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

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)

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)

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’

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

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

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)

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)

Cognitive Tests GP Practice Memory Clinic MMSE AMT 6-CIT ACE-III (Preference. Total score 100, takes about 15 minutes) MOCA (Total score 30, has Executive items) RUDAS (Rowlands Universal Dementia Assessment Scale)(Used especially with non-English/poor English/poor education patients)

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

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

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

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)

Thank you – any questions