Open access to memory clinics

Around 850,000 people in the UK are living with dementia, but the number of people who actually have the condition without being given a formal diagnosis is thought to far exceed this. People who have undiagnosed dementia are much less likely to receive the specialist help they need, and they deteriorate more quickly than those who are supported and treated.

Part of the problem is the fact that the current system relies on primary health care workers recognising the early signs and following criteria to refer patients to specialist memory clinics. There are currently 222 memory clinics in England, each seeing an average of 576 patients annually, with the number of patients seen increasing by 31 per cent from 2013 to 2014.  Here, patients will be given a battery of tests that may take one to two hours, as well as detailed histories and other causes of dementia can be excluded.

The criteria can differ markedly depending on where you live. Some memory clinics will only take patients who have already undergone cognitive tests, the Mini Mental State Examination, blood tests that look for specific markers, urine tests and physical examinations. These requirements may be arduous and time consuming, so not surprisingly, people can slip through the cracks. GPs have difficulty assessing patients with memory problems in strict accordance with guidance within a 10-minute consultation; in our experience, a significant proportion of available consultation time can be taken up by carrying out just one of the brief cognitive tests.

There are currently 222 memory clinics in England, each seeing an average of 576 patients annually, with the number of patients seen increasing by 31 per cent from 2013 to 2014.

One way to speed up diagnoses could be to open up the referral process to these memory clinics so that patients and carers could self-refer when suspicions were raised. In one small nurse-lead study in Australia, of 64 patients who self-referred to a direct access memory clinic, one third were in fact diagnosed with dementia. This supports the notion that self-referral could be one way forward.

Practice nurses could also be given responsibility to carrying out assessments according to protocols, reducing pressure on GPs and specialists.

A system that discourages or delays referral for dementia is highly counterproductive: an urgent review of this area is necessary to establish a system that effectively supports patients and clinicians in early diagnosis, treatment and prevention.

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