Specific care programme for the elders
Specific care program for the older adults: Memory Clinics

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Abstract

Memory Clinics are interdisciplinary, specialized outpatient units for the early diagnosis of cognitive impairments and rare forms of dementia in the rapidly growing older population. At the Basel Memory Clinic, a team of neuropsychologists, geriatricians, neurologists, and psychiatrists use standardized procedures to comprehensively diagnose patients in the earliest possible stages of dementia or mild cognitive impairment. In collaborative efforts with family physicians and dementia care providing agencies, such as the Alzheimer's Association, patients and families are offered up-to-date pharmacologic and non-pharmacologic treatment options and educational and counseling services. These efforts aim to maintain the quality of life of both patients and caregivers as long as possible and to delay nursing home placement which accounts for the majority of costs associated with dementia.

Introduction

Dementia is a syndrome caused by a great variety of diseases and progressively affects cognitive functioning in older individuals. As the prevalence and incidence increase exponentially with age, today, an estimated 30 million people in the world are affected, and there are about 4.6 million new cases every year (one new case every 7 s). Since our average life expectancies are still on the rise, the estimated number of demented individuals will be over 100 million by the year 2050 [1].

Dementia begins with subtle cognitive changes that represent an abnormal decline from a previous level of functioning [2], [3]. By convention, dementia is diagnosed only when patients’ functioning in daily life is affected, such that they start to require help with complex tasks. However, all dementias begin with a form of mild cognitive impairment [4], which requires specialist knowledge and accurate normative data for its detection. Early detection is critical in order to begin pharmacologic treatment as early as possible, which for some forms of dementia may reverse symptoms (e.g., hydrocephalus, thyroid dysfunction) or slow or temporarily delay the progression of the disease (e.g., vascular dementia and Alzheimer's disease, respectively). Moreover, early detection allows patients to benefit from other forms of therapy, and family members to be counseled to cope with the significant psychological burden of caregiving. The purpose of Memory Clinics is to meet these challenges by performing interdisciplinary, specialist examinations and arriving at consensus diagnoses and treatment recommendations for the referring family physicians.

Here, we briefly review the development of European Memory Clinics, then outline current diagnostic operating procedures, and end with a discussion of future directions in the diagnosis and treatment of dementia.

The first dementia assessment center opened in 1983 in Newcastle, U.K. [5]. In the early and mid-1980s, other developed countries started establishing “Memory Clinics”, i.e. outpatient facilities specializing in the early diagnosis of dementing illnesses and offering non-pharmacological treatment options [6]. One of the first Memory Clinics in continental Europe was opened 1985 by Professor Hannes B. Stähelin, the head of Geriatrics at the University Hospital in Basel, Switzerland. From the beginning, the approach of Memory Clinics has been interdisciplinary, with cognitive and neuropsychological assessment at the core of the examinations.

Many countries have since established their own guidelines or recommendations for the diagnosis and treatment of dementias [7], [8]. Although not identical, they all agree that dementia (or MCI) should be diagnosed early, and that the diagnosis of early cases and rare forms of dementia requires specialist assessments.

Section snippets

Diagnostic operating procedure at the Basel Memory Clinic

Memory Clinics pursue an interdisciplinary approach with multidisciplinary teams. The key examinations include a neuropsychological assessment, medical (internist, neurological, psychiatric) exam with blood workup, and neuroimaging. Valuable additional information can be acquired from additional examinations such as a gait analysis, providing the corresponding technical equipment is available. We will discuss these steps in more detail, using the diagnostic operating procedure of the Memory

Special treatment programs for patients with beginning dementia

At the Basel Memory Clinic, all patients and families are offered counseling and cognitive training, where appropriate, provided in cooperation with the local section of the Alzheimer's Association. This close working relationship allows for the optimal sharing of available resources. Current treatment guidelines recommend non-pharmacological interventions, such as cognitive training, in combination with pharmacological treatment [7], [8]. One such training program specifically designed for

Assessment of mental competence

An additional task of Memory Clinics is the assessment of mental competence as a prerequisite for the participation in drug trials, drafting a last will, or the patient giving advanced directives. In these cases, Memory Clinics must determine the patient's capacity to understand the issues in question and recognize and understand the alternatives. Moreover, it should be demonstrated that the patient's current decision is consistent with his or her previous beliefs and value system.

Future directions

In the ensuing decades, the incidence and prevalence rates of dementia will dramatically increase. Therefore, the capacities of existing Memory Clinics must be greatly increased in order for them to adequately deal with the needs of future patients and families. In addition, Memory Clinic specialists must keep family physicians and general practitioners apprised of the cutting edge methods to accurately screen for cognitive problems in their daily practice [22].

To improve the diagnosis of

Conflict of interest statement

No conflicts of interest.

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