6 - The multidisciplinary memory clinic approach

Summary

The aim of this chapter is to describe briefly the origins, principles and organization of the Cambridge Memory Clinic (CMC) which was started by the editors in 1990. Memory clinics vary a great deal in scope and services. In their useful paper on memory clinics in the British Isles, Wright and Lindesay (1995) surveyed 20 such facilities, reporting that in only 45% a psychiatric instrument was used as a routine to measure ‘affective state’; and although psychiatrists seemed to participate in about 75% of clinics, their role and the comprehensiveness of their psychiatric assessment were unclear. Some clinics seem to have a wide scope: for example, in an excellent study, Verhey et al. (1995) assessed the DSM-III-R psychiatric status of 430 consecutive patients and in 61 subjects found depression, 39 dysthymia, 23 adjustment disorder, 18 personality disorder, 6 anxiety disorder and 2 somatoform disorder; the authors made the important point that the low rates of non-affective psychiatric disorder reported by some clinics is likely to result from a perfunctory psychiatric examination or the use of insensitive instruments. On the other hand, many such clinics do not include a routine neurological or formal neuropsychological assessment.

The Cambridge Memory Clinic

The objective when founding this clinic was to establish a truly multidisciplinary service which combined behavioural neurology, neuropsychiatry and neuropsychology. From the start its main objective was to assess patients complaining of memory impairment and patients whose memory is considered as impaired by others, even when the patient has no awareness of deficit.