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Effectiveness of dementia follow-up care by memory clinics or general practitioners: randomised controlled trial

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3086 (Published 15 May 2012) Cite this as: BMJ 2012;344:e3086
  1. Els J Meeuwsen, scientific researcher in geriatrics1,
  2. René J F Melis, senior researcher in geriatrics1,
  3. Geert C H M Van Der Aa, geriatrician2,
  4. Gertie A M Golüke-Willemse, geriatrician3,
  5. Benoit J M De Leest, geriatrician4,
  6. Frank H J M Van Raak, psychologist5,
  7. Carla J M Schölzel-Dorenbos, geriatrician16,
  8. Desiree C M Verheijen, geriatrician7,
  9. Frans R J Verhey, professor of old age psychiatry and neuropsychiatry8,
  10. Marieke C Visser, neurologist9,
  11. Claire A Wolfs, senior researcher in psychiatry and psychology8,
  12. Eddy M M Adang, senior researcher in efficiency studies10,
  13. Marcel G M Olde Rikkert, professor in geriatrics1
  1. 1Department of Geriatrics/Alzheimer Centre Nijmegen, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, Netherlands
  2. 2Department of Geriatrics, Catharina Hospital, 5602 ZA, Eindhoven, Netherlands
  3. 3Department of Geriatrics, Rijnstate Hospital, 6800 TA, Arnhem, Netherlands
  4. 4Department of Geriatrics, Elkerliek Hospital, 5700 AB, Helmond, Netherlands
  5. 5GGZ Oost-Brabant, Centre Land van Cuijk, 5830 AC, Boxmeer, Netherlands
  6. 6Memory Clinic, Slingeland Hospital, 7000 AD, Doetinchem, Netherlands
  7. 7Department of Geriatrics, Gelderse Vallei Hospital, 6710 HN, Ede, Netherlands
  8. 8Department of Psychiatry and Neuropsychology/Alzheimer Centre Limburg, Maastricht University Medical Centre+, 6202 AZ, Maastricht, Netherlands
  9. 9Department of Neurology/Alzheimer Centre Amsterdam, VU Medical Centre Amsterdam, 1007 MB, Amsterdam, Netherlands
  10. 10Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre
  1. Correspondence to: E Meeuwsen E.Meeuwsen{at}ger.umcn.nl
  • Accepted 26 March 2012

Abstract

Objective To examine the effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared with general practitioners.

Design Multicentre randomised controlled trial.

Setting Nine memory clinics and 159 general practitioners in the Netherlands.

Participants 175 patients with a new diagnosis of mild to moderate dementia living in the community and their informal caregivers.

Interventions Usual care provided by memory clinic or general practitioner.

Main outcome measures Caregiver rated quality of life of the patient measured with the quality of life in Alzheimer’s disease instrument and self perceived burden of the informal caregiver measured with the sense of competence questionnaire (intention to treat analysis).

Results 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 general practitioner group. Caregivers’ burden was 2.4 (−5.8 to 1.0) points lower in the memory clinic group than in the general practitioner group.

Conclusion 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.

Trial registration Clinical trials NCT00554047.

Footnotes

  • We thank all participants for their contribution. We also thank the research assistants for carrying out all the measurements and the staff of the memory clinics for their participation.

  • Contributors: GCHMVDA, GAMG-W, BJMDL, FHJMVR, CJMS-D, DCMV, FVRJ, MCV, CAW, and MGMOR recruited the participants. EJM, RJFM, and EMMA analysed the data and, with and MGMOR, interpreted the data and wrote the manuscript. All authors approved the final manuscript. MGMOR is the guarantor.

  • Funding: This work was supported by ZonMw (Netherlands Organization for Health Research and Development; grant no 945-07-703) and by the Radboud University Nijmegen Medical Centre.

  • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study was approved by the Medical Ethics Committee of the Radboud University Nijmegen Medical Centre.

  • Data sharing: The dataset is available from the corresponding author at e.meeuwsen{at}ger.umcn.nl. Participants’ consent was not obtained, but the data presented are anonymised and risk of identification is low.

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