[Dementia--diagnosis and treatment in a geriatric memory clinic]

Today it is certain that dementia is caused by a disease and not by ageing. The field is within the neurological, psychiatric and geriatric subject areas. In the city of Copenhagen, discovery and treatment of dementia occur on three levels: (1) in general practice, (2) in local memory clinics headed by specialists in geriatrics, neurology and/or psychiatry, and (3) in the memory clinic at H:S Rigshospitalet. In 2000, the geriatric clinic at H:S Bispebjerg Hospital established a local memory clinic. The fact that the clinic was created within a basic speciality other than neurology, as at Rigshospitalet, made it necessary to carry out developmental work.

A descriptive evaluation of 450 consecutive patient courses was performed. The patients were evaluated and treated in the memory unit in the period from 14 March 2001 to 31 December 2004.

330 (73%) of the 450 patients were women, and 120 (27%) were men. The median age was 84 years (range 64-97 years), and the median MMSE score was 24 (range 1-30) at first consultation in the memory unit. A cerebral CT was done on 339 patients (75%), and a SPECT scan was done on 6 patients (1%). 90 patients (20%) were evaluated by a gerontopsychiatrist during the treatment course, and 151 patients (34%) were evaluated by a neuropsychologist. A diagnosis of irreversible dementia was made for 322 patients (72%).

Most of the patients referred had a MMSE score greater than 20, and even patients with very high MMSE scores may suffer from irreversible dementia. Compared with examinations in Danish memory clinics in the context of neurology, there was a higher number of patients with irreversible dementia. The difference may probably be explained by the average age difference between the patients referred. The threshold of referring for evaluation of cognitive dysfunction may be lower for younger patients than for older patients. The geriatric concept is an appropriate platform for evaluation and treatment of older patients with cognitive dysfunction before such patients are hospitalized on an emergency basis or break down socially. To carry out complete and qualified evaluation and treatment, it is essential to establish local and close cooperation with a gerontopsychiatrist, a neurologist and a neuropsychologist.