How do memory clinics compare with traditional old age psychiatry services?

Abstract

100 consecutive referrals to the Northern Memory Clinic (NMC) were compared with 100 referrals to a traditional Old Age Psychiatry (OAPsych) service in the same city in terms of demographic variables, cognitive function (assessed by the Mini-Mental State Examination), and diagnosis. The study also examined the ability of psychometric assessments (CAMCOG, MMSE, Trail-Making Tests A & B, Word Fluency) and CT scans included in the NMC assessment to differentiate between those with and without DSM-IV dementia. NMC patients were significantly younger than OAPsych patients, had lower levels of cognitive impairment, and had a wider range of diagnoses. The NMC patients who were diagnosed as having dementia were found to be at least 2 years earlier in the course of the disease than those seen by the OAPsych team. The CAMCOG and MMSE were proved to be effective at distinguishing between patients diagnosed as dementing versus non-dementing with cut-offs of 82/83 and 23/24 respectively, confirming previous findings. The Memory subscale of the CAMCOG, though much shorter, was equally as effective using a cut-off of 20/21. Trail-Making Tests, Word Fluency (FAS), and measurement of the minimum width of the medial temporal lobe (MTL) on angled CT scans were poor indicators of dementia in this sample. This study confirms that the memory clinic is targeting a distinct patient group compared to traditional old age psychiatry services, is identifying cases of dementia much earlier, and as such has potential to make valuable contributions to patient care.