Referring to the Memory Clinic

1. Referring to the Memory Clinic Dr Johan Schoeman Associate Specialist, Luton Memory Clinic Lead

2. Objective Good-quality early diagnosis and intervention for all. • rapid and competent specialist assessment • accurate diagnosis, sensitively communicated to person with dementia and their carers • treatment, care and support provided as needed following diagnosis. Living well with dementia: A National Dementia Strategy (February 2009)

3. Driver • ‘NHS England has achieved the aim of increasing the proportion of people with dementia who are able to get a formal diagnosis from under half, to at least two-thirds of people affected’. • We need to maintain a diagnosis rate of at least 66% Prime Minister’s Challenge on Dementia 2020 (March 2016)

4. Achieving – Objective and Driver • Standards: MSNAP (Memory Services National Accreditation Programme) • QI (Quality Improvement): Maintaining/improving diagnosis rate of 66% in 90% of patients referred by GP Surgeries • Close liaison with GP Surgeries: secure ‘Appropriate Referrals’

5. Appropriate Referral from GP • GP perspective of the ‘story of forgetfulness’ • Patient Summary: PMH, PPH, Medication, Allergies • Carer contact details • Need for an interpreter? • Dementia Blood Screen: U&E Calcium profile FBC Glucose (HBA1c) TFT ESR/CRP LFT (GGT) Vit. B12 + Folate Lipids

6. Further consideration to… • Current alcohol (drug) misuse • Recent discharge from hospital: Episode of delirium (‘most cases recover within 4 weeks or less. However, delirium lasting, with fluctuations, for up to 6 months is not uncommon’) • Recent Orthopaedic or Cardiac Surgery • CVA within 4-6 months • On-going significant Psychiatric Illness (most commonly depression) The ICD-10 Classification of Mental and Behavioural Disorders. WHO 1992 The ICD-10 Classification of Mental and Behavioural Disorders. Geneva. 1992

7. Further consideration to… • Significant Life Event (bereavement, divorce, moving house) • Person younger than 40 years old • Moderate to Severe Learning Disability • Acquired head injuries • Significant analgesic usage (opioids/opioid derivatives)

8. Memory Clinic Assessment • Pre-clinic: DBS, Radio-imaging • Capacity and Consent • ‘Story of Forgetfulness’ from Patient and Informant/s • Specific questions related to dementia symptomatology • Full Medical and Mental Health History • Risks to health and safety • Cognitive Test • Functional Questionnaire (Relative/Carer completes)

9. Cognitive Tests

10. Most important criterion Good ‘Story of forgetfulness’ If in doubt, we refer for OT AMPS (Assessment of Motor and Process Skills) and/or Neuropsychology Assessment

11. Most often diagnose… • Dementia of Alzheimer type, late onset • Dementia of Alzheimer type, mixed • Vascular dementia • Mild cognitive disorder • ‘Person with feared complaint in whom no diagnosis is made’ – Z71.1 (ICD-10) • Lewy body dementia • Dementia in Parkinson’s disease • Fronto-temporal dementia

12. Follow-up • Cognitive Enhancing Drug prescription (e.g. donepezil) • Attending a Post-diagnostic Group • Refer: Alzheimer Society, Age Concern • Discuss: continued driving, Lasting Power of Attorney • Discharge to GP

13. Take-home message • Good ‘story of forgetfulness’ from GP perspective • Relative/carer contact details • Patient Summary • Dementia Blood Screen • Score of Cognitive Test in Surgery (if possible) • Recent Radio-imaging reports (if any)

14. Thank you – any questions