Integrated multidisciplinary diagnostic approach for dementia

Wolfs et al have described a cluster randomised controlled trial in The Netherlands in which patients with suspected dementia received integrated multidisciplinary assessment or usual care. ¹ Input to the intervention group aimed to combine the hospital-based approach of a memory clinic with the care-oriented approach of a community mental health team. This intervention led to some modest improvements in outcome. Usual care during the trial was provided by the general practitioner, or involved referral to a regional memory clinic, a department of geriatric medicine or mental health service for the elderly.

The integrated approach only lasted for about 2 weeks, after which detailed diagnostic and therapeutic advice was given to general practitioners. Given that dementia is a progressive neuro-degenerative disorder with constantly changing medical and social care needs, we would be surprised if this intervention could sustain superiority over ongoing care from any community mental health service for elderly people – no matter how rudimentary. Further details on treatment as usual would have been useful, as would a reanalysis of the results taking into account the different types of service received by the control patients.

We agree with Wolf et al that memory clinics need to integrate with multidisciplinary community services. We have argued previously that the sub-specialist memory clinics in the UK have not been useful in the overall management of dementia since they have distorted care priorities and have focused on the prescribing and monitoring of medication. ² Wolf et al's controlled trial has provided support for integration of services for the diagnosis and care of dementia. This has to be organised not only in the initial diagnostic stages but also on an ongoing basis, with close liaison between multidisciplinary health services, local social work departments and primary care throughout the course of patients' progressive illness.