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    • In this issue of Castanho and colleagues address

    2018-11-09

    In this issue of Castanho and colleagues () address whether cognitive tests performed using videoconferencing could provide comparable diagnostic information as an in-clinic evaluation. They studied 69 individuals, aged 57 to 95years, across the diagnostic spectrum from normal to dementia and in various locales, i.e., ionomycin health centers, assisted living facilities and nursing homes. To validate the videoconferencing procedure, each participant received The Telephone Interview for Cognitive Status-Modified, Portuguese version (TICSM-PT) over the telephone in addition to receiving the TICSM-PT via a videoconference and finally a face-to face, in-clinic assessment, using the Mini Mental State Exam (MMSE). They sought to determine if the use of the videoconference approach in different locales provided comparable information to an in-clinic assessment. Validating these innovative technologies with currently known and endorsed procedures is critical in order to determine whether the data derived from these assessments are reliable and provide accurate diagnostic information. report a high correlation between the telephone and video versions of the TICSM-PT assessments and with the in-clinic MMSE. They also found that the videoconferencing approach had a high level of accuracy for detecting cognitive impairment and that the test findings acquired from the videoconferencing approach demonstrated good sensitivity and specificity. also examined the applicability of videoconferencing in various settings and locales and found that individuals, across settings, were “at ease” throughout the videoconference test administration and that there was no significant difference in approaches between locales. The important findings of this pilot study confirm that cognitive test assessment via videoconferencing will allow clinicians to reliably follow-up on their dementia patients who live in assisted living facilities and nursing homes. Studies, such as that presented by , are critical if 21st century technology is to be accepted in the clinical and research setting. This study adds to a growing body of literature validating technologies that are unobtrusive, continuous and performed at-home for measuring cognition and behavior (). From a clinical and research perspective, implementation of home-based technologies for cognitive test administration would greatly reduce the burden of in-clinic visits and enable close patient follow-up of individuals residing anywhere, not just within easy driving distance of a clinic or research center. The ease of at-home cognitive test assessment could also benefit clinical trials by allowing for more frequent assessments of cognitive change in the individual\'s natural environment. This approach has the potential of increasing the reliability of cognitive endpoints, thus yielding more sensitive measurements of change over time (). The results of Castanho and colleagues\' study () underscore the importance of validating newer technologies for clinical use. As technology becomes integrated into healthcare, further validation studies will be required to ensure that the technologies used to perform routine in-clinic evaluations provides the same valid and reliable data as the in-clinic, face-to-face assessment. Disclosure
    Bipolar disorder, also known as manic-depressive illness, which affects three out of 200 people is a long-term disease, presents remittent depressive, hypomanic, manic or mixed episodes of illness, and bears a serious risk of death from suicide (). About half of the time patients with bipolar disorder have symptoms impairing their work, social activities or relationships with others. Treatment focuses on preventing the recurrence of episodes and can clearly improve the outcome. Circadian clocks are intrinsic pacemakers. They evolve their properties, when subjected to selection, but have remained conservative during evolution (). These intrinsic clocks not only generate the oscillation in those physiological functions and behaviors that demonstrate the daily and seasonal fluctuations, but also maintain these oscillations in their adaptive response to the time-giving signals, such as exposure to light, which they receive from the habitat.