There are 4 memory clinics within the health board made up of memory clinic nurses and medical practitioners.
Each service has limited administrative support and access to Psychology and Occupational Therapy for assessment and formulation purposes. Any further assessments (e.g. to atypical presentations) may require a referral to services outside the current model.
The Memory Clinic core team is available during the working hours of Monday to Friday.
You can be referred by your GP, a Neurologist or a Physician (once you have been assessed and it is deemed that neurological conditions have been excluded)
If any other service/profession would like to make a referral to the memory clinic service. This could be the CMHT, Acute Hospital, or Frailty Team, they are able to do so by highlighting their concerns to the individual’s GP. They can also request that the GP refers the patient onto the memory clinic (attaching their letter of concerns if appropriate), along with the appropriate ‘referral information’, which can be found below.
• Individuals of any age with suspected Dementia, which cannot be attributed to a pre-diagnosed or known neurological condition or mental health condition (see exclusion criteria below)
Senior clinical decision makers make a decision regarding accepting or refusing a referral as they are received into the team base via the postal service. (Electronic and telephone referrals are not currently accepted within the base).
If they are not sure regarding appropriateness, they will consult with another senior clinical decision maker. During this process the following basic information should be available, either via GP referral or care partner.
Without the following information the referral will not be accepted:
• Patient personal details (Name, address, date of birth)
• Brief description of presenting difficulties (inc. consent to referral)
• Medical history (physical and mental health, details of any past and ongoing medical investigations).
• Current Medication
• Test results: routine haematology; biochemistry tests (electrolytes, calcium, glucose, and renal and liver function); thyroid function tests; serum vitamin B12 and folate levels; ECG and midstream urine test if delirium is a possibility
• Any other service involvement (past or present)
• Any potential risks if present (e.g. lack of insight / ability to consent)
• Information regarding named ‘carer’ or next of kin (if appropriate)
• Information regarding the physical examination completed (if completed)
• Neuro-imaging (CT, MRI or other) use the ‘dementia screen’ template to request scan.
In order to facilitate an accurate formal baseline assessment, an individual that has a known severe or moderate mood, anxiety or psychiatric disorder should initially be referred to Community Mental Health Team for an assessment and treatment (if appropriate). This should be done with the view of referring back to Memory Clinic, once mood is considered ‘stable’ and their mental health has been excluded as a cause for their memory difficulties.
• Individuals with physical health conditions (e.g. cancer, metabolic disorders): change in cognition temporally linked to changes in physical health or to the introduction of medications known to produce changes in cognitive functioning should be investigated and causal links excluded prior to accepting referral.
• Patients presenting with known significant current alcohol or substance misuse issues should be referred to the appropriate service prior to referral (e.g. Community Drug and Alcohol Team). Accurate evaluation of cognitive functioning would only be recommended following a 3-6 month period of abstinence.
• Individuals with a known functional neurological disorders (e.g. Non Epileptic Attack Disorder) or neurological condition (e.g. epilepsy, Multiple Sclerosis, Mitochondrial disorders, Chronic Migraines) should be referred to the appropriate services.
• Individuals with a known acquired or traumatic brain injury (inc. Hypoxic Brain Injury, Brain infection or inflammation due to meningitis, Encephalitis, Haemorrhagic stroke requiring neurosurgical intervention; Ischemic stroke) should be referred to appropriate services.
• Individuals with a known Learning Disability should be referred to the Learning Disability services for assessment and support, unless specifically requested to be seen by Primary Care Memory Clinic Team.
• Individuals who already have a diagnosis of dementia (e.g. request for medication review when behaviour changes) should be referred to CMHT or share care (see ‘Prescribing Support Guidance’ policy).
The assessment should aim to cover the following, as minimum standard:
This should capture the patient and informant (where possible) view of current difficulties, with specific reference to the following:
• Cognition – E.G. memory, language, attention, vision, executive functioning
• Physical health – E.G. metabolic, cardiovascular, neurological
• Motor skills – Including the individuals’ history and risk of falls)
• Mood – Changes to an individuals’ emotional well-being.
• Behaviour / Personality E.G. initiation, interest, irritability
• Subjective reporting of changes to Instrumental Activities of Daily Living
• Family history – I.E. any dementia in family?
• Systemic issues – Such as their living situation and circumstances, ongoing stresses
• Risk Assessment- This should include driving
• Functional Capacity / Informant Questionnaires regarding function: Functional Assessment Questionnaire (FAQ), as recommended by NICE (2018).
• Addenbrooke’s Cognitive Examination-iii (UK Version) is the recommended screening tool as it’s the most sensitive clinically. Different versions should be used for repeat assessments (i.e. monitoring purposes).
• The MOCA-blind should be used with those with visual impairments.
• Mood Assessment: Hospital Anxiety and Depression Scale (HADS)