Dementia diagnosis delayed by complex referral criteria

Complex and time-consuming memory clinic referral criteria are contributing to delays in the diagnosis of dementia, according to a paper published today by the Journal of the Royal Society of Medicine. Around 850,000 people are living with dementia in the UK but the number thought to have dementia substantially exceeds those with a formal diagnosis. Early diagnosis is a priority for the government and the NHS.

Currently GPs are responsible for referring patients for assessment and diagnosis by specialists, usually in dedicated memory clinics which set referral criteria. There is considerable variation in referral criteria, with requirements set by some memory clinics that exceed national guidelines. Requirements can include different combinations of cognitive tests, laboratory blood tests, urine tests and physical examination that vary between clinics.

Lead author Dr Benedict Hayhoe, of the School of Public Health at Imperial College London, says: "GPs have difficulty assessing patients with memory problems in strict accordance with guidance within a 10-minute consultation; in our experience a significant proportion of available consultation time can be taken up by carrying out just one of the brief cognitive tests." He went on to suggest that, with current workload pressures on primary care, complex criteria involving multiple investigations are likely to provide a significant disincentive for referral.

The authors set out alternative approaches to speed up diagnosis. Dr Hayhoe said: "A primary care led process, perhaps staffed by practice nurses carrying out assessments according to protocols, may speed up diagnosis while reducing pressure on GPs and specialists." He added that it may also be appropriate to allow people with memory concerns direct access to memory clinics.

Dr Hayhoe concludes: "A system that discourages or delays referral for dementia is highly counterproductive; an urgent review of this area is necessary to establish a system that effectively supports patients and clinicians in early diagnosis, treatment and prevention."