title: Telemedicine and the evaluation of cognitive impairment: the additive value of neuropsychological assessment.
abstract: BACKGROUND
  The number of people in the United States living with dementia is projected to rise to over 7.1 million in the next 12 years, representing a 40% increase from current levels. This anticipated "dementia tsunami" has led to a recent state and national policy emphasis on early detection, improved care quality, reduced caregiver burden, and increased access to care. The ability to achieve these objectives is limited by few dementia specialists in rural and small communities and the challenges of travel to and within congested urban regions for dementia patients and their caregivers. Telemedicine is one such means for responding to this lack of access to subspecialty assessment and care. We describe our early experiences with this technology applied to neuropsychological assessments, with data from 31 patients.
  
  
  METHODS
  As part of an interdisciplinary dementia care demonstration project, clinical video teleconferencing provides real-time high resolution video interactions between dementia subspecialists in a major metropolitan medical center and patients in 3 outlying clinics located 180, 150, and 100 miles away. Comprehensive neuropsychological assessments, designed to address referral questions related to neurocognitive disorders via clinical video teleconferencing, are conducted as one component of interdisciplinary care.
  
  
  RESULTS
  Eighty-seven percent of patients referred for neuropsychological assessment had an inaccurate neurocognitive diagnosis at the time of referral. Unmet and unrecognized mental health treatment needs were identified in over 77% of patients. In addition, acceptance was good for patients, caregivers, and clinicians.
  
  
  CONCLUSIONS
  Teleneuropsychology is proving to be an excellent resource for clarifying cognitive and psychiatric diagnoses, and integrating individual strengths, weaknesses, and preferences into treatment and care plans used by other health care providers, patients, and caregivers.
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA. Electronic address: kathryn.harrell@va.gov.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Harrell
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA; David Geffen School of Medicine at the University of California, Los Angeles, CA.
authors.forename: Stacy S
authors.initials: SS
authors.lastname: Wilkins
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA.
authors.forename: Megan K
authors.initials: MK
authors.lastname: Connor
authors.affiliation: VA Greater Los Angeles Healthcare System, Los Angeles, CA; David Geffen School of Medicine at the University of California, Los Angeles, CA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Chodosh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D014481:United States; D049269:Videoconferencing
keywords: Telemedicine; cognitive assessment; dementia; neuropsychology; telehealth