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 ...

ObjectiveTo evaluate the cost-effectiveness of post-diagnosis dementia treatment and coordination of care by memory clinics compared to general practitioners’ care.MethodsA multicentre randomised trial with 175 community dwelling patients newly diagnosed with mild to moderate dementia, and their informal caregivers, with twelve months’ follow-up. Cost-effectiveness was evaluated from a societal point of view and presented as incremental cost per quality adjusted life year. To establish cost-effectiveness, a cost-utility analysis was conducted using utilities based on the EQ-5D. Uncertainty surrounding the incremental cost-effectiveness ratio (difference in costs divided by difference in effects) was calculated by bootstrapping from the original data.ResultsCompared to general practitioners’ care, treatment by the memory clinics was on average €1024 (95% CI: −€7723 to €5674) cheaper, and showed a non-significant decrease of 0.025 (95% CI: −0.114 to 0.064) quality adjusted life years. The incremental cost-effectiveness point estimate from the bootstrap simulation was € 41 442 per QALY lost if one would use memory clinic care instead of general practitioner care.ConclusionNo evidence was found that memory clinics were more cost-effective compared to general practitioners with regard to post-diagnosis treatment and coordination of care of patients with dementia in the first year after diagnosis.Trial Registration ClinicalTrials.gov NCT00554047

ClinicalTrials.gov Identifier NCT00554047.

Research on geriatric syndromes has helped to clarify risk factors and established effective intervention strategies, yet the results based on this evidence have mostly failed to translate into clinical practice. The translation of geriatric syndrome research into practice faces unique challenges, which may heighten the barriers to evidence-based implementation. The British Medical Research Council framework (MRC) for development and evaluation of complex interventions, turns out to be very valuable in developing and evaluating interventions in the complex clinical reality of geriatrics. This paper illustrates the different phases of this framework on the basis of examples from geriatric research projects in The Netherlands. The discussed barriers in complex interventions can be mapped using the different phases in the MRC-framework and thus become feasible challenges for good quality research.

According to current dementia guidelines from 2005 (CBO) functional brain imaging by PET-scan of the brain has no place in the analysis of a dementia syndrome. Differential diagnosis between Alzheimer disease and other causes of dementia remains important because there are differences in natural course and treatment. Here we present three patients aged 62, 71 and 68 years with dementia syndrome who were assessed at an outpatient memory clinic. After geriatric assessment and subsequent brain MRI the etiology of the dementia remained unclear. In all three patients the etiology became clear after using a 18 FDG PET-scan of the brain. We conclude that 18 FDG PET imaging of the brain has added value in the analysis of dementia syndrome with an unclear etiology after initial analysis.