Can patients with dementia be assessed at a distance? The use of Telehealth and standardised assessments

Background : Telehealth could be a medium for the provision of cognitive assessments to distant sites. Aims : The aims of the present study were to determine the interrater reliability of the Standardized Mini Mental State Exam (SMMSE) and the Geriatric Depression Scale (GDS) through Telehealth as compared to face‐to‐face administration. Methods : Duplicate interviews of subjects with cross‐over of interview modality were carried out. Twenty patients were interviewed between two sites 11 km apart. Subjects were persons older than 65 years (mean age 82 years) who consented to Telehealth assessments. The outcome measures were the differences in assessment scores between the two media. Results : The average SMMSE score by remote assessment was 24.0 (range 11.0−30.0) and by direct assessment was 24.3 (range 9.0−30.0). The correlation between direct and remote SMMSE scores was 0.90. The mean difference between direct and remote SMMSE scores was −0.3 (95% confidence interval (CI): −4.6 to 4.0). In 8 of 20 participants (40%) the difference between Telehealth and direct assessments was two points or more on the SMMSE. The average GDS by remote assessment was 6.1 (range 1.0−14.0) and by direct assessment was 5.8 (range 2.0−13.0). The correl­ation between direct and remote GDS scores was 0.78. The mean difference between direct and remote GDS assessment was 0.3 (95% CI: −3.8 to 4.4). Conclusion : Remote assessments with SMMSE and GDS using Telehealth methods yielded similar results to direct assessments. However, there was a moderate ­difference between face‐to‐face and Telehealth assessments in some subjects, which could influence clinical ­decision‐making. (Intern Med J 2004; 34: 239−242)