The use of digital technology for the prevention, diagnosis, management, and assistance of patients with cognitive disorders and their caregivers has witnessed a dramatic increase in recent years. Telemedicine and eHealth technology services have proven to be valuable instruments for remote support and care in neurocognitive disorders, as consistently shown during the COVID-19 pandemic (see [1,2] for examples). The severe constraints on health care resources and the reduced time available to chronic patients during the pandemic have demonstrated the urgent need for the reorganization of memory clinic services to ensure adequate diagnosis and care [3]. Accordingly, many initiatives have tested digital technology solutions and telemedicine services in dementia settings [4,5], particularly in Alzheimer disease (AD), which represents one of the highest-risk and fastest-growing burdens on the health care system [6,7]. Literature evidence showed good levels of feasibility and effectiveness, particularly in individuals living in remote or underserved geographical areas or where in-person access to care facilities is limited [8]. Overall, patients with cognitive disorders and caregivers reported good satisfaction rates for digital technology, suggesting a general propensity toward adopting it routinely [8-10].

The literature highlights various solutions, including digital diagnostic instruments, tools for active and passive monitoring, and digital technologies supporting cognitive and motor rehabilitation. These tools have shown promising results not only in optimizing diagnostic pathways, disease management, and treatments, in avoiding dysfunctional and harmful disease trajectories, but also in helping the empowerment of patients and caregivers through active engagement in their care pathways [11,12]. However, despite the growing evidence suggesting the potential benefit of digital technology tools in cognitive patients, their integration into the daily routines of memory clinics is still limited [13].

Preliminary evidence suggested the presence of enabling factors such as familiarity, acceptability, and a positive attitude toward digital technology that could facilitate its adoption [9,13,14]. Conversely, inadequate experience with technology, poor digital literacy, and low education levels, as well as insufficient accommodation for motor and sensory impairments, may cause reduced acceptability and engagement in older adults [9,15]. However, a clear understanding of factors promoting or hampering the use of digital tools in memory clinics is still lacking.

Given these considerations, we reviewed existing literature with a particular interest in studies reporting features facilitating the use of digital technology in users (eg, competence, attitudes) or evaluating the performance of digital solutions (eg, usability). The main research question is whether digital competence and the attitudes of patients and caregivers may affect the adoption of digital technology. The final goal is to explore real-world needs, facilitators, and barriers in the field and to provide patient-oriented guidance for using and implementing novel digital technology tools in memory clinics.

Out of the 597 articles initially retrieved, 554 papers were excluded during the screening phase (ie, 222 duplicates, 121 nonoriginal papers, 204 off-topic articles, and 7 articles not in English). A detailed review of the full texts led to the exclusion of 25 articles, with 18 papers meeting the eligibility criteria for this study. See Figure 2 for details of the PRISMA flow diagram. Analyses of inter-rater reliability showed good agreement levels for both the screening (κ=0.76; 94.46% agreement) and the eligibility (κ=0.75; 87.76% agreement) phases. Quality assessment of the included studies showed a middle-high quality of evidence.

Retained papers showed high heterogeneity in terms of study design (ie, qualitative vs quantitative), sample features (eg, patients and caregivers with various disease severity), and data type (eg, unstructured vs structured data). Given the high methodological and population-based heterogeneity across studies, results are presented as a narrative synthesis, focusing on shared themes and distinct sources of variability rather than on statistical aggregation.

See Tables 1 and 2 for details of included papers and the quality assessment.

Digital technology in dementia is an area of rapid development marked by diverse approaches across countries. A huge step forward has been made during the COVID-19 pandemic, acting as a catalyst for extensive research and development of eHealth and mHealth solutions, favoring the testing of digital solutions in memory clinics and promoting their implementation in practice [2,4,42]. In this study, we reviewed the existing literature on digital competence, attitude to technology, and use of digital tools in AD, with the final aim to underline main factors affecting the adoption of digital solutions and provide useful information for their future development and use in memory clinics.

Literature evidence revealed several barriers in adopting digital technology in dementia. Among the main factors, the severity of cognitive deficits is the first key element. As adherence to digital technology interventions decreases with the severity of cognitive decline [23,24,31,37,38], clinicians and researchers should embrace technology-based solutions at an earlier stage of the care pathway with the aim to improve use and effectiveness. With the progression of the disease, poor verbal and motor initiative may affect patient engagement with digital technology, reducing interest, initiative, and participation [27]. In such cases, behavioral or sensory-based interventions, such as sensory stimulation delivered through digital devices, represent an appropriate choice. Therefore, an in-depth assessment of the behavioral and cognitive profile should always guide the specialist to choose the right digital tool to use and address patients accordingly.

Age, digital literacy, and special needs (eg, visual or auditory impairments) are additional variables that limit the access or use of digital technology both for patients and caregivers, without affecting the will to participate in telecare services [21,25,43]. These aspects are of particular relevance in memory clinics, where final users are often patients and caregivers in old adulthood [44]. The type of digital device may also impact the feasibility and real-life implementation of digital protocols, with smartphones being more accessible compared to computers or other devices [27,29,30]. Consequently, smartphones show higher acceptability scores in patients [45,46], although some challenges in the use of touchscreen and software updates are reported, particularly among those with poor digital literacy and visual impairments [24].

Another crucial barrier to the stable use of eHealth and mHealth solutions is the need for training and support [27,29,30,34,36]. The availability of formal support in the technology setup or training has been shown to positively impact willingness and acceptability [30,34,41]. As individuals may be unlikely to embrace burdensome technologies [26], preliminary training at health care facilities before the in-home adoption should be recommended to overcome potential technophobia in patients and caregivers [13,21]. The evaluation of specific digital needs in each single patient-caregiver dyad may guarantee a more inclusive and practical approach.

Therefore, the lack of active involvement of final users in the design, development, and testing of novel digital solutions crucially contributes to the poor applicability of these instruments in real-life scenarios [47].

In addition, developing technologies without user burden is pivotal for their success. Minimizing the burden on caregivers is of paramount importance, as they are often responsible for managing digital tools (eg, calendars for medication or televisits). The mitigation of stress and anxiety due to the use of technologies is crucial for caregivers [26,35,37,38], particularly for those individuals with disadvantageous socioeconomical backgrounds, who face additional challenges in adapting to the tools and using them effectively [35]. Co-design with end-users and adaptation of the digital tool to real-life needs are therefore critical [47].

Several limitations characterize the body of research analyzed in this review. Many studies involved small sample sizes that were not fully representative of the AD population, often excluding individuals who were unable or unwilling to participate for various reasons. Availability of high-speed internet connection [23,24], recruitment or screening modality (eg, through email, social media or videoconference) [26,27], and socioeconomic status of participants [23,37] are additional variables affecting results, while study design (eg, lack of control group or randomized approach [28]) and measurement issues (eg, lack of pre-post measures [36]) are crucial aspects that hamper the reliability of data findings.

In conclusion, digital tools have the potential to significantly influence the quality of dementia services acting on different dimensions [13]. They can increase effectiveness by enabling faster access to specialist care, better diagnoses and treatments, and preventing avoidable hospitalizations. They improve timeliness, reducing waiting lists and unnecessary travel. They ensure patient-centeredness and safe care, providing care tailored to individual needs and values and treating patients more appropriately. They provide integrated, more efficient, and equitable care by taking an interdisciplinary approach involving multiple specialists, improving cost-effectiveness, and overcoming geographic barriers addressing cultural diversity. However, the adoption of digital technology is limited by many patient-related barriers. Improving digital competence in the patient-caregiver dyads and implementing a systematic patient-oriented strategy for the development and use of digital tools (eg, by promoting participated design, early timing of solution adoption and availability of training and technical support) remain critical factors to consider for the successful incorporation of digital eHealth and mHealth solutions and services into future memory clinics.