Angelopoulou Efthalia, Stamelos Ioannis, Smaragdaki Evangelia, Vourou Kalliopi, Stanitsa Evangelia, Kontaxopoulou Dionysia, Koros Christos, Papatriantafyllou John, Zilidou Vasiliki, Romanopoulou Evangelia, Georgopoulou Efstratia-Maria, Sakka Paraskevi, Karanikas Haralampos, Stefanis Leonidas, Bamidis Panagiotis, Papageorgiou Sokratis
1st Neurology Department, Aiginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece.
Laboratory of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece.
Geriatrics (Basel). 2025 Jul 16;10(4):94. doi: 10.3390/geriatrics10040094.
BACKGROUND/OBJECTIVES: Access to specialized care for patients with cognitive impairment in remote areas is often limited. Despite the increasing adoption of telemedicine, standardized guidelines have not yet been specified. This study aimed to develop a comprehensive protocol for the specialized neurological, neuropsychological, and neuropsychiatric assessment of patients with cognitive disorders in remote areas through telemedicine.
We analyzed data from (i) a comprehensive literature review of the existing recommendations, reliability studies, and telemedicine models for cognitive disorders, (ii) insights from a three-year experience of a specialized telemedicine outpatient clinic for cognitive movement disorders in Greece, and (iii) suggestions coming from dementia specialists experienced in telemedicine (neurologists, neuropsychologists, psychiatrists) who took part in three focus groups. A critical synthesis of the findings was performed in the end.
The final protocol included: technical and organizational requirements (e.g., a high-resolution screen and a camera with zoom, room dimensions adequate for gait assessment, a noise-canceling microphone); medical history; neurological, neuropsychiatric, and neuropsychological assessment adapted to videoconferencing; ethical-legal aspects (e.g., data security, privacy, informed consent); clinician-patient interaction (e.g., empathy, eye contact); diagnostic work-up; linkage to other services (e.g., tele-psychoeducation, caregiver support); and instructions for treatment and follow-up.
This protocol is expected to serve as an example of good clinical practice and a source for official telemedicine guidelines for cognitive disorders. Ultimate outcomes include the potential enhanced access to specialized care, minimized financial and logistical costs, and the provision of a standardized, effective model for the remote diagnosis, treatment, and follow-up. This model could be applied not only in Greece, but also in other countries with similar healthcare systems and populations living in remote, difficult-to-access areas.
背景/目的：偏远地区认知障碍患者获得专科护理的机会往往有限。尽管远程医疗的应用日益广泛，但尚未制定标准化指南。本研究旨在制定一项全面方案，通过远程医疗对偏远地区认知障碍患者进行专业的神经学、神经心理学和神经精神学评估。
我们分析了以下数据：（i）对现有认知障碍相关建议、可靠性研究和远程医疗模式的全面文献综述；（ii）希腊一家专门的认知运动障碍远程医疗门诊三年经验的见解；（iii）参与三个焦点小组的远程医疗领域痴呆症专家（神经科医生、神经心理学家、精神科医生）提出的建议。最后对研究结果进行了批判性综合分析。
最终方案包括：技术和组织要求（例如，高分辨率屏幕和带变焦功能的摄像头、适合步态评估的房间尺寸、降噪麦克风）；病史；适应视频会议的神经学、神经精神学和神经心理学评估；伦理法律方面（例如，数据安全、隐私、知情同意）；医患互动（例如，同理心、眼神交流）；诊断检查；与其他服务的联系（例如，远程心理教育、照顾者支持）；以及治疗和随访指导。
本方案有望成为良好临床实践的范例以及认知障碍官方远程医疗指南的来源。最终成果包括可能增加获得专科护理的机会、将财务和后勤成本降至最低，以及提供一个标准化、有效的远程诊断、治疗和随访模式。该模式不仅可应用于希腊，也可应用于其他拥有类似医疗体系且有居住在偏远、难以到达地区人群的国家。
