Should old age psychiatry develop memory clinics? A comparison with domiciliary work

[Organization of out-patient psychiatric care in dementia and cognitive impairment in aged. Part II: Clinical and economic efficacy of memory clinics and Alzheimer's disease centers]

The part II of the review is focused on a history of developing of memory clinics and Alzheimer's disease centers as well as on the indices of their activity in various countries and in Russia. Approaches to the evaluation of clinical and economic efficacy of new technologies of organization of care and a role of the national programs in solving of the problem of old age dementias were considered.

A memory clinic v. traditional community mental health team service: comparison of costs and quality

Aims and method To compare the cost and quality of a memory-clinic-based service (MCS) with a traditional community mental health team (CMHT) service. Using a retrospective case-note review, we studied two groups, each with 33 participants. Consecutive referrals for diagnostic 'memory' assessments over 4 months were evaluated. Participants were evaluated for up to 6 months. Results The MCS was less costly than the CMHT service but the difference was not statistically significant (mean cost for MCS was £742, mean cost for CMHT service was £807). The MCS offered more multidisciplinary and comprehensive care, including: pre- and post-diagnostic counselling, more systematic screening of blood for reversible causes of dementia, more use of structured assessment instruments in patients/carers, signposting to the third sector as well as more consistent copying of letters to patients/carers. Clinical implications An MCS service offered more comprehensive and multidisciplinary service at no extra cost to secondary care.

An assessment of the new memory clinic at Cork University Hospital

Objective: Dementia is a progressive brain disease. The prevalence of dementia increases with age. Symptomatic pharmacological treatments for dementia are available. Psychological and social interventions can support the patient and their carer. Early recognition and diagnosis of dementia are necessary to access this care and reduce crisis-led intervention. A memory clinic service is ideally placed to commence the assessment and management of dementia. The objective of this paper was to describe the setting up of the memory clinic in Cork University Hospital and review the characteristics of the first 118 patients.

Method: One hundred and eighteen patients were assessed at the memory clinic between July 2004 and Feb 2007. In general the service operated on a two-appointment system. The first appointment was for a comprehensive assessment with investigations. The second appointment was a feedback session with discussion of the diagnosis, prognosis and management plan for the patient and generally their carer. We examined their demographic characteristics, clinical details, psychological test results and results of investigations.

Results: Of the 127 patients referred, 118 (92.9%) attended. Fifteen (12.7%) patients had diagnosis of mild cognitive impairment (MCI), 93 (78.8%) patients were diagnosed with dementia and 5 (4.2%) had diagnosis of depressive disorder with no co-morbid dementia. The dementia type in descending frequency was Alzheimer's disease (50.5%), vascular dementia (34.4%), mixed type dementia (10.8%), Frontal lobe dementia (2.2%) and Lewy body type (2.2%). Of the 93 (78.8%) patients with dementia, 47 (50.5%) had MMSE score ≥20, 29 (31.2%) had MMSE score 11-19 and 17 (18.3%) had score of 0-10. Thirty-three (35.5%) patients were on antidementia medication at the point of referral and a further 16 (17.2%) patients were commenced on these drugs following assessment.

Conclusion: The memory clinic provides a service for the assessment of mild cognitive impairment (MCI) and dementia. It offers diagnosis, an opportunity to receive specific advice regarding dementia management, differentiation between dementia and depression and a resource point for carers and patients.

Progress in diagnosis and management of Alzheimer's disease

Purpose

Knowledge of Alzheimer's disease (AD), timely recognition and good management should be the norm in all health and social care settings. This paper seeks to focus on developments in diagnosis and treatment.

Design/methodology/approach

Key research papers and policy documents published in the last few years are reviewed, with an emphasis on those most relevant to Wales.

Findings

The number of people with AD is predicted to steadily increase over the next 40 years. Recent policy developments have recognised the importance of better identification and management of dementia and have proposed memory clinics as the core of new services for early diagnosis and identification. Newer biomarkers of AD enable diagnosis to be made more reliably and at a stage before the patient is demented (prodromal AD). Latest guidance from the National Institute for Health and Clinical Excellence (NICE) now recommends that the use of anticholinesterase inhibitor drugs or memantine is considered in all patients with AD. There is active research into newer treatment approaches, notably the role of cognitive rehabilitation in early dementia and the use of potentially disease‐modifying drugs such as anti‐amyloid antibodies. Unfortunately, current research funding is inadequate and only a small minority of people with AD become involved with research.

Originality/value

The paper shows that, given the growing importance of AD, there is an urgent need to boost recruitment of people with dementia into research trials. There is also a need to address ethical considerations of diagnosing prodromal AD – this is important for both the person undergoing assessment and for society as a whole.