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      Implementing Remote Memory Clinics to Enhance Clinical Care During and After COVID-19

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          Abstract

          Social isolation is likely to be recommended for older adults due to COVID-19, with ongoing reduced clinical contact suggested for this population. This has increased the need for remote memory clinics, we therefore review the literature, current practices and guidelines on organizing such remote memory clinics, focusing on assessment of cognition, function and other relevant measurements, proposing a novel pathway based on three levels of complexity: simple telephone or video-based interviews and testing using available tests (Level 1), digitized and validated methods based on standard pen-and-paper tests and scales (Level 2), and finally fully digitized cognitive batteries and remote measurement technologies (RMTs, Level 3). Pros and cons of these strategies are discussed. Remotely collected data negates the need for frail patients or carers to commute to clinic and offers valuable insights into progression over time, as well as treatment responses to therapeutic interventions, providing a more realistic and contextualized environment for data-collection. Notwithstanding several challenges related to internet access, computer skills, limited evidence base and regulatory and data protection issues, digital biomarkers collected remotely have significant potential for diagnosis and symptom management in older adults and we propose a framework and pathway for how technologies can be implemented to support remote memory clinics. These platforms are also well-placed for administration of digital cognitive training and other interventions. The individual, societal and public/private costs of COVID-19 are high and will continue to rise for some time but the challenges the pandemic has placed on memory services also provides an opportunity to embrace novel approaches. Remote memory clinics’ financial, logistical, clinical and practical benefits have been highlighted by COVID-19, supporting their use to not only be maintained when social distancing legislation is lifted but to be devoted extra resources and attention to fully potentiate this valuable arm of clinical assessment and care.

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          Most cited references73

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          Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

          In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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            Systematic review of the validity and reliability of consumer-wearable activity trackers

            Background Consumer-wearable activity trackers are electronic devices used for monitoring fitness- and other health-related metrics. The purpose of this systematic review was to summarize the evidence for validity and reliability of popular consumer-wearable activity trackers (Fitbit and Jawbone) and their ability to estimate steps, distance, physical activity, energy expenditure, and sleep. Methods Searches included only full-length English language studies published in PubMed, Embase, SPORTDiscus, and Google Scholar through July 31, 2015. Two people reviewed and abstracted each included study. Results In total, 22 studies were included in the review (20 on adults, 2 on youth). For laboratory-based studies using step counting or accelerometer steps, the correlation with tracker-assessed steps was high for both Fitbit and Jawbone (Pearson or intraclass correlation coefficients (CC) > =0.80). Only one study assessed distance for the Fitbit, finding an over-estimate at slower speeds and under-estimate at faster speeds. Two field-based studies compared accelerometry-assessed physical activity to the trackers, with one study finding higher correlation (Spearman CC 0.86, Fitbit) while another study found a wide range in correlation (intraclass CC 0.36–0.70, Fitbit and Jawbone). Using several different comparison measures (indirect and direct calorimetry, accelerometry, self-report), energy expenditure was more often under-estimated by either tracker. Total sleep time and sleep efficiency were over-estimated and wake after sleep onset was under-estimated comparing metrics from polysomnography to either tracker using a normal mode setting. No studies of intradevice reliability were found. Interdevice reliability was reported on seven studies using the Fitbit, but none for the Jawbone. Walking- and running-based Fitbit trials indicated consistently high interdevice reliability for steps (Pearson and intraclass CC 0.76–1.00), distance (intraclass CC 0.90–0.99), and energy expenditure (Pearson and intraclass CC 0.71–0.97). When wearing two Fitbits while sleeping, consistency between the devices was high. Conclusion This systematic review indicated higher validity of steps, few studies on distance and physical activity, and lower validity for energy expenditure and sleep. The evidence reviewed indicated high interdevice reliability for steps, distance, energy expenditure, and sleep for certain Fitbit models. As new activity trackers and features are introduced to the market, documentation of the measurement properties can guide their use in research settings. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0314-1) contains supplementary material, which is available to authorized users.
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              Computerized Cognitive Training in Older Adults With Mild Cognitive Impairment or Dementia: A Systematic Review and Meta-Analysis.

              Previous meta-analyses indicate that computerized cognitive training (CCT) is a safe and efficacious intervention for cognition in older adults. However, efficacy varies across populations and cognitive domains, and little is known about the efficacy of CCT in people with mild cognitive impairment or dementia.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                18 September 2020
                2020
                18 September 2020
                : 11
                : 579934
                Affiliations
                [1] 1 Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London , London, United Kingdom
                [2] 2 The University of Exeter Medical School, The University of Exeter , Exeter, United Kingdom
                [3] 3 Psychological Medicine and Older Adults, South London & Maudsley NHS Foundation Trust , London, United Kingdom
                [4] 4 Ecog Pro Ltd , Bristol, United Kingdom
                [5] 5 SESAM—Centre for Age-Related Medicine, Stavanger University Hospital , Stavanger, Norway
                [6] 6 Department of Public Health, Faculty of Health Sciences, University of Stavanger , Stavanger, Norway
                Author notes

                Edited by: Gianfranco Spalletta, Santa Lucia Foundation (IRCCS), Italy

                Reviewed by: Valentina Ciullo, Santa Lucia Foundation (IRCCS), Italy; Luca Cravello, ASST Rhodense, Italy

                *Correspondence: Andrew P. Owens, andrew.owens@ 123456kcl.ac.uk

                This article was submitted to Aging Psychiatry, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2020.579934
                7530252
                33061927
                04e5b5d9-a73c-43a5-8fb9-8207ce529f3f
                Copyright © 2020 Owens, Ballard, Beigi, Kalafatis, Brooker, Lavelle, Brønnick, Sauer, Boddington, Velayudhan and Aarsland

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 03 July 2020
                : 31 August 2020
                Page count
                Figures: 2, Tables: 2, Equations: 0, References: 87, Pages: 15, Words: 8668
                Categories
                Psychiatry
                Hypothesis and Theory

                Clinical Psychology & Psychiatry
                dementia,cognitive impairment,telemedicine,neuropsychological assessment,geriatric psychiatry and aging,remote measurement technologies

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