Pelosi et al.1 criticise memory clinics as costly luxuries, focussing
on mild cases of dementia with few significant support needs. Specialist
old age psychiatry services were originally developed in response to the
scandalous lack of recognition or understanding of dementia, and the
absence of anything but the most basic care in response to crisis
presentations late in the course of the disorder.
Consequently, among the
service principles originally enunciated by pioneers such as Tom Arie were
that they should aim to be as accessible and comprehensive as possible2.
One of the effects of the availability of anti-dementia drugs is that
patients are now presenting and being referred with milder cognitive
impairments; this gives us an important opportunity to prepare patients
and their families for what is to come, and to anticipate and prevent some
of the later problems. Memory clinics do not just prescribe and monitor
drug treatments; they can provide information, practical and emotional
support both individually and in groups, advice and guidance about issues
such as employment, financial planning and fitness to drive, non-
pharmacological interventions such as anxiety management, ‘coping with
forgetfulness’ classes and memory training, health education to optimise
residual cognitive functioning, and prompt referral to other health and
social care services as needs change. They can also provide a focus for
professional training in dementia assessment and care, for research into
future therapeutic possibilities, and for the development of services for
those who are still neglected, such as younger adults or those with
learning disabilities. We should be investing more, not less, in the
development and evaluation of this particular service model.
1 Pelosi, A.J., McNulty, S.V., and Jackson, G.A. (2006) Role of
cholinesterase inhibitors in dementia care needs rethinking. British
Medical Journal, 333, 491-3.
2 Arie, T. (1970) The first year of the Goodmayes psychiatric
service for old people. Lancet ii, 1175-82.
Rapid Response:
Memory clinics have a role in dementia care
Pelosi et al.1 criticise memory clinics as costly luxuries, focussing
on mild cases of dementia with few significant support needs. Specialist
old age psychiatry services were originally developed in response to the
scandalous lack of recognition or understanding of dementia, and the
absence of anything but the most basic care in response to crisis
presentations late in the course of the disorder.
Consequently, among the
service principles originally enunciated by pioneers such as Tom Arie were
that they should aim to be as accessible and comprehensive as possible2.
One of the effects of the availability of anti-dementia drugs is that
patients are now presenting and being referred with milder cognitive
impairments; this gives us an important opportunity to prepare patients
and their families for what is to come, and to anticipate and prevent some
of the later problems. Memory clinics do not just prescribe and monitor
drug treatments; they can provide information, practical and emotional
support both individually and in groups, advice and guidance about issues
such as employment, financial planning and fitness to drive, non-
pharmacological interventions such as anxiety management, ‘coping with
forgetfulness’ classes and memory training, health education to optimise
residual cognitive functioning, and prompt referral to other health and
social care services as needs change. They can also provide a focus for
professional training in dementia assessment and care, for research into
future therapeutic possibilities, and for the development of services for
those who are still neglected, such as younger adults or those with
learning disabilities. We should be investing more, not less, in the
development and evaluation of this particular service model.
1 Pelosi, A.J., McNulty, S.V., and Jackson, G.A. (2006) Role of
cholinesterase inhibitors in dementia care needs rethinking. British
Medical Journal, 333, 491-3.
2 Arie, T. (1970) The first year of the Goodmayes psychiatric
service for old people. Lancet ii, 1175-82.
Competing interests:
None declared
Competing interests: No competing interests