Recommendationsforthe comprehensive cognitive neurology telemedicine examination

ABSTRACT

Objective: To provide evidence-based recommendations for conducting a comprehensive cognitive neurology telemedicine examination. Background: Given the current COVID-19 pandemic and the risk of nosocomial spread of infection, neurology visits are increasingly performed via telemedicine. Older adults with cognitive impairment may be at particularly high risk from COVID-19. There are no practice parameters to guide clinicians in performing cognitive neurology telemedicine evaluations. Design/Methods: A framework for cognitive neurology telemedicine examination is provided. Specific recommendations are offered based on literature review, available best practices, and one subspecialty center's experience with cognitive telemedicine visits during the first eight months of the COVID-19 pandemic, from March to October 2020, at its epicenter in New York City. Results: Most aspects of the examination can be performed with access to history of present illness, past medical history, and presence of an informant who can be an active intermediary in the exam. The Mental Status evaluation can be assessed telephonically without significant adjustment. Availability of secure video capabilities allows for assessment of the general appearance of the patient and the environment. The opportunity to see the environment of a patient firsthand offers additional context that is valuable in the overall care of the patient. Praxis, visuospatial assessment, behavior/affect, and patient-caregiver interaction are best assessed via video along with the remainder of the neurologic evaluation, including a gait exam. Conclusions: A comprehensive, evidence-based evaluation of the patient with cognitive decline can be performed by phone or video. Providing a framework to guide both trainees and practitioners is critical to optimize care for older adults during this pandemic, and can be expanded to diverse populations in varied clinical settings.