Memory clinics no better than GP care for post-diagnosis treatment of dementia, according to new RCT

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Memory clinics are becoming more widespread in the UK and elsewhere. They offer assessment, support, information and advice to people with memory problems and their carers. GPs will often refer patients to memory clinics if they feel that they may be in the early stages of dementia, but need an assessment before a diagnosis can be made. Increasingly, memory clinics are being used for post-diagnosis treatment and coordination of care.

The diagnosis and general management of dementia is described in detail in NICE-SCIE clinical guideline CG42 on dementia, which recommends that memory assessment services should:

Offer a responsive service to aid early identification and include a full range of assessment, diagnostic, therapeutic and rehabilitation services to accommodate the needs of people with different types and all severities of dementia, and the needs of their carers and family (see the clinical guideline (PDF) for further detail on the recommendations made for each service component)

A new randomised controlled trial has been published in the BMJ that compares the effectiveness of treatment and care provided by memory clinics and GPs. The aim was to see if if was worth the extra time and expense to send patients on to memory clinics, rather than simply care for them in primary care. Memory clinics have been shown to be effective as diagnostic facilities, but are they also effective for post-diagnosis treatment and care?

The study took place in the Netherlands where 175 community-living patients with a recent diagnosis of mild to moderate dementia were randomised to receiving care either from a memory clinic or from their GP.

The outcomes of interest were:

  • Quality of life
  • Burden of care

Here’s what they found:

  • The quality of life of the patients in the memory clinic group was 0.5 (95% confidence interval −0.7 to 1.6) points higher than in the GP group
  • Caregivers’ burden was 2.4 (−5.8 to 1.0) points lower in the memory clinic group than in the general practitioner group

The authors concluded:

No evidence was found that memory clinics were more effective than general practitioners with regard to post-diagnosis treatment and coordination care for patients with dementia. Without further evidence on the effectiveness of these modalities, other arguments, such as cost minimisation, patients’ preferences, or regional health service planning, can determine which type of dementia care is offered.

The study is well conducted and robust, but has a number of weaknesses worth noting:

  • They recruited patients only from memory clinics so the study population may not be representative of the general population
  • The study involved Dutch patients, so professionals in other countries may feel that the results are not generalisable to their own healthcare system
  • The follow-up was only 12 months long, which may have missed many outcomes that develop more slowly over time with dementia
  • The ‘pragmatic’ trial was not double-blind

Links

Meeuwsen E. et al Effectiveness of dementia follow-up care by memory clinics or general practitioners: randomised controlled trial. BMJ 2012;344:e3086

Dementia: supporting people with dementia and their carers in health and social care. CG42 Dementia (PDF). NICE guideline, Nov 2006 (Amended Mar 2011).

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