Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-08T07:50:31.319Z Has data issue: false hasContentIssue false

An assessment of the new memory clinic at Cork University Hospital

Published online by Cambridge University Press:  13 June 2014

Abraham Popoola
Affiliation:
Department of Psychiatry of Old Age, Cork University Hospital
Maria O'Donovan
Affiliation:
Cork University Hospital
Eleanor Mullan
Affiliation:
Old Age Psychiatry, Ireland

Abstract

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.

Type
Brief Report
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Jorm, AF, Korten, AE, Henderson, AS, The prevalence of dementia: a quantitative integration of the literature. Acta Psychiatrica Scandinavica 1987 Nov; 76(5): 465–79.CrossRefGoogle ScholarPubMed
2.Society of Actuaries population studies working party report, Ireland (2003).Google Scholar
3.Eamon, O'Shea. Implementing policy for dementia care in Ireland: The time for action is now. The Alzheimer's society of Ireland, Feb 2007.Google Scholar
4.Busse, Aet al.Mild cognitive impairment: prevalence and incidence according to different diagnostic criteria. The British Journal of Psychiatry 2003; 182: 449454.CrossRefGoogle ScholarPubMed
5.Petersen, RCet al.Mild cognitive impairment: clinical characteristics and outcome. Arch Neurol 1999; 56 (3): 303–8.CrossRefGoogle Scholar
6.Petersen, RC. Mild cognitive impairment as a diagnostic entity. J intern Med 2004; 256:183–94.CrossRefGoogle ScholarPubMed
7.Emory Alzheimer's disease Research Centre: Mild cognitive impairment fact sheets. Wesley Woods Health Centre, 1841 Clifton road, Atlanta, GA30329.Google Scholar
8.Luce, Aet al.How do memory clinics compare with traditional old age services?. International Journal of Geriatric Psychiatry 2001; 16, 837845.CrossRefGoogle Scholar
9.Simpson, Set al.Should old age psychiatry develop memory clinic? A comparison with domiciliary work. Psychiatric Bulletin 2004; 28:78828.CrossRefGoogle Scholar
10. A vision for change: Report of the Expert Group on Mental Health Policy in Ireland 2006.Google Scholar
11.Folstein, MFet al.Mini-Mental State a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189198.CrossRefGoogle Scholar
12.Rosen, Adas- WG, Mohs, R.C. and Davis, K.L.A new rating scale for Alzheimer's diseaseAmerican Journal of Psychiatry Vol.141, pp 13561364.Google Scholar
13.Hughes, CP, Berg, L, Danziger, WL, Martin, RL. A new clinical scale for the staging of dementia. Br J Psychiatry June 1982; 140:566–72.CrossRefGoogle ScholarPubMed
14.Yasavage, JA, Brink, TL, Rose, TLet al.Development and Validation of a geriatric depression screening scale: a preliminary report J.Psychiatr Res, 1983; 17:3749.CrossRefGoogle Scholar
15.Zarit, SH, Reever, KE, Bach-Peterson, J. Relatives of impaired elderly: Correlates of feelings of burden. Gerontologist 1980 Dec; 20(6):649655.CrossRefGoogle ScholarPubMed
16.Mahony, FL, Barthel, D. “Functional evaluation: The Barthel indexMaryland state medical journal 1965; 14:5661.Google Scholar
17.Woodward, TS, Iverson, GL. The behavioural assessment scale: internal consistency and factor structure for an elderly psychiatric population. Applied Neuropsychology 1999, vol 6, No 3, pages 170–7CrossRefGoogle ScholarPubMed
18.World Health Organisation, Geneva. The ICD-10 – International Statistical Classification of Diseases and Related Health Problems, Tenth Revision: Clinical description and diagnostic guideline.Google Scholar
19.Thompson, Pet al.Memory clinic attenders: a review of 150 consecutive patients. Aging & Mental Health 1997; 1 (2):181183.CrossRefGoogle Scholar
20.Byrne, EJ, Lennox, G, Lowe, J, Godwin-Austen, RB. Diffuse Lewy body disease: Clinical features in 15 cases. Journal of Neurology 1989; Neurosurgery and Psychiatry.Google ScholarPubMed
21.Bruscoli, M, Lovestone, S. Is MCI really just early dementia? A systematic review of conversion studies. International Psychogeriatrics 2004; 16:129–40.CrossRefGoogle ScholarPubMed
22.Morris, JC, Storandt, M, Miller, JPet al.Mild cognitive impairment represents early-stage Alzheimer's disease. Archives of Neurology 2001; 58:397405.CrossRefGoogle Scholar
23.Petersen, RC, Doody, R, Kurz, Aet al.Current concept in mild cognitive impairment. Archives of Neurology 2001; 58:1985–92.CrossRefGoogle ScholarPubMed
24.Rosenstein, LD. Differential diagnosis of the major depressive dementias and depression in middle and late adulthood: a summary of the literature of the early 1990s. Neuropsychol Rev. 1998; 8:109167.CrossRefGoogle ScholarPubMed
25.Alexopoulos, GS, Meyers, BS, Young, RCet al.The course of geriatric depression with “reversible dementia”: a controlled study. Am J Psychiatry. 1993; 150:16931699.Google ScholarPubMed
26.Devanand, DP, Sano, M, Tang, MXet al.Depressed mood and the incidence of Alzheimer's disease in the elderly living in the community. Arch Gen Psychiatry. 1996; 53:175182.CrossRefGoogle ScholarPubMed
27.Sweet, RA, Hamilton, RL, Butters, MAet al.Neuropathology correlates of late onset major depression. Neuropsychopharmacology. 2004; 29:22422250.CrossRefGoogle ScholarPubMed
28.Swanwick, GJRet al.A memory clinic for the assessment of mild dementia. Irish Journal of Psychological Medicine, 1996; 13:15–8.Google Scholar
29.Myrra, JF, Vernooij-Dassen, , Moniz -Cook, ED, Woods, RTet al.INTERDEM group 2005: Factors affecting timely recognition and diagnosis of dementia across Europe. From awareness to stigma. International Journal of Geriatric Psychiatry, 2005, Volume 20, Issue 4 pages 377386.Google Scholar
30.Central Statistics Office, 1997. Census 1996. Principal Demographic Results. Dublin: Stationary Office.Google Scholar
31.Moniz-Cook, E, Woods, R. The role of memory clinics and psychosocial intervention in the early stages of dementia. International Journal of Geriatric Psychiatry 1997; 12, 11431145.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
32.Rice, K, Warner, N. Breaking the bad news: What do Psychiatrists tell patients with dementia about their illness? International Journal of Geriatric Psychiatry 1994; 9, 467471.CrossRefGoogle ScholarPubMed
33.Gilliard, J, Gwilliam, C. Sharing the diagnosis: A survey of disorders clinics, their policies on informing people with dementia of the support they offer. International Journal of Geriatric Psychiatry 1996; 11, 10011003.3.0.CO;2-I>CrossRefGoogle Scholar
34.Brodaty, H, Gresham, M, Luscombe, G. The prince Henry Hospital Dementia caregivers' training programme. International Journal of Geriatric Psychiatry 1997; 12, 183192.3.0.CO;2-J>CrossRefGoogle Scholar
35.Logiudice, Det al.Do memory clinics improve the quality of life of carers? A randomised pilot trial. International Journal of Geriatric Psychiatry 1999; 14, 626632.3.0.CO;2-5>CrossRefGoogle Scholar