QoL assessment provides a format for patients and (in)formal caregivers to express whether an intervention has made an important difference to the patient's life. Improvement of QoL in dementia should have high priority in care, treatment and research. This study shows that severity of dementia, care type, setting, and the specific QoL domains an intervention focuses on, determine which QoL instrument is most appropriate in a specific situation.

There are several instruments to assess needs of dementia patients and caregivers. Domains of unmet needs and HRQoL overlap. The Hierarchy Model of Needs in Dementia (HMND) offers a new theoretical framework to address the interplay between meeting of needs and improvement of HRQoL in dementia. By identifying unmet needs in dementia-research and focussing on unmet needs in dementia-care, much can be done to improve HRQoL.

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). ResultsThe 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. ConclusionNo 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. IntroductionMemory clinics used to focus on diagnosing dementia. However, they are increasingly involved in post-diagnosis treatment and coordination of care, especially since the introduction of anti-dementia drugs (cholinesterase inhibitors) in the 1990s. Previous research has indicated that memory clinics as diagnostic facilities are an efficient healthcare investment, 1-4 but no direct scientific evidence shows the effectiveness of treatment and follow-up of dementia by memory clinics. A few years ago, Great Britain announced a national dementia strategy. 7 The main goals of the strategy are improving public and professional awareness of dementia, enhancing early diagnosis and intervention for everyone, and providing higher quality care and support during all stages of dementia.8 9 This national strategy intends to achieve its goals by providing easy access to services and support through establishing a nationwide network of multidisciplinary memory clinics. The implementation of this strategy has led to a widespread discussion on the justification of this approach. 6 10-14 The critics of this strategy question the effectiveness of the treatment and follow-up memory clinics provide after a diagnosis is made. 15The discussion about the best way to treat and provide care for patients with dementia is also a matter of debate in other countries.14 16 17 To our knowledge, no randomised trials comparing the effectiveness of post-diagnosis dementia treatment and care coordination by memory clinics and general practitioners have ...

One in seven community-dwelling elderly with newly diagnosed AD is at risk of malnutrition. The degree of impairment in daily functioning is independently related to nutritional status. Therefore, assessment of the nutritional status should be included in the comprehensive assessment of AD patients. The relation between daily functioning, nutritional status and AD warrants further investigation.