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Memory Clinics

WAI-Affiliated Dementia Diagnostic Clinic Network

 

Development Process

A major program of the WAI is to encourage the development of accessible quality multidisciplinary dementia diagnostic services in Wisconsin that will promote early diagnosis and treatment as well as support for caregivers. The need for more accessible diagnostic services is often recognized by local community organizations; other times it is the physician or nurse practitioner who recognizes the need in his or her own practice.  WAI outreach staff will convene these groups of concerned people to discuss this need and through a series of meetings discuss how to meet it. 

 

The development of a memory clinic may take some time as the health care system’s administration needs to support it and an interdisciplinary team needs to be assembled.  Some times a physician may need to be identified or a business plan developed.   Physicians as well as administrators may need to be educated about the need for early diagnosis, the benefits to medical practice and to community health and how to bill for services.  If the health care system does not have a psychologist or social worker, partnering community agencies may have to be asked to provide them. Trust of referring physicians needs to be established, often through educational programs presented by the memory clinic physician and/or WAI staff.  Community education programs are often presented to increase public awareness about the signs and symptoms of dementia and the need for early diagnosis.

 

Physicians, nurses, social workers, OTs and psychologists who will be working in the memory clinic are invited to observe and learn from the dementia diagnostic team at the UW Health Geriatric Assessment Center’s memory clinic in Madison. They are provided with a practice protocol, that through experience, has demonstrated efficient use of staff time, forms to use and the guidelines for affiliation with the WAI network.  Members of the developing memory team or management staff may observe or talk with staff from WAI- affiliated clinics to learn from their experience.  Information learned from these sources is then incorporated into a model that will work in their own clinic practice.

SUGGESTED PROTOCOL

Protocol: 1) Mail letter and patient history form to patient/family or caregiver. 2) Contact family/patient or caregiver 1 week prior to visit (as a reminder, describe purpose and content of visit, ask if they have any special concerns). 3) Clinic visits. First clinic visit is two hours. First hour consists of cognitive testing, family interview and a team meeting. Second hour consists of history and physical, family conference and plan of care. Second clinic visit (one to two weeks later) includes a review of results/diagnostic impression and supportive services if needed. 4) Schedule follow-up visits in one month, three month, nine month and then six to twelve month intervals.

 

 

Guidelines for Clinics in the WAI-Affiliated Dementia Diagnostic Clinic Network

  1. The clinic must provide interdisciplinary care that at a minimum includes the services of a physician, social worker or equivalent and neuropsychologist or similarly trained personnel.
  2. The clinic should be affiliated with a medical organization that provides space, scheduling assistance and modern laboratory and radiology services.
  3. All clinics must have a relationship with their local Alzheimer’s Association Chapter that will provide longitudinal education and support to persons affected by Alzheimer’s disease and their families.
  4. The medical evaluation must be provided by a qualified physician, physician’s assistant or nurse practitioner who has been trained in neurology, psychiatry or geriatrics.
  5. Diagnosis to follow DSM-IV and NINCDS Criteria for Alzheimer’s disease, DSM-IV criteria for vascular dementia, and relevant research diagnostic criteria for MCI, frontotemporal dementia, and Lewy body dementia
  6. Cognitive testing must include at least a brief cognitive battery that evaluates key areas in a validated standardized manner.
    • Strongly encourage use of the Repeatable Battery for Assessment of Neuropsychological Status (RBANS).
    • For clinical purposes only, an alternative is to choose a separate measure from each of the following categories:
      1. A standardized cognitive mental status exam
      2. A category fluency measure
      3. A standardized measure of visual praxis
      4. A word list learning test
      5. A brief standardized measure of executive function
    • Cognitive test data should be supported by information about everyday cognitive function provided by a family member or other close informant
  1. Psychological assessment to include screening for depression.
  2. Information gathered from an informant at the time of diagnosis will include IADL and ADL functional screens.
  3. A caregiver burden assessment will be included in the initial visit and referral for information and services made to appropriate community services, if indicated.
  4. Clinics are encouraged to participate in a systematic and high quality data collection.
  5. Physicians and other clinic staff must be willing to attend annual CME and organizational meetings sponsored by the WAI.

 

For More Information

For more information about dementia diagnostic clinic development or the WAI-Affiliated Dementia Diagnostic Clinic Network, contact Barbara Lawrence at 608-829-3302 or blawrence@wisc.edu.

 

Go to list of Memory Clinics


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