Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Impact of the National Dementia Strategy in a neurology-led memory clinic

AJ Larner
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.10-5-526
Clin Med October 2010
AJ Larner
Consultant neurologist Cognitive Function Clinic Walton Centre for Neurology and Neurosurgery Liverpool
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
Loading

The National Dementia Strategy (NDS) was officially launched on 3 February 2009. It proposed three key themes to address the problem of dementia: improved awareness of the condition, early diagnosis and intervention, and higher quality of care. A pathway for NDS implementation, anticipated to roll-out over a five-year period, was proposed.1 One year on, the National Audit Office (NAO) published a report into progress on NDS delivery, but frontline services were omitted since they were not anticipated to have changed, as local implementation plans are still being developed. Old age psychiatrists and general practitioners (GPs) were surveyed as part of the audit, but neurologists and geriatricians with specialist interests in dementia and cognitive disorders did not feature.2

The possible impact of NDS in a neurology-led memory service was examined by comparing referral numbers, sources and diagnoses in the 12-month periods immediately before (February 2008–February 2009) and after (February 2009–February 2010) the NDS launch (Table 1).

View this table:
  • View inline
  • View popup
  • Download powerpoint
Table 1.

Referral numbers, sources and diagnoses before and after the National Dementia Strategy (NDS) launch.

These data showed a 12% increase in new referrals seen in the second time period, with a marked increase in the percentage of referrals coming from primary care (70.2% ν 58.2%). The null hypothesis that the proportion of new referrals from primary care was the same in the cohorts referred before and after NDS launch (equivalence hypothesis) was rejected (χ2=6.18, df=1, p<0.01).

A decrease in the percentage of patients receiving a diagnosis of dementia (DSM-IV-TR criteria) was noted in the patient cohort from the second time period (29.8% ν 32.9%). The null hypothesis that the proportion of new referrals receiving a diagnosis of dementia was the same in the two cohorts was not rejected (χ2=0.63, df=1, p>0.1).

These findings may indicate that the NDS has increased the total number of referrals to neurology-led memory clinics, perhaps by raising awareness of dementia, although the increase is not as marked as that seen following the publication of guidelines on identification, treatment and care of people with dementia under the joint auspices of the National Institute for Health and Clinical Excellence and the Social Care Institute for Excellence (NICE/SCIE) in November 2006.3,4 The post-NDS increase in referrals has come mostly from primary care, supporting the NAO finding that GPs are becoming more positive about diagnosing dementia early,1 but with no accompanying increase in the number of new diagnoses of dementia, hence no evidence for closure of the dementia ‘diagnosis gap’ (too few people being diagnosed with dementia or diagnosed early enough). The impression is that more ‘worried well’ individuals are being referred, rather than those with previously undiagnosed dementia. This is of concern since, as remarked in another context, ‘Health services struggle when they are overwhelmed by people who don't need to be there' (T Stephenson, Observer, 26 July 2009). GPs may need more guidance in identifying possible dementia cases requiring onward referral to secondary care. A previous study noted only 20% of GP referrals to this clinic had undergone any assessment with a recognised cognitive test.5

Footnotes

  • Letters not directly related to articles published in Clinical Medicine and presenting unpublished original data should be submitted for publication in this section. Clinical and scientific letters should not exceed 500 words and may include one table and up to five references.

  • © 2010 Royal College of Physicians

References

  1. ↵
    1. Department of Health
    . Living well with dementia: a National Dementia Strategy. London: Department of Health, 2009.
  2. ↵
    1. National Audit Office
    . Improving dementia services in England - an interim report. London: National Audit Office, 2010.
    1. National Institute for Health and Clinical Excellence/Social Care Institute for Excellence
    . Dementia: supporting people with dementia and their carers in health and social care. NICE Clinical Guidance 42. London: NICE, 2006.
    1. Larner AJ
    . Impact of the National Institute for Health and Clinical Excellence and Social Care Institute for Excellence's dementia guidelines in a neurology-led memory clinic. Clin Med 2009; 9:197–8.
    OpenUrlPubMed
  3. ↵
    1. Fisher CAH
    , Larner AJ. Frequency and diagnostic utility of cognitive test instrument use by GPs prior to memory clinic referral. Fam Pract 2007; 24:495–7.doi:10.1093/fampra/cmm038
    OpenUrlAbstract/FREE Full Text
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Impact of the National Dementia Strategy in a neurology-led memory clinic
AJ Larner
Clinical Medicine Oct 2010, 10 (5) 526; DOI: 10.7861/clinmedicine.10-5-526

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Impact of the National Dementia Strategy in a neurology-led memory clinic
AJ Larner
Clinical Medicine Oct 2010, 10 (5) 526; DOI: 10.7861/clinmedicine.10-5-526
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Impact of the National Dementia Strategy in a neurology-led memory clinic: 5-year data
  • Impact of the 2011 NICE guidance on dementia drugs in a neurology-led memory clinic
  • Google Scholar

More in this TOC Section

Letters to the Editor

  • Response
  • Functional disorders and chronic pain
  • A further explanation for chest pain without visible coronary artery disease
Show more Letters to the Editor

Clinical & Scientific Letters

  • The preference of general practitioners for structured outpatient clinic letters
  • Where there is no resident neurologist: a case for a neurology attachment for acute medicine trainees
  • Early intervention can influence an outcome – time to introduce an alert system for all cancer patients?
Show more Clinical & Scientific Letters

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians