Telemedicine, Technology, and the Future of Alzheimer and Dementia Care

Howard Fillit, MD

Although 2020 has presented the medical community with many unique challenges and required adjustments to care, clinicians have sought to focus on the silver linings, instead.

The rapid transition to a telemedicine-based model of care now provides many elderly patients and their caretakers with an easier way to connect with their physicians and health care team. From the provider perspective, this window into a patient’s home life also has its advantages, as it allows for additional observations and guidance for improved care and well-being.

In an interview with NeurologyLive®, Howard Fillit, MD, founding executive director and chief science officer of the Alzheimer’s Drug Discovery Foundation, and clinical professor of geriatric medicine and palliative care, medicine, and neuroscience at Mount Sinai School of Medicine, discussed the impact that the coronavirus disease 2019 pandemic has had on dementia care and the long-coming updates to the care model that it has actually helped to ignite.

What advantages does telemedicine offer to the Alzheimer disease community?

Telehealth has been percolating along for decades now, but this has really just accelerated the adoption of it in medical practice, and I think in a really good way. It’s going to change the future of how we practice medicine, and I think it’s a good thing for geriatric patients in general. I’m a geriatrician. These patients are often frail, they have multiple comorbidities, many of them are in living in poverty, and even just to get to the doctor is tough. Especially for someone with Alzheimer disease and their loved ones, their caregivers.

Getting dressed, getting in the taxi in confusing environments, getting to the waiting room, sitting in the waiting room—all that stuff is hard for a lot of patients with Alzheimer disease. Same with getting in the car if you’re in suburbia or outside the cities, so I think that telehealth is a big advantage for patients with Alzheimer disease. I hope that, going forward, especially with new payment models for telemedicine, that this will be encouraged.

The kind of questions that patients often ask of doctors in the care of patients with Alzheimer disease are often about care and management. We do have medications that are modestly effective, but certainly most of the questions that I get are about care and management of patients and advice to caregivers. It can be very effectively delivered on a telemedicine platform—and when I say telemedicine, I include the old-time technology that we call the phone. We don’t have to have video conferencing to give advice. I have gotten phone calls from stressed out caregivers asking “What should I do? What should I do about this?” and in the extreme, sometimes, it requires medication, for agitation for example, but I definitely think that Alzheimer disease can be effectively managed with the advice of physicians through technology platforms.

Have you encountered any challenges with applying telemedicine?

The main challenge, which I don’t see as a big challenge, is incorporating telemedicine and especially video conferencing. We all do phone calls. Doctors often say, “OK, I’ll take your phone calls from 8 AM to 9 AM, and then I have to see patients,” but with video conferencing, you really have to sit there and [go] face-to-face [with patients]. It’s managing and figuring out how to incorporate telemedicine into the workflow of the day. That’s the biggest challenge, setting aside time for video conferencing with patients and doing scheduling.

The other thing is that patients with Alzheimer disease can often be confused, and I think actually seeing the patient through a video conferencing platform can be really advantageous as opposed to just a plain phone call in many ways.

At the Alzheimer’s Drug Discovery Foundation, through our work with the Diagnostics Accelerator and Bill Gates and his organization, we’re looking at incorporating all kinds of other technologies besides video conferencing in order to better evaluate a patient with Alzheimer disease. Things like evaluating speech and language, motion detectors and looking at how people move around, and all kinds of other symptoms that we can detect with new technology. The video conferencing and the telemedicine—it’s just 1 aspect of how technology will be used in the future care of patients with Alzheimer. There will be many other platforms, including computerized cognitive testing. Testing that you can do on your phone to see how a patient’s doing and these other aspects of behavior that will help us with early diagnosis, to ramp up and improve the rigor and efficiency and cost of clinical trials, and bring new drugs to market for Alzheimer disease.

What do you forsee as the future impact of telemedicine care?

To me, it’s amazing. Honestly, I remember when we got our first TV in 1953. That’s where I’m coming from. I was only 5 years old then, but it’s just amazing. To apply that to health care now, I really do think it’s going to change things. It’ll make health care more efficient, more effective, and it’s also from your point of view of peer to peer. In geri- atric medicine, we often have family conferences, and often, families these days are all over the country—all over the world. I’ve had family conferences already to discuss a particular issue regarding

a patient with Alzheimer disease with a video conference that included someone from California, Florida, New York, and Paris all in 1 place. That wouldn’t have happened if we had to do it physically. It could have been done on telephone, but I don’t think it has the same impact. There’s no turning back at this point. Telemedicine is going to be a vital part of geriatric care and of health care in general.