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Memory clinics and dementia care: the issue is stigma not screening
- David Jolley, Esme Moniz-Cook (18 February 2009)
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David Jolley, Consultant Psychiatrist and Honorary Reader PSSRU, Manchester University, Dover Street MM13 9PL, Esme Moniz-Cook
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Critics are right to question the evidence base for Memory Clinics (1) if the only purpose for these is to screen for drug treatments. However, a comprehensive worldwide review of memory clinics which had a particular focus on developments in the UK, outlined a much wider role and set of functions, which included providing an acceptable, accessible, high quality assessment, rehabilitation and follow-up facility for people with memory concerns or suspected dementia and their families (2). The Dementia Strategy rightly embraces an important underlying conceptual problem. If a narrow disease framework is the focus of treatment in dementia services, then the sceptics may understandably remain pessimistic. However if dementia is also construed as a common long-term disability of later life, then Memory Clinics can serve to neutralise the double stigma of age and dementia and provide timely interventions that help people and their families to ‘live well with the condition’. A pan-European study of dementia, noted that irrespective of dementia resources, stigma associated with dementia was associated with the lack of supportive interventions or the under-use of these where they existed (3). Furthermore, the effects of stigma were less marked in countries with widespread Memory Clinics and other dementia care services. In its effort to counteract stigma, the Dementia Strategy recommends the sustained development of Memory Clinics to act as a reference point for people, carers, professionals and the public and also serve as a source of support and guidance on best practice in dementia. We suggest that properly resourced Memory Clinics are well placed to provide a ‘value for money’ service that raises expectations about living well with dementia, using the emerging range of early psychosocial interventions to promote maintenance of purpose, pleasure, meaningful activity, valued relationships and quality of life for people and their families (5). 1. Coombes R. Evidence lacking for memory clinics to tackle dementia, say critics. BMJ 2009: 338:b550 2. Jolley D and Moniz-Cook E. Memory Clinics in context. Indian Journal of Psychiatry 2009: 51: S70-76 3. Vernooij-Dassen, M., Moniz-Cook, E., Woods, R., De Lepeleire, J. et al. Factors affecting timely recognition and diagnosis of dementia across Europe: from awareness to stigma. International Journal of Geriatric Psychiatry 2005: 20: 377-386 4. National Institute for Health and Clinical Excellence and Social Care Institute for Excellence. Dementia: supporting people with dementia and their carers in health and social care. National Clinical Practice guideline number 42: available from www.nice.org.uk/guidance/index.jsp?action=byID&o=10998 5. Moniz-Cook E and Manthorpe J. (2009) Early Psychosocial Interventions in Dementia: Evidence-Based Practice. Jessica Kingsley, London. David Jolley Hon. Reader Manchester University, PSSRU Dover Building, Dover Street, Manchester M13 9PL Esme Moniz-Cook Hon. Professor of Clinical Psychology and Ageing, Institute of Rehabilitation, Hull York Medical School, University of Hull, 215 Anlaby Road, Hull HU3 2 PG Competing interests: None declared |
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