Neurodegenerative Disease-Related Psychosis Can be Managed Via Telehealth

Telehealth could help treat and diagnose patients who experience hallucinations and delusions as a result of neurodegenerative diseases, according to a report published in the International Journal of General Medicine.

Between 40 and 60 percent of patients who have dementia or Parkinson’s disease experience psychosis, which can negatively impact function, cognition, quality of life, and survival.

A panel of experts in geriatric psychiatry, movement disorders, and neuropsychology gathered virtually in October 2020 to discuss best practices for using telehealth services to treat and diagnose Parkinson’s disease psychosis and dementia-related psychosis.

There are several aspects of telemedicine that may benefit the older population in particular.

Many clinics and health systems turned to telehealth services when the COVID-19 pandemic hit in order to reduce exposure to the coronavirus. As the pandemic continues, telehealth treatment could be beneficial for geriatric patients who have health issues or are immunocompromised.

Additionally, telehealth visits can help eliminate the need to travel. Patients with neurodegenerative diseases may lose the ability to drive over time and may have to rely on public transportation. But accessing public transportation may also prove to be difficult for individuals who have cognitive impairment or a physical disability.

With in-person visits, patients may have to turn to family members to provide transportation, which can increase care partner burden. Using virtual services instead could help patients and their loved ones overcome the struggle of finding transportation.

Telehealth can also expand access to care for many patients, according to the panel of experts. Individuals with neurodegenerative diseases have a high likelihood of becoming homebound as their disease progresses. Homebound healthcare tends to be fragmented and lacks the cohesiveness of in-person care, the report stated.

However, by implementing and using a telehealth program, providers could create a more stable and continuous homebound healthcare routine for patients that aims to prevent the need for emergency services. Virtual care could also aid in mental healthcare management, referrals for additional therapies, medication changes, remote rehabilitation, and administration of cognitive tests, the panel said.

Telehealth visits may also increase access to care for individuals who live in rural areas, as certain specialists are usually located in urban and coastal areas.

Further, using telehealth can allow providers to gain insight into the patient’s home environment during a video appointment. For example, the patient could show the provider the food in their refrigerator, which might help the provider get a sense of the patient’s living conditions.

Despite these benefits, the panel acknowledged the barriers to accessing telehealth, including low digital literacy, inadequate access to proper devices or internet, and device malfunctions. Providers and clinics should have plans in place to help educate patients about the technology prior to the appointment and offer solutions in case these problems do occur.

Providers must also consider the patient before offering telehealth as a care option, as some older patients who have a physical disability may be better suited for in-person care.

When it comes to diagnosing patients with Parkinson’s disease psychosis or dementia-related psychosis, the panel recommended an initial in-person visit that may help establish a relationship between the patient and the provider. One disadvantage of telehealth is that providers cannot perform a complete neurological exam virtually, as it requires sensory testing and an examination of balance, reflexes, muscle tone, and strength.

During telehealth visits, the panel noted that care partners can be a key element for success, as they can offer additional information to the provider during, before, and after appointments. The care partner could also help perform behavioral and cognitive assessments on the patient.

Providers should monitor patients during virtual visits to detect any behavior that might point to psychosis, including darting eyes, paranoia, or distrust, the report stated. Providers can also monitor patients for negative side effects if they are taking medication such as antipsychotics.

“Although the long-term outlook of telemedicine for older patients with degenerative disease in the outpatient setting remains unknown, these recommendations highlight ways to maximize use of virtual healthcare and encourage care providers to use telemedicine to maintain consistent and high-quality care remotely,” the report concluded.