Abstract
Melis and colleagues 1 argue for rigorous evaluation of memory clinics but at the same time admit that the need for service development is urgent, given the ageing of the population and the expected rise in the prevalence of dementia syndrome. This dilemma is a common one, and leads to the use of ‘best available’ evidence to inform policy, rather than ‘best quality’.
The National Dementia Strategy proposes a public education campaign about the early signs of dementia and asserts that general practice lacks the skills and confidence to undertake memory assessment. This risks weakening the gatekeeper function of general practitioners (GPs) and an unevaluated expansion of specialist services. The evaluation of such services that Melis and colleagues rightly desire cannot, in such circumstances, be about their effectiveness, since they are needed to manage the demand created by new policies. It could be an evaluation of their costs, and possibly their cost effectiveness.
Since one-quarter of the population aged 65 years and over have sufficient subjective memory impairment to cause them some concern, 2 GPs could become very busy referring people with memory lapses to clinics that will in turn become increasingly crowded. Unfortunately subjective memory impairment correlates poorly with objective impairment, and is only a weak predictor of dementia; it is associated more strongly with depression. If those admitting to memory impairment are followed through with psychological testing, only one in five of those who subsequently develop dementia will be identified. 3 The memory clinics could quickly fill up with the depressed. There is much that can be done for older people with depression, of course, but this would again require a re-engineering of a memory clinic model. Melis and colleagues have drawn an important issue to our attention.
Footnotes