In the last of a series of three articles for World Alzheimer’s Day (21 September), we consider future treatments for the disease.
Telemedicine or video conferencing in lieu of face-to-face meetings could become an invaluable part of the standard Alzheimer’s disease (AD) care regimen in the future.
The value of using telemedicine is especially great for patients who live in rural areas, patients who have difficulties in travelling to a specialist’s medical office, and patients who have chronic diseases that require frequent assessments over many years.
Many AD patients face such challenges, making them ideal candidates to benefit from this tool. GlobalData’s epidemiology analysis reports that there are 11.5 million total prevalent cases of AD in the seven major markets (7MM: the US, France, Germany, Italy, Spain, the UK, Japan).
As such, the impact of this potential change in healthcare delivery could be very significant. AD patients are commonly cared for in the home setting, and moving an AD patient to an unfamiliar place such as a medical office may trigger extreme anxiety and distress, and could potentially cause physical harm. However, it is crucial to regularly monitor the mental function of AD patients as the disease progresses over time in order to provide them with the best medical care.
Physicians frequently use the Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale cognitive subscale (ADAS-cog) to access patient status. Carotenuto and colleagues reported in a study published in 2018 in the Journal of Medical Internet Research that assessments done through teleconference were no different than tests done in-person at a hospital in Italy.
Researchers in Japan also tested the accuracy of using video teleconferencing to administer the ADAS-cog in a Japanese population. The results published in the Journal of Telemedicine and Telecare by Yoshida and colleagues in May 2019 were positive, showing that there is a high level of agreement in cognitive levels evaluated via telemedicine compared to face-to-face sessions. The study participants covered a wide range of cognitive impairments, including healthy elderly patients, patients with mild cognitive impairment (MCI), and patients with dementia.
Several challenges still stand in the way of widespread use of telemedicine in AD. First, both the Italian and Japanese studies are relatively small, with sample sizes of 28 and 73 test subjects, respectively. This is the case in similar studies in other populations as well. Larger clinical studies in a wide range of populations are needed to ensure that diagnostic tests can be conducted accurately over teleconference. Other limitations include patient access, legislation, reimbursement, the infrastructure of setting up telehealth clinics, and overcoming technology hurdles in the elderly population, as they are more likely to not be tech-savvy. Caregivers would play an important role in helping patients connect with physicians using teleconference technologies.
Clinical studies on patient perception of telemedicine have shown variable results. A clinical study in the US by Stead and Vinson published in 2019 in the journal Nursing Older People found that while telemedicine produces accurate results, patients preferred face-to-face meetings. Another clinical study by Lindauer and colleagues published in a 2017 issue of The Gerontologist reported that AD patients, caregivers, and physicians were satisfied with telemedicine. However, both studies cited technical issues due to lack of familiarity with devices such as iPads and computer-connected cameras.
Nonetheless, the future is promising for telemedicine in AD. The US, for example, is continuously improving access to telemedicine. The American Medical Association supports remote patient monitoring and added digital services to the 2020 list of Current Procedural Terminology (CPT) codes, and the American Telemedicine Association’s 2019 report shows continued increases in the number of states that have adopted policies that improve the coverage and reimbursement of telehealth.
GlobalData (2019). Thematic Reports: Digital Therapeutics and Their Impact on Healthcare, June 2019, GDHCHT025
GlobalData (2019). Expert Insight: Social Contact Is Important to Reduce the Risk of Dementia, August 2019, GDHC2582EI
GlobalData (2019). Expert Insight: NIH Proposes First Guidance for Alzheimer’s-Like Brain Disorder, May 2019, GDHC2424EI
GlobalData (2017). Expert Insight: Women Make Up More than 70% of Alzheimer’s Disease Prevalent Cases, November 2017, GDHC1400EI
GlobalData (2017). EpiCast Report: Alzheimer’s Disease – Epidemiology Forecast to 2026, October 2017, GDHCER162-17
GlobalData (2017). PharmaPoint: Alzheimer’s Disease – Global Drug Forecast and Market Analysis to 2026, September 2017, GDHC149PIDR