Lessons from COVID-19 pandemic: Clinical experiences on telemedicine in patients with dementia in Iran.

One of the impacts of COVID-19 pandemic on health system has been increasing the burden on the patients with dementia and their families. Telemedicine has shown to be a solution for this vulnerable group and can be used for cognitive assessment, medication adjustment, patient referral, reduces the travel time, cost and caregiver burden. Despite the challenges in acceptance for this novel technology in the elderly it can reduce the burden of disease and increase access to specialised services. All these alongside neurologic visit could be provided with a telephone hotline or preferably video-platform tele-visit. However, barriers to develop telemedicine include a lack of broadband internet access and the need for insurance coverage. The American Academy of Neurology has been developed a comprehensive guideline to implement the tele-visit approach in the COVID-19 crisis with a special approach to neurological examination limitations in the patients. Numerous studies evaluated this approach to assess patients including dementia. Overall, the patients, caregivers, and the neurologists reported a high satisfaction rate. Yaadmaan Institution for Brain, Cognition and Memory Studies with a multidisciplinary team including cognitive neurologist, psychiatrist, psychologist, geriatrician, and clinical pharmacist is the first private referral center for cognitive disorders in Iran. After starting quarantine and tight restrictions and because of too many families who were seeking help for their patients via Yaadmaan helpline, we decided to start Telemedicine method. The approach and compatible examinations have been shown in Table 2 and 3 respectively. In addition, we defined a list of serious states to avoid Telemedicine for patients referal to the hospital in Table 4. Based on our one-year experiences, it seems there are promising results in-terms of feasibility, acceptability and convenience for the patient, caregiver and physician. However, due to the emergence of this pandemic, Telemedicine and its crucial role in Iran has not yet been identified in the insurance and health system appropriately. Even though Telemedicine was started as a practical and urgent solution against COVID-19 restrictions, it is necessary to be evaluated as an alternative method for clinical evaluations of the patients with dementia in Iran in the future.