What is a memory clinic?
By Frank Jessen
(posted 25th September 2017)
Memory clinics are interdisciplinary special services, which offer a detailed work-up of memory problems in people in later life. Usually, patients are referred to memory clinics by their primary care physician, psychiatrist or neurologist and it is at the memory clinic that patients provide a history of their memory problems, which is ideally supported by a spouse or caregiver.
The next step is to perform a cognitive test. These tests are standardized measures of memory, language abilities, attention and other domains, which are used to determine whether a patient has a cognitive capacity within the age-expected age range or below. This is often followed by blood examinations to detect any medical conditions, which may cause memory problems – for example, hypothyroidism. Also, a brain magnetic resonance imaging (MRI) scan is usually obtained to identify brain lesions, such as infarcts or tumors, which can also cause memory disturbances. In some centres, advanced technologies such as positon emission tomography (PET – which show the molecular aspects of the brain), are also provided. Most memory clinics offer examination of the cerebrospinal fluid (CSF) which can identify Alzheimer’s disease (AD) related changes of protein concentrations, allowing the diagnosis of AD with high certainty.
Memory clinics usually offer a variety of treatment options. These include counselling and non-pharmacological interventions, such as cognitive training or occupational therapy as well as caregiver support groups. Memory clinics also assess the need for pharmacological anti-dementia treatment and sometimes provide the medication directly. Many memory clinics also offer patients the chance to participate in clinical trials with novel pharmacological and non-pharmacological therapies. The focus of these trials is usually very early treatment or prevention of dementia in AD. The Silver Santé Study provides an excellent example of the role memory clinics play in clinical trials. At the Clinic for Psychiatry and Psychotherapy at the University Hospital Cologne, where I am director, patients are currently taking part one of the Study’s trials to assess the effect of short-term interventions, such as on behavioural measures. Each patient has some level of subjective cognitive decline, so their improvement can be measured along with the intervention. Behavioural measures will be monitored to see how much of a difference can be made to participants’ well-being due to the intervention.
Memory clinics provide dementia diagnosis and treatment at an expert level and are a key component of up-to-date dementia care. The more refined future dementia treatment becomes, the more central the role of memory clinics for patients and professionals will be. We hope that the results of the Silver Santé Study can feed into that refinement and help enhance and improve how we all safeguard our mental health and well-being in later life.