Video-telemedicine in a memory disorders clinic: evaluation and management of rural elders with cognitive impairment.
OBJECTIVE
Telemedicine is increasingly being used to provide consultation for healthcare in rural areas. Little work has been done with dementia although preliminary research suggests that clinical diagnosis performed via telemedicine consultation is valid. We implemented a program to provide multidisciplinary, state-of-the-art diagnosis of cognitive impairment by video-telemedicine (VTM) integrated into a clinical setting.


METHODS
Patients at a rural veteran's community clinic were referred by their local provider for evaluation of memory complaints by the multidisciplinary team of the San Francisco Veterans Administration (SFVA) Memory Disorders Clinic (MDC). The evaluation was integrated into the usual clinic structure and included a neurological evaluation and neuropsychological testing by the MDC team via video assisted by a remote clinician at the community clinic.


RESULTS
We evaluated 15 new patients referred to our multidisciplinary clinic. In each case, the VTM format permitted the MDC team to arrive at a working diagnosis; 12 patients with dementia, two with mild cognitive impairment, and one cognitively normal. Relevant treatment recommendations were made to the patients and caregivers. The evaluation results were discussed with providers who joined the MDC postclinic conference via VTM. In the majority of cases, recommendations were followed and there was satisfaction with VTM by providers and patients.


CONCLUSIONS
VTM is emerging as an effective way to provide consultation and care to rural residents who may not have access to specialty services and can be integrated into current clinical settings.
Department of Neurology, University of California, San Francisco, San Francisco, California CA 94121, USA. cbarton@memory.ucsf.edu
Cynthia
C
Barton
Rebecca
R
Morris
Johannes
J
Rothlind
Kristine
K
Yaffe
D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology; D003156:Community Mental Health Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis* / Q000453:epidemiology; D011594:Psychometrics; D012017:Referral and Consultation; D012424:Rural Population / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration*; D014481:United States; D014493:United States Department of Veterans Affairs; D014741:Video Recording