Abstract
Social isolation is likely to be recommended for older adults due to COVID-19, with ongoing reduced clinical contact suggested for this population. This has increased the need for remote memory clinics, we therefore review the literature, current practices and guidelines on organizing such remote memory clinics, focusing on assessment of cognition, function and other relevant measurements, proposing a novel pathway based on three levels of complexity: simple telephone or video-based interviews and testing using available tests (Level 1), digitized and validated methods based on standard pen-and-paper tests and scales (Level 2), and finally fully digitized cognitive batteries and remote measurement technologies (RMTs, Level 3). Pros and cons of these strategies are discussed. Remotely collected data negates the need for frail patients or carers to commute to clinic and offers valuable insights into progression over time, as well as treatment responses to therapeutic interventions, providing a more realistic and contextualized environment for data-collection. Notwithstanding several challenges related to internet access, computer skills, limited evidence base and regulatory and data protection issues, digital biomarkers collected remotely have significant potential for diagnosis and symptom management in older adults and we propose a framework and pathway for how technologies can be implemented to support remote memory clinics. These platforms are also well-placed for administration of digital cognitive training and other interventions. The individual, societal and public/private costs of COVID-19 are high and will continue to rise for some time but the challenges the pandemic has placed on memory services also provides an opportunity to embrace novel approaches. Remote memory clinics’ financial, logistical, clinical and practical benefits have been highlighted by COVID-19, supporting their use to not only be maintained when social distancing legislation is lifted but to be devoted extra resources and attention to fully potentiate this valuable arm of clinical assessment and care.
Highlights
Cognitive impairment and dementia increase with age and represent major challenges for patients, their families and society
There is the dilemma faced by many patients regarding their concerns about potentially having dementia and wanting to speak to a clinician, offset against concerns of contracting COVID-19 should they allow a clinician into their home or visit a clinic [4]
Instruments used in pre-COVID-19 clinical settings are straightforwardly adapted for remote assessment
Summary
Cognitive impairment and dementia increase with age and represent major challenges for patients, their families and society. Older people are at higher risk from COVID-19, due to ongoing age-related psychosocial changes, existing physical and mental health conditions and smaller social networks, on whom they may be reliant. Older adults are recommended to minimize risk of infection by using social distancing measures, yet the importance of a timely diagnosis of dementia remains unchanged, or has arguably increased due to the high association between COVID-19 and dementia [2]. There is the dilemma faced by many patients regarding their concerns about potentially having dementia and wanting to speak to a clinician, offset against concerns of contracting COVID-19 should they allow a clinician into their home or visit a clinic [4]. Remote memory assessments can potentially resolve this dilemma and provide an opportunity to re-evaluate how existing methods can be adapted for remote assessment and how digital technology can be used to automate cognitive assessments and data collection
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