A new one‐stop interdisciplinary cognitive clinic model tackles rural health inequality and halves the time to diagnosis: Benchmarked against a national dementia registry

Abstract

ObjectivesUnequal access to cognitive assessments is a major barrier to timely diagnosis, especially for those living in rural or remote areas. ‘One‐stop’ cognitive clinic models are a proposed solution, but few such clinics exist. We evaluate the implementation of a new one‐stop State‐wide clinic model in Tasmania, Australia, where 27% of people live in rural/remote areas.MethodsA novel single‐visit protocol has been developed, comprising interdisciplinary medical and cognitive assessments, research participation, consensus diagnosis and management plan. A cross‐sectional evaluation was undertaken using the RE‐AIM (reach, effectiveness, adoption, implementation, maintenance) framework and results benchmarked against the national Australian Dementia Network Registry.ResultsOver the first 52 consecutive weekly clinics: Reach: 130 adults were assessed (mean age [SD] 70.12 years [10.31]; 59.2% female) with 40 (36.8%) from rural/remote areas. Effectiveness: 98.5% (128/130) received a same‐day diagnosis: 30.1% (n = 40) Subjective Cognitive Decline, 35.4% (46) Mild Cognitive Impairment, 33.1% (43) dementia and one case inconclusive. Adoption: 22.9% (156) of General Practitioners referred patients. Implementation: Nearly all ‘ideal’ diagnostic clinical practices were met and >90% of surveyed patients reported ‘good/very good’ clinic experience. The wait from referral to diagnosis was 2 months shorter than other national Registry clinics (78 vs. 133 days).ConclusionsThis ‘one‐stop’ model provides an interdisciplinary consensus cognitive diagnosis quickly and is well accepted; this may reduce health inequities especially for people living in rural/remote areas. This cognitive clinic model may be of relevance to other centres worldwide and also provides a rich data source for research studies.

Development of a smartphone screening test for preclinical Alzheimer’s disease and validation across the dementia continuum

“…This GP letter will include a numerical research code used during the TapTalk assessments so that, if the participant attends the clinic, their data can easily be linked. The ISLAND Clinic protocol has been described previously in Alty et al [ 62 ]; in brief it is a state-wide cognitive clinic that provides facilities and expertise for clinical diagnosis in a ‘one-stop’ interdisciplinary model where participants will have cognitive, medical and movement assessments performed on one day. They will also have an MRI brain scan, blood tests and an array of other tests.…”

“…This means that through the standard ISLAND Clinic processes, all participants recruited through the RHH will have the opportunity to have thorough medical and cognitive assessments, including neuropsychological tests, an interdisciplinary consensus diagnosis and management plan for their cognitive symptoms [ 62 ]. The established diagnosis of ‘cognitively unimpaired’ (objectively ‘normal’ on ISLAND Clinic tests), ‘MCI’ and ‘AD dementia’ (AD and mixed AD/vascular) also allow us to validate TapTalk scores against the gold standard clinical diagnosis.…”

“…All patients aged ≥ 50 years who are referred to the ISLAND Clinic by their GP with at least 3 months of cognitive symptoms, and no established diagnosis of MCI or dementia, will be invited to take part in the TapTalk study. When participants attend the ISLAND Clinic, they are routinely assessed for their capacity to consent to research as part of ethics approved ISLAND Clinic procedures [ 62 ]. A researcher will administer the TapTalk and MoCA (or RUDAS) in the same way as described for participants recruited via the RHH.…”

“…Consent will be sought for this long-term storage as well as linkage to extension projects. Specifically, data linkages with the ISLAND Project [ 45 ], TAS Test Project [ 38 ], and the ISLAND Clinic [ 62 ], are intended. Access will be requested through the University of Tasmania and the principal investigators of the studies.…”

Current evidence on the association of tongue strength with cognitive decline in older adults and the known risk factors of frailty, sarcopenia and nutritional health: a scoping review protocol

“…This interdisciplinary team will seek ongoing input from community members, policy-makers, researchers and healthcare providers who are working to reduce dementia risk. These consultants will include staff working at the Wicking Centre’s ISLAND Cognitive Clinic, 32 the Wicking Centre’s ISLAND Project 33 and at the Royal Hobart Hospital. All will be invited to three meetings to discuss and provide feedback on 1) the proposed review process and study design, (2) results of the search and (3) plans for dissemination of the results.…”