Memory assessment services and health‐related quality of life: 1‐year follow‐up

Park, Min Hae; Smith, Sarah C.; Ritchie, Craig W.; Hendriks, A. A. Jolijn; Black, Nick

doi:10.1002/gps.4913

Cited by 4 publications

(6 citation statements)

References 26 publications

(52 reference statements)

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“…Patients' mean health-related quality of life improved in the first 6 months irrespective of diagnosis. Another cohort study 106 found that self-reported health-related quality of life improved in all study participants over the first year after their initial appointment at a MAS. People with a diagnosis of dementia saw greater improvement in health-related quality of life than people with MCI or no diagnosis.…”

Section: Memory Clinics/memory Assessment Servicesmentioning

confidence: 93%

“…Memory clinics or MASs were investigated in 16 studies 16,46,48,49,70,77,[102][103][104][105][106][107][108][109][110][111] (Table 9).…”

Section: Memory Clinics/memory Assessment Servicesmentioning

confidence: 99%

“…Patient outcomes were investigated in four studies. 46,105,106,109 A cohort study 105 investigated changes in patients' health-related quality of life 6 months after referral to a MAS in England. Patients' mean health-related quality of life improved in the first 6 months irrespective of diagnosis.…”

Section: Memory Clinics/memory Assessment Servicesmentioning

confidence: 99%

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Assessment and management pathways of older adults with mild cognitive impairment: descriptive review and critical interpretive synthesis

Chambers

Cantrell

Sworn

2022

Health Soc Care Deliv Res

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Background Mild cognitive impairment in older adults is a risk factor for dementia. Mild cognitive impairment is a result of a diverse range of underlying causes and may progress to dementia, remain stable or improve over time. Objectives We aimed to assess the evidence base around the assessment and management pathway of older adults with mild cognitive impairment in community/primary care, hospital and residential settings. Data sources In January 2021, we searched MEDLINE, EMBASE, PsycInfo®, Scopus, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (i.e. Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials), Science Citation Index and Social Science Citation Index. The search was limited to studies published in English between 2010 and 2020. Grey literature and citation searches were also performed. Methods We performed two separate evidence reviews: (1) a descriptive review with narrative synthesis focusing on diagnosis, service provision and patient experience; and (2) a critical interpretive synthesis of evidence on the advantages and disadvantages of ‘mild cognitive impairment’ as a diagnostic label. Results A total of 122 studies were included in the descriptive review, of which 29 were also included in the critical interpretive synthesis. Study participants were most commonly recruited from populations of community-living older adults or those who had sought medical help from their general practitioner for memory problems. Follow-up searching identified a further 11 studies for the critical interpretive synthesis. The descriptive review identified multiple barriers to efficient diagnosis, starting with patient reluctance to seek help. General practitioners have a variety of cognitive tests available, but substantial numbers of patients meeting criteria for dementia do not have a diagnosis recorded. Patients may be referred to a memory clinic, but these clinics are mainly intended to identify and support people with dementia, and people with mild cognitive impairment may be discharged back to their general practitioner until symptoms worsen. Availability of scanning and biomarker tests is patchy. Qualitative studies show that patients with mild cognitive impairment and their carers find the process of investigation and diagnosis difficult and frustrating to negotiate. The key finding from the critical interpretive synthesis was that the need for a ‘timely’ diagnosis outweighs the ongoing debate about the value, or otherwise, of early investigation and labelling of memory problems. Determining what is a timely diagnosis involves balancing the perspectives of the patient, the health system and the clinician. Conclusions The two reviews reported here have applied different ‘lenses’ to the same body of evidence. Taken together, the reviews highlight the importance of a timely diagnosis for memory problems and identify barriers to obtaining such a diagnosis, from reluctance to seek help through to patchy availability of advanced diagnostic tests. Limitations The review was primarily descriptive, reflecting the prespecified review questions. Study selection was complicated by lack of a consistent definition of mild cognitive impairment and its overlap with other memory disorders. It was not possible to employ double study selection, data extraction or quality assessment, although processes of checking and verification were used throughout the review. Future work Priorities include evaluating remote methods of memory assessment and preparing for the likely future availability of disease-modifying treatments for early dementia. Research is needed on the investigation of memory problems in hospital and social care settings. Study registration This study is registered as PROSPERO CRD42021232535. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 10. See the NIHR Journals Library website for further project information.

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Section: Memory Clinics/memory Assessment Servicesmentioning

confidence: 93%

“…Memory clinics or MASs were investigated in 16 studies 16,46,48,49,70,77,[102][103][104][105][106][107][108][109][110][111] (Table 9).…”

Section: Memory Clinics/memory Assessment Servicesmentioning

confidence: 99%

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Assessment and management pathways of older adults with mild cognitive impairment: descriptive review and critical interpretive synthesis

Chambers

Cantrell

Sworn

2022

Health Soc Care Deliv Res

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“…This study focuses on HRQL reported by the patient. Proxy‐reports by their carer are reported elsewhere . Patient questionnaires included disease‐specific (DEMQOL) and generic (EQ‐5D‐3 L) HRQL outcomes.…”

Section: Methodsmentioning

confidence: 99%

Cost‐effectiveness analysis of English memory assessment services 2 years after first consultation for patients with dementia

Gomes

Pennington

Black

et al. 2018

Int J Geriat Psychiatry

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Objectives: This paper aims to compare changes over 2 years in patients' healthrelated quality of life (HRQL) with the health and social care costs of diagnosis and treatment of people newly referred to memory assessment services (MAS). Methods:We analysed observational data from 1318 patients referred to 69 MAS who completed resource use and HRQL questionnaires at baseline 3, 6, 12, and 24 months. We reported mean differences in HRQL (disease-specific DEMQOL and generic EQ-5D-3 L), quality-adjusted life years (QALYs), costs and costeffectiveness between baseline, and 2-year follow-up.Results: Two years after referral to MAS, patients reported a higher DEMQOL score (mean gain 4.47, 95% confidence interval, 3.08-5.90) and EQ-5D-3 L (0.014, −0.011 to 0.039). Mean total costs and QALYs over 24 months was £2411 (£1721-£2873) and 0.027 (0.003-0.051), respectively. Assuming that patients' HRQL would not have altered over the 2 years had they not attended MAS, these outcomes suggest an incremental cost-effectiveness ratio of £89 546 (£38 123-£145 864) based on changes in EQ-5D-3 L. If we assumed that patients' HRQL would have declined by about 10% over this period had they not attended MAS, the cost-effectiveness ratio would be £25 056. The largest MAS (N = 32; 46%) with over 50 new patients a month were more likely to be cost-effective than smaller ones (P < 0.01).Conclusions: MAS are effective and can be cost-effective for diagnosing and treating people with suspected dementia. Large variations in costs between clinics suggest that many MAS could improve their cost-effectiveness. KEYWORDS cost-effectiveness analysis, dementia, England, memory assessment services 1 | INTRODUCTION The number of people living with dementia worldwide has increased in the last two decades mainly driven by population ageing. 1 In 2017, there were an estimated 50 million people with dementia, with nearly 10 million new cases expected now every year. 1 Dementia is a major cause of disability and burden of care in elderly people and is associated with rising health care costs. The costs associated with dementia worldwide are expected to rise above $1 trillion in 2018, which represents over 1% of the global GDP. 2 These rising costs are mostly due to the increased need for social and health care and family support (informal care). 2There is considerable evidence that early diagnosis and support for those with dementia enables them to live well for longer and helps reduce long-term costs. 3,4 To encourage this, referral of people with

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“…All of the available HRQL instruments for people with dementia were originally developed using psychometric methods based on Classical Test Theory (CTT) [30] and although widely used at the time, instruments developed using CTT have a number of weaknesses (see [22] for an overview). Firstly, they generate scales that at best are ordinal rather than equidistant interval scales.…”

Section: Psychometric Approachesmentioning

confidence: 99%

Measuring Health-Related Quality of Life in Dementia

Smith

2022

Springer Series in Measurement Science and Technology

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Dementia presents unique challenges for the measurement of health-related quality of life (HRQL). The subjective nature of the HRQL construct, the cognitive demands of questionnaires, and the necessity of sometimes relying on a proxy report taken together mean that traditional questionnaires scored using classical psychometrics may not provide robust measurement. Advanced psychometric methods, such as those based on Rasch measurement theory, can provide possible solutions to these challenges. Rasch based methods have been used with the DEMQOL/DEMQOL-Proxy disease specific HRQL instrument to measure HRQL in people with dementia, to provide robust scales, to equate self- and proxy-reported instruments, and to create a cross walk from a proxy-reported measurement to the equivalent self-reported measurement. These methods also provide a qualitative understanding of statistical change. Advanced psychometric methods such as those based on Rasch measurement theory therefore provide a potentially powerful way to address the challenges of measuring HRQL for people with dementia. However, the use of these methods is not a quick fix. They require careful development of a conceptual framework describing the construct (HRQL) and a commitment to keeping the person with dementia’s perspective central at all stages of the process.

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Memory assessment services and health‐related quality of life: 1‐year follow‐up

Abstract: Improvements in HRQL observed at 6 months are maintained up to 1 year after the first MAS appointment, more so among those who receive a diagnosis of dementia. Continued follow-up will determine if the improvement is even longer lasting.

Cited by 4 publications

References 26 publications

Assessment and management pathways of older adults with mild cognitive impairment: descriptive review and critical interpretive synthesis

Assessment and management pathways of older adults with mild cognitive impairment: descriptive review and critical interpretive synthesis

Cost‐effectiveness analysis of English memory assessment services 2 years after first consultation for patients with dementia

Measuring Health-Related Quality of Life in Dementia

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