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 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)

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