METHODS: The ADAS_Cog and the MMSE test were administered to 28 subjects (8M) in two conditions: the face-to-face condition and the video-conference modality. Subjects were all participating to the randomized, double blind, placebo controlled ASCOMALVA study. The administration was done at the enrollment of the patients in the study, baseline, and after 6, 12, 18 and 24 months. Subjects were randomized in two groups. Group A subjects were submitted to the ADAS_Cog and the MMSE test by the face-to-face modality first; two weeks later the same tests were administered via telemedicine by videoconferencing. Group B were submitted vice-versa to the videoconference modality first, and then to the face to face. A two-tailed Student "t" test was done to evaluate the differences between the two modality. RESULTS: There was no significant difference in MMSE scores and ADAS_Cog scores (p minus .05) administered by telehealth versus face to face modality. In patient with moderate AD the administration via telemedicine gives worse results on average than the face to face mode CONCLUSIONS: The most employed tool to assess and measure the cognitive functions in subjects potentially affected by degenerative dementia are the MMSE and the ADAS_Cog. Both are required in the clinical trials to assess the severity of the damage and the effectiveness of new drugs. Their employ by videoconference should be very useful. We found that both the MMSE and the ADAS Cog test may be applied in subjects with mild to moderate Alzheimer disease, and that the scores obtained by videoconference are related to those obtained by the face to face condition. Videoconference may be very useful to reach patients with cognitive damages, to assess their stability or progression, to measure the efficacy of therapies.