Stillerova Tereza, Liddle Jacki, Gustafsson Louise, Lamont Robyn, Silburn Peter
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute and UQ Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.
Aust Occup Ther J. 2016 Dec;63(6):373-380. doi: 10.1111/1440-1630.12288. Epub 2016 Apr 5.
The distances and distribution of people, and pressures on the health system in Australia mean that access to services for people living with a neurodegenerative condition may be inadequate. Telehealth may offer ways to provide timely and efficient monitoring and support. People with Parkinson's disease require regular screening of their symptoms and needs, but may have limited access to health professionals. Cognitive changes can impact on occupational performance, thus timely monitoring of cognition is important for informing occupational therapy interventions.
To evaluate the feasibility of screening cognition in people with Parkinson's disease using available technology in their homes.
Eleven participants with Parkinson's disease completed the Montreal Cognitive Assessment face-to-face and then via videoconferencing one week later using the technology available at their home. Participants and assessors provided feedback on their experience.
All Montreal Cognitive Assessment items could be completed over videoconference (e.g. Skype), with a median difference of 2 (IQR: 1-2.5) between face-to-face and videoconference scores. Higher scores were not favoured by either mode of assessment. Three participants received inconsistent cognitive classifications between the two assessment methods. Participant and assessor feedback indicated reported benefits including convenience as well as technological limitations.
Given the pressures on the health system and the apparent acceptability to consumers, occupational therapists may explore the utility of readily accessible technology to enable timely monitoring of cognition for people with Parkinson's disease. Further research is needed to develop and demonstrate the reliability and validity of this approach.
澳大利亚人口的分布距离、人口压力以及卫生系统所承受的压力意味着，患有神经退行性疾病的人群可能无法充分获得医疗服务。远程医疗或许能提供及时且高效的监测与支持途径。帕金森病患者需要定期筛查其症状和需求，但他们接触医疗专业人员的机会可能有限。认知变化会影响职业表现，因此及时监测认知状况对于指导职业治疗干预措施至关重要。
评估利用帕金森病患者家中现有技术筛查其认知功能的可行性。
11名帕金森病患者先面对面完成蒙特利尔认知评估，一周后通过视频会议使用家中现有的技术再次完成该评估。参与者和评估者就他们的体验提供了反馈。
所有蒙特利尔认知评估项目都可以通过视频会议（如Skype）完成，面对面评估得分与视频会议评估得分的中位数差异为2（四分位间距：1 - 2.5）。两种评估方式都不存在得分更高的偏好。三名参与者在两种评估方法下获得了不一致的认知分类。参与者和评估者的反馈表明，报告的益处包括便利性以及技术局限性。
鉴于卫生系统面临的压力以及消费者对其明显的接受度，职业治疗师可以探索利用易于获取的技术，以便对帕金森病患者的认知状况进行及时监测。需要进一步开展研究来开发并证明这种方法的可靠性和有效性。
