Profiles of the Different Diagnostic Outcomes at the NHSCT Memory Service: Dementia Assessment Outcome

Background The Northern Health and Social Care Trust (NHSCT), Northern Ireland, established a Memory Service in 2013 to offer timely differential diagnosis and improve quality of care in dementia. Timely diagnosis offers advantages for the person which include; better adjustment, slowing of progression and planning ahead. There are also significant savings to the health economy. Increasing awareness about dementia has increased the number of people who seek assessment for dementia. This is a positive development as it will increase the number of people who receive a timely diagnosis but it also increases the number of people who attend for assessment who do not have dementia.

Method Since 2013 there have been over 6000 referrals to the NHSCT Memory Service. come from GPs or hospital liaison. An anonymised database was set up to record information on the profile of people referred to the service. This includes demographic information, details about their social, medical and psychiatric history, performance on the Addenbrooks Cognitive Examination-III (ACE-III), Bristol Activities of Daily Living, Zarit Caregiver Burden Scale and the outcome of the assessment.

Results 59.3% of people attending for assessment receive a diagnosis of dementia. Of these 43.5% are diagnosed with probable Alzheimer’s disease, 16% vascular dementia, 1.1% Lewy body dementia, 0.6% frontotemporal dementia and 33.3% mixed dementia. 26.4% attend with Mild Cognitive Impairment (MCI). 40% of people with MCI are subsequently diagnosed with dementia. Analysis of data from the different assessment outcomes highlights the different profiles of specific dementias, MCI, MCI who subsequently develop a dementia and mental health presentations.

Conclusions Greater understanding of the profiles of the different outcomes has significant benefits. 40.7% of people attending the Memory Service did not have dementia. Sharing information about the profile of people who are likely to have a dementia with referral agents will help them to make more informed decisions about who to refer to specialist Memory Services. This has benefits for the person by avoiding the unnecessary stress of a referral for assessment of dementia. It also offers savings to the health economy by reducing inappropriate referrals. Greater understanding of the cognitive profile and relative strengths and weakness of the different types of dementia enables appropriate advice to be provided and the opportunity for the development of compensation strategies. Greater understanding of MCI and MCI which is likely to develop into dementia offers the opportunity to provide early intervention and also informs decisions about who should be offered follow up assessment. This data has facilitated better planning of services to accommodate the number of people presenting to the Memory Service who are likely to have dementia.