Tele-Health and neurology: what is possible?

Emerging information and communication technology is changing medical and psychological practice by enabling the provision of services across time and distance, yet there are significant concerns about these applications. Given the emerging nature of trial evidence in teleneurology, our aim is to provide a narrative review, in order to investigate possible oncoming fields of applications that are very important in healthcare practices delivered to patients affected by neurological diseases. We will focus on the use of Tele-Health in neurological practice, highlighting the potential benefits of applying information and communication technology also to psychosocial and educational aspects of neurological diseases treatment. This work is based on PubMed search, manual search of published abstracts/conference proceedings, and consultation with investigators in neurological disease. We refer also to the broader Tele-Health research concerning mental diseases. Tele-Health has obvious advantages in rural areas, where it improves access to health services, obviating the need for patients and healthcare workers to travel and assuring continuance to healthcare services delivery. Even in urban areas, however, Tele-Health can improve access to health services and to information. It may sometimes also be cheaper than conventional practice, even if there is generally limited knowledge of the cost-effectiveness of Tele-Health services compared to conventional methods of delivering health services.

Videoconference-based mini mental state examination: a validation study.

BACKGROUND: Neuropsychological testing is a prime criterion of good practice to document cognitive deficits in a rapidly aging population. Telecommunication technologies may overcome limitations related to test administration. We compared performance of the Italian videoconference-based version of the Mini Mental State Examination (VMMSE) with performance of the standard MMSE administered face-to-face (F2F), to validate the Italian version of the 28-item VMMSE. MATERIALS AND METHODS: To validate the Italian version of the VMMSE, we compared its performance with standard F2F. The sample (n=342) was administered three VMMSEs within 6 weeks after F2F testing. We identified the optimal cutoff through the receiver operating characteristic curve, as well as the VMMSE consistency through inter- and intrarater reliability (Inter/RR and Intra/RR) analysis. RESULTS: We found high levels of sensitivity and specificity for the optimal VMMSE cutoff identification and an accuracy of 0.96 (95% confidence interval 0.94-0.98). Intra/RR and inter/RR were highly significant. CONCLUSIONS: This study demonstrates that VMMSE is a valid instrument in clinical and research screening and monitoring of subjects affected by cognitive disorders. This study shows a significant correlation between videoconference assessment and the F2F one, providing an important impetus to expand studies and the knowledge about the usefulness of tele-assistance services. Our findings have important implications for both longitudinal assistance and clinical care of demented patients.