Dementia in the clinic

One of my PhD colleagues, Rebecca Atkinson, wrote recently that each student at Sussex funded by the Alzheimer’s Society charity is afforded the opportunity to complete placements in a local Memory Assessment Services (MAS) clinic. I was paired with Consultant Psychiatrist Dr Cathy Ulliott, who specialises in old age psychiatry, and have attended the outpatient centre in Shoreham twice since May.

On my first visit, I met with Cathy to discuss the process that patients in this area of Sussex experience when they are referred to the MAS team. In different NHS regions, the practice can differ, but in the local Sussex area, patients will be referred by their GP to the MAS team, and first contact is typically with a specialist nurse, with whom the patient will complete a number of assessments including the ACE (Addenbrookes Cognitive Examination). The patient will typically also have a brain scan. Together, assessments such as these help the clinician build a picture of a person’s performance in cognitive domains of language, spatial ability, problem solving, and aspects of memory, alongside being able to determine whether any damage, degeneration, or reduced vascular supply is evident in the brain.

On my second visit, I attended Dr Ulliott’s clinic, in which she met with three patients. The primary role of these appointments was to establish a diagnosis for each individual, based upon the results of the assessments, in combination with information on the individual’s family and medical histories, and interviews with the patient and their carer(s) in terms of how their cognitive difficulties might be presenting in their everyday life. Following diagnoses and administration of treatment (where possible and appropriate), patients would meet with the Dementia Advisor on-site, who is employed by the Alzheimer’s Society. The Dementia Advisor is able to help the patient and their carer navigate Social Services’ Care Needs Assessments, give information on the different types of dementia, and provide materials and contacts for social and professional support available in the local area.

The patients I observed were aged between 78-82, two male and one female; all three patients were given diagnoses of mixed dementia, vascular dementia with Alzheimer’s. What struck me most keenly during my observation of the sessions however, was the difference between each of these patients’ abilities despite receiving the same diagnosis, and being of similar ages. Differences were noticeable in terms of the patients’ capacity to recognise and articulate their abilities and limitations, and the reports from the caregivers accompanying the patient (in all three cases, the patient’s spouse), but most surprising to me was the differences that were evident in each individual’s ability to perform in the memory assessment tests, and the extent their problems affected their completion of everyday tasks and ability to live a full life.

The differences between each of the patients I saw in Dr Ulliott’s clinic brought home to me the extent to which other aspects of health can affect the subjective patient experience of having dementia, as well as the way in which individual differences and life experiences may affect both the personal experience and observable development of dementia/cognitive decline at certain stages – an aspect particularly relevant to research being conducted at Sussex.

I was also struck by how difficult it can be to establish accurate diagnoses of the various forms of dementia, and the importance of the expertise and discernment of the Psychiatrist in their analysis not only of the clinical test results, but of the conversations, reporting of symptoms and lifestyle effects of the memory and cognitive problems obtained from the patient and their carer. I found the visit to the MAS clinic extremely informative and look forward to visiting with Dr Ulliott again.

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