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Patients: Referral Patterns

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Dementia in Clinical Practice: A Neurological Perspective

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Abstract

This chapter examines referral patterns to a dedicated neurology-led cognitive disorders clinic located in a secondary care setting in terms of the numbers of patients seen over the period 2002–2016, referral sources (primary and secondary care), patient characteristics (age, gender, ethnicity, social class, handedness) and casemix in terms of diagnosis. Although referral numbers have increased over the 15-year period, the proportion receiving a diagnosis of dementia has fallen, which may indicate the persistence of a dementia diagnosis gap.

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References

  • Ahmadi-Abhari S, Guzman-Castillo M, Bandosz P, et al. Temporal trend in dementia incidence since 2002 and projections for prevalence in England and Wales to 2040. BMJ. 2017;j2856:358.

    Google Scholar 

  • Alzheimer’s Society. Dementia UK update. 2nd ed. London: Alzheimer’s Society; 2014.

    Google Scholar 

  • Association of British Neurologists. Acute neurological emergencies in adults. London: Association of British Neurologists; 2002.

    Google Scholar 

  • Audit Commission. Forget me not. Developing mental health services for older people in England. London: Audit Commission; 2002.

    Google Scholar 

  • Bharambe V, Larner AJ. Epidemiology of functional cognitive disorders: a retrospective memory clinic study. Poster P39, Association of British Neurologists Annual Meeting, Birmingham, 9–11 May, 2018.

    Google Scholar 

  • Blackburn D, Wakefield S, Bell S, Harkness K, Venneri A, Reuber M. Functional memory disorder; review from a memory clinic. J Neurol Neurosurg Psychiatry. 2014;85:e4.

    Article  Google Scholar 

  • Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive “vital signs” measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15:1021–7.

    Article  CAS  PubMed  Google Scholar 

  • Brodaty H, Pond D, Kemp NM, et al. The GPCOG: a new screening test for dementia designed for general practice. J Am Geriatr Soc. 2002;50:530–4.

    Article  PubMed  Google Scholar 

  • Brodaty H, Low-Lee F, Gibson L, Burns K. What is the best dementia screening instrument for general practitioners to use? Am J Geriatr Psychiatry. 2006;14:391–400.

    Article  PubMed  Google Scholar 

  • Brooke P, Bullock R. Validation of a 6 item Cognitive Impairment Test with a view to primary care usage. Int J Geriatr Psychiatry. 1999;14:936–40.

    Article  CAS  PubMed  Google Scholar 

  • Buschke H, Kuslansky G, Katz M, et al. Screening for dementia with the Memory Impairment Screen. Neurology. 1999;52:231–8.

    Article  CAS  PubMed  Google Scholar 

  • Cagliarini AM, Price HL, Livemore ST, Larner AJ. Will use of the Six-Item Cognitive Impairment Test help to close the dementia diagnosis gap? Aging Health. 2013;9(6):563.

    Article  CAS  Google Scholar 

  • Cannon P, Larner AJ. Errors in the scoring and reporting of cognitive screening instruments administered in primary care. Neurodegener Dis Manag. 2016;6:271–6.

    Article  PubMed  Google Scholar 

  • Copeland JR, McCracken CF, Dewey ME, Wilson KC, Doran M, Gilmore C, Scott A, Larkin BA. Undifferentiated dementia, Alzheimer’s disease and vascular dementia: age- and gender-related incidence in Liverpool. The MRC-ALPHA study. Br J Psychiatry. 1999;175:433–8.

    Article  CAS  PubMed  Google Scholar 

  • Cordell CB, Borson S, Boustani M, et al. Alzheimer’s Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimers Dement. 2013;9:141–50.

    Article  PubMed  Google Scholar 

  • Davies RR, Doran M, Larner AJ. Early-onset dementia. Prog Neurol Psychiatry. 2011;15(4):12–6.

    Article  Google Scholar 

  • Department of Health. Living well with dementia: a National Dementia Strategy. London: Department of Health; 2009.

    Google Scholar 

  • Department of Health. Prime Minister’s challenge on dementia. Delivering major improvements in dementia care and research by 2015. London: Department of Health; 2012.

    Google Scholar 

  • Department of Health. G8 dementia summit declaration. London: Department of Health; 2013.

    Google Scholar 

  • Department of Health. Prime Minister’s challenge on dementia 2020. London: Department of Health; 2015.

    Google Scholar 

  • Department of Health/Alzheimer’s Society. Understanding dementia. A resource pack for GPs and patients. London: Alzheimer’s Society; 2009.

    Google Scholar 

  • Doran M. Diagnosis of presenile dementia. Br J Hosp Med. 1997;58:105–10.

    PubMed  CAS  Google Scholar 

  • Fearn S, Larner AJ. Have Quality and Outcomes Framework Depression Indicators changed referrals from primary care to a dedicated memory clinic? Ment Health Fam Med. 2009;6:129–32.

    Google Scholar 

  • Ferran J, Wilson K, Doran M, Ghadiali E, Johnson F, Cooper P, McCracken C. The early onset dementias: a study of clinical characteristics and service use. Int J Geriatr Psychiatry. 1996;11:863–9.

    Article  Google Scholar 

  • Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005;366:2112–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fisher CAH, Larner AJ. FAQs: memory loss. Practitioner. 2006;250(1683):14–6, 19, 21.

    PubMed  Google Scholar 

  • Fisher CAH, Larner AJ. Frequency and diagnostic utility of cognitive test instrument use by general practitioners prior to memory clinic referral. Fam Pract. 2007;24:495–7.

    Article  CAS  PubMed  Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.

    Article  CAS  PubMed  Google Scholar 

  • Gale TM, Larner AJ. Six-Item Cognitive Impairment Test (6CIT). In: Larner AJ, editor. Cognitive screening instruments. A practical approach. 2nd ed. London: Springer; 2017. p. 241–53.

    Chapter  Google Scholar 

  • Ghadiri-Sani M, Larner AJ. Cognitive screening instrument use in primary care: is it changing? Clin Pract. 2014;11:425–9.

    Article  CAS  Google Scholar 

  • Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing. 1972;1:233–8.

    Article  CAS  PubMed  Google Scholar 

  • Hussey D, Foy K, Meehean K. Quality of dementia referrals to later life psychiatry service. Psychiatr Bull. 2009;33:154–5.

    Article  Google Scholar 

  • Kinsey SE, Giles FJ, Holton J. Cusum plotting of temperature charts for assessing antimicrobial treatment in neutropenic patients. BMJ. 1989;299:775–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Larner AJ. Two simple questions in the identification of dementia. J Neurol Neurosurg Psychiatry. 2005a;76:1317. (abstract 023)

    Article  Google Scholar 

  • Larner AJ. An audit of the Addenbrooke’s Cognitive Examination (ACE) in clinical practice. Int J Geriatr Psychiatry. 2005b;20:593–4.

    Article  CAS  PubMed  Google Scholar 

  • Larner AJ. Neurologists still have a role in the dementia care pathway. Clin Med. 2007a;7:528–9.

    Article  CAS  Google Scholar 

  • Larner AJ. DemTect: 1-year experience of a neuropsychological screening test for dementia. Age Ageing. 2007b;36:326–7.

    Article  CAS  PubMed  Google Scholar 

  • Larner AJ. Addenbrooke’s Cognitive Examination (ACE) for the diagnosis and differential diagnosis of dementia. Clin Neurol Neurosurg. 2007c;109:491–4.

    Article  CAS  PubMed  Google Scholar 

  • Larner AJ. Neuropsychological neurology: the neurocognitive impairments of neurological disorders. Cambridge: Cambridge University Press; 2008.

    Book  Google Scholar 

  • 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. 2009a;9:197–8.

    Article  CAS  Google Scholar 

  • Larner AJ. Quality of dementia referrals. Psychiatr Bull. 2009b;33:316.

    Article  Google Scholar 

  • Larner AJ. ACE-R: cross-sectional and longitudinal use for cognitive assessment. In: Fisher A, Hanin I, editors. New trends in Alzheimer and Parkinson related disorders: ADPD 2009. Collection of selected free papers from the 9th International Conference on Alzheimer’s and Parkinson’s disease AD/PD. Prague, Czech Republic, March 11–15, vol. 2009. Bologna: Medimond International Proceedings; 2009c. p. 103–7.

    Google Scholar 

  • Larner AJ. Impact of the National Dementia Strategy in a neurology-led memory clinic. Clin Med. 2010;10:526.

    Article  CAS  Google Scholar 

  • Larner AJ. Teleneurology by internet and telephone. A study in self-help. London: Springer; 2011.

    Book  Google Scholar 

  • Larner AJ. Head turning sign: pragmatic utility in clinical diagnosis of cognitive impairment. J Neurol Neurosurg Psychiatry. 2012a;83:852–3.

    Article  CAS  PubMed  Google Scholar 

  • Larner AJ. Screening utility of the Montreal Cognitive Assessment (MoCA): in place of - or as well as - the MMSE? Int Psychogeriatr. 2012b;24:391–6.

    Article  CAS  PubMed  Google Scholar 

  • Larner AJ. Neuropsychological neurology: the neurocognitive impairments of neurological disorders. 2nd ed. Cambridge: Cambridge University Press; 2013a.

    Book  Google Scholar 

  • Larner AJ. Addenbrooke’s Cognitive Examination-Revised (ACE-R): pragmatic study of cross-sectional use for assessment of cognitive complaints of unknown aetiology. Int J Geriatr Psychiatry. 2013b;28:547–8.

    Article  CAS  PubMed  Google Scholar 

  • Larner AJ. Impact of the National Dementia Strategy in a neurology-led memory clinic: 5-year data. Clin Med. 2014a;14:216.

    Article  CAS  Google Scholar 

  • Larner AJ. Screening utility of the “attended alone” sign for subjective memory impairment. Alzheimer Dis Assoc Disord. 2014b;28:364–5.

    Article  CAS  PubMed  Google Scholar 

  • Larner AJ. Performance-based cognitive screening instruments: an extended analysis of the time versus accuracy trade-off. Diagnostics (Basel). 2015a;5:504–12.

    Article  Google Scholar 

  • Larner AJ. Diagnostic test accuracy studies in dementia. A pragmatic approach. London: Springer; 2015b.

    Google Scholar 

  • Larner AJ. Mini-Addenbrooke’s Cognitive Examination diagnostic accuracy for dementia: reproducibility study. Int J Geriatr Psychiatry. 2015c;30:1103–4.

    Article  CAS  PubMed  Google Scholar 

  • Larner AJ, editor. Cognitive screening instruments. A practical approach. 2nd ed. London: Springer; 2017.

    Google Scholar 

  • Larner AJ. Dementia and the health of the nation. In: Severn A, editor. Cognitive changes after surgery. London: Springer; 2018. (in press).

    Google Scholar 

  • Larner AJ, Coles AJ, Scolding NJ, Barker RA. The A-Z of Neurological Practice. A guide to clinical neurology. 2nd ed. London: Springer; 2011.

    Google Scholar 

  • Lobo A, Launer LJ, Fratiglioni L, et al. Prevalence of dementia and major subtypes in Europe: a collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000;54(Suppl5):S4–9.

    PubMed  CAS  Google Scholar 

  • McManus IC. The history and geography of human handedness. In: Sommer IEC, Kahn RS, editors. Language lateralization and psychosis. Cambridge: Cambridge University Press; 2009. p. 37–58.

    Chapter  Google Scholar 

  • Meeuwsen EJ, Melis RJF, Van Der Aa GCHM, et al. Effectiveness of dementia follow-up care by memory clinics of general practitioners: randomised controlled trial. BMJ. 2012;344:e3086.

    Article  PubMed  PubMed Central  Google Scholar 

  • Menon R, Larner AJ. Use of cognitive screening instruments in primary care: the impact of national dementia directives (NICE/SCIE, National Dementia Strategy). Fam Pract. 2011;28:272–6.

    Article  CAS  PubMed  Google Scholar 

  • Milne A, Culverwell A, Guss R, Tuppen J, Whelton R. Screening for dementia in primary care: a review of the use, efficacy and quality of measures. Int Psychogeriatr. 2008;20:911–26.

    Article  CAS  PubMed  Google Scholar 

  • 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: National Institute for Health and Clinical Excellence; 2006. (www.nice.org.uk/cG042)

    Google Scholar 

  • O’Connor DW, Pollitt BA, Hyde JB, et al. Do general practitioners miss dementia in elderly patients? BMJ. 1988;297:1107–10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Price HL, Larner AJ. Type 2 diabetes and cognitive impairment: a case for screening? Prog Neurol Psychiatry. 2013;17(5):6–7.

    Article  Google Scholar 

  • Prince M, Wimo A, Guerchet M, et al. World Alzheimer Report 2015. The global impact of dementia. An analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International; 2015.

    Google Scholar 

  • Rossor MN, Fox NC, Mummery CJ, Schott JM, Warren JD. The diagnosis of young-onset dementia. Lancet Neurol. 2010;9:793–806.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sackett DL, Haynes RB. The architecture of diagnostic research. BMJ. 2002;324:539–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Schoenmaker N, Van Gool WA. The age gap between patients in clinical studies and in the general population: a pitfall for dementia research. Lancet Neurol. 2004;3:627–30.

    Article  PubMed  Google Scholar 

  • Seeher KM, Brodaty H. The General Practitioner Assessment of Cognition (GPCOG). In: Larner AJ, editor. Cognitive screening instruments. A practical approach. 2nd ed. London: Springer; 2017. p. 231–9.

    Chapter  Google Scholar 

  • Sells R, Larner AJ. The Poppelreuter figure visual perceptual function test for dementia diagnosis. Prog Neurol Psychiatry. 2011;15(2):17–8. 20–1

    Article  Google Scholar 

  • Stone J, Pal S, Blackburn D, Reuber M, Thekkumpurath P, Carson A. Functional (psychogenic) cognitive disorders: a perspective from the neurology clinic. J Alzheimers Dis. 2015;48(Suppl1):S5–17.

    Article  PubMed  Google Scholar 

  • Williamson J, Larner AJ. MACE for diagnosis of dementia and MCI: 3-year pragmatic diagnostic test accuracy study. Dement Geriatr Cogn Disord. 2018;45 (in press).

    Google Scholar 

  • Wimo A, Prince M. World Alzheimer Report 2010. The global economic impact of dementia. London: Alzheimer’s Disease International; 2010.

    Google Scholar 

  • Wohl H. The cusum plot: its utility in the analysis of clinical data. N Engl J Med. 1977;296:1044–5.

    Article  CAS  PubMed  Google Scholar 

  • Wojtowicz A, Larner AJ. General Practitioner Assessment of Cognition: use in primary care prior to memory clinic referral. Neurodegener Dis Manag. 2015;5:505–10.

    Article  PubMed  Google Scholar 

  • Wojtowicz A, Larner A. Scoring errors in cognitive screening instruments administered in primary care. J Neurol Neurosurg Psychiatry. 2016;87:e1.

    Article  Google Scholar 

  • Wojtowicz A, Larner AJ. Diagnostic test accuracy of cognitive screeners in older people. Prog Neurol Psychiatry. 2017;21(1):17–21.

    Article  Google Scholar 

  • World Health Organization. Dementia: a public health priority. Geneva: World Health Organization; 2012.

    Google Scholar 

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Authors and Affiliations

  1. Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK

    A. J. Larner

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Larner, A.J. (2018). Patients: Referral Patterns. In: Dementia in Clinical Practice: A Neurological Perspective. Springer, Cham. https://doi.org/10.1007/978-3-319-75259-4_1

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  • DOI: https://doi.org/10.1007/978-3-319-75259-4_1

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