Telemedicine, dementia and Down syndrome: Implications for Alzheimer disease

Abstract

Background Individuals with Down syndrome (DS) who are at risk for dementia of the Alzheimer type (DAT) often live at sites remote from major medical centers. Telemedicine (TM) is a modality for providing medical care at remote locations but is underutilized for populations with Alzheimer disease (AD). Methods We studied the feasibility of using TM to evaluate symptoms of DAT in 90 individuals with DS. Dementia was assessed by an informant questionnaire, a direct measure of praxis, pathological reflexes on the neurologic examination, and the presence of cortical atrophy on a neuroimaging procedure. The neurologist was blinded to the scores on neuropsychological measures. Differences in average cognitive scores between a TM and traditional academic medical center–based clinic site (TAC) were tested using 2-way analysis variance with site and premorbid IQ as factors. Logistic regression was used to explore the relationship, in addition to the cognitive scores, of influences such as age, premorbid IQ, and site to the prediction of the physician’s diagnosis of dementia. Results Components of the neurologic, imaging, and neuropsychological examinations differentiated subjects with and without DAT ( p≤0.008) irrespective of whether a subject was evaluated at a TM or TAC site. Conclusions It is feasible to make a diagnosis of DAT in DS by TM. This study supports the need for formal reliability and validity studies of TM preparatory to the consideration of this modality for use in clinical trials for AD.