Neurology - School of Medicine Dundee

Part of the School of Dundee and NHS Tayside

Dementia

Since the Scottish Government announced in 2007 that dementia would be a “National Priority”, we have seen a substantial change in the field of dementia care in Scotland. We saw the first HEAT (Health Improvement, Efficiency, Access to Services and Treatment) target related to dementia in 2008 with the aim of increasing the number of people diagnosed and registered with GP practices (DEM 1) by 2011 to at least 61% of the expected prevalence (according to Eurodem estimates). In 2011, the “Standards of Care for Dementia in Scotland” and “Providing Excellent Framework” were published by the Scottish Government. In 2013, the second “Scottish Dementia Strategy” was published and the Post Diagnostic HEAT target announced and a series of commitments to improve dementia care.

 

Dementia is a clinical diagnosis made when acquired cognitive deficit in more than one area of cognition interferes with activities of daily living and represents a decline from a previously higher level of functioning. Dementia can result from a number of single or combined underlying aetiologies and is usually progressive. The probability of developing dementia increases with age.

Patients might present to Primary Care with subjective memory impairment with symptoms such as:

 

-           Lapses in memory

-           Difficulty concentrating

-           Forgetfulness

-           Worried about “forgetting things”

-           Feeling “something is not right”

 

 

Why is Diagnosis Important?

A diagnosis is important to help enable an individual to plan for the future.  An earlier diagnosis can lead to:

  • a better quality of life for the individual with dementia and their carers/families
  • ensuring that the right level of support and treatment is given at the right time
  • reducing the chances of misdiagnosis or inappropriate treatment and care
  • allowing individuals with dementia to live well with dementia in their home for as long as possible
  • an opportunity to plan for what support and care the individual will need in the future (including end of life care).

 

Some individuals can be reluctant to be given a diagnosis.  This can be evidenced in them not wishing to have their memory problems assessed or not wishing to receive the diagnosis after they have completed the assessments. Sometimes this reluctance can be due to their anxiety about what is going to be involved in the assessment process or their beliefs about their future care and treatment.  For such individuals, an explanation of the benefits of early diagnosis highlighted above as well as a clear pathway that describes the intervention expected can be reassuring.

 

Cognitive Neuroscience Clinic (Young onset dementia clinic)

 

This is a Tayside-wide service currently hosted within Clinical Neurosychology in Ninewells hospital. It offers a multidisciplinary, diagnostic service for the following patients:

 

  • < 65 years old with suspected dementia (typical diagnoses including dementia, mild cognitive impairment and subjective memory impairment often secondary to underlying functional psychiatric disorders)

 

  • >=65 years old with rapidly progressive, atypical or rare / unusual presentation of dementia.

 

This clinic is currently staffed by a Consultant Neurologist (Post currently covered by senior neurology trainees), Consultant Clinical Neuropsychologist (Dr Alison Livingstone) and Consultant Psychiatrist (Dr David Rooke). Additional staffing is provided by psychologists from within Dr Livingstone’s service under her supervision as well as administrative support.

 

The clinic runs weekly, on a Wednesday morning, level 6, Ninewells hospital. Patients are typically seen jointly by the neurologist and the psychiatrist and separately by AL. An appointment will usually take several hours, or most of the morning.

 

Referrals are currently accepted from GPs and Secondary Care services across Tayside. However, it is envisaged that this clinic will consolidate a “tertiary” role within this pathway. The clinic aims to provide a diagnosis following multidisciplinary assessment and appropriate investigations and then onward referral to appropriate locality services for post diagnostic follow up and management.

 

Link to NHS Tayside dementia pathway here