WHAT IS A MEMORY CLINIC?
The purpose of a memory clinic is to investigate people presenting with the symptom of memory impairment and help in the early detection of all the possible causes including dementia. The original University College memory clinic accepted self referrals, referrals from carers and from all health care professionals, especially GPs. This wide access was thought necessary as concern on the part of sufferer and carer can be immense, and professional expertise currently poor at recognizing this and detecting early and potentially treatable conditions. Thus a memory clinic will be of practical help to clients but it should also function as a district 'resource centre', with educational and research functions linked to all disciplines concerned in the care of the elderly mentally infirm. In this way general practitioners, district nurses and social services can have a specialist multidisciplinary centre where early referral and assessment could be the first stage. The next stage would be chosen from a spectrum of resources, such as the other expertise available within a psychogeriatric unit: counseling and information, day care, relative and volunteer support groups, day and night sitting, intermittent respite care, and later, if necessary, a permanent home in a hospital or community setting.
The different professionals available within a memory clinic will vary. A standard core of clinical psychologist, physician and psychiatrist is the norm. These professionals usually assess independently, collating their data to form a cumulative profile of the person concerned. Nursing input is helpful and social-work involvement extremely important.
The job of the clinical psychologist is to work out whether or not any memory loss is indeed present. To do this he/she will ask the person to perform numerous tests. Some tests involve the naming of things, vocabulary tests and the ability to fit things together (cerebral function test). Others assess how quickly one can react to a command or if one can remember something a few minutes after seeing it (Kendrick battery). Increasingly computers are being used as part of a range of tests. The computer tests provide statistical data and usually have good patient compliance, i.e., they are 'user friendly'. A good history from the person (usually necessarily supplemented by others) and full physical examination are needed. The physician looks for and rules out the treatable causes of memory loss. This screening will involve Wood and urine tests, X-rays, ECG and possibly some form of brain scan. This part is extremely important: amongst the University College patients 8 per cent were found to have reversible causes responsible for their memory loss. The physician also attempts to sub-classify those people found to be suffering from the symptoms of dementia into a disease type, either Alzheimer's disease or multi-infarct dementia (or indeed one of the other rare types). To do this the Hachinski score is used - a scoring system based on a list of symptoms and signs due to hardening of the arteries. A score of 7 or more usually indicates that the condition is due to furred-up blood vessels and multi-infarct dementia. The truth of the matter, using the evidence obtained during post-mortems (detailed examination of the body after death including examination of slices of the brain under the microscope), however, is that there is considerable overlap between the two conditions.
The psychiatrist in the team assesses the mental state. If any dementia is found the psychiatrist tries to work out how severe the condition is, i.e. what stage the dementia has reached. The psychiatrist also has to examine for so-called affective disorders, the most important of which is depression. This assessment will involve a fairly lengthy interview. Amongst the University College patients, 10 per cent of them were found to have an affective disorder.
At the end of all the interviews and assessments (often spanning a period of time) everyone gets together to pool their information and the people seen are placed under various headings. There will be those with no memory loss shown and hence no clinical diagnosis given. These patients can be reassured. They or their carers thought that they were losing their memory or becoming demented and the worry probably made the situation very much worse. The problem usually goes after the reassurance. Other subgroups will be found to have potentially reversible conditions or affective disorders such as depression causing their memory loss. These people are told of the possible problem and referred to their own family doctor or specialist after consultation with the GP. They can obviously be reassessed after the appropriate treatment.
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