Development of memory clinics in the Netherlands over the last 20 years

Abstract

Objectives Memory clinics (MCs) have been established to improve diagnosis and treatment of cognitive disorders, including dementia. The aim of this study was to determine the characteristics and working methods of MCs in the Netherlands in 2016. More insight into different working methods can be used to improve the quality of care in Dutch MCs. Additionally, the findings will be compared with earlier results to investigate the development of MCs since 1998. Methods A survey was sent in 1998, 2004, 2009, and 2017 to all operational Dutch MCs with questions about organization, collaboration, patients, and diagnostic procedures. Results From 1998 to 2016, the number of MCs increased substantially from 12 to 91. The capacity increased from 1560 patients to 24,388. In 1998, most patients received a dementia diagnosis (85%), while in 2016, half of the patients were diagnosed with milder cognitive problems. MCs are more often part of regional care chains and are better embedded within regional care organizations. Diagnostic tools, such as blood tests (97%), neuropsychological assessment (NPA) (95%), and neuroimaging (92%), were used in nearly all MCs. The number of patients in whom these tools were used differed greatly between MCs (NPA: 5%‐100%, neuroimaging: 10%‐100%, and CSF: 0.5%‐80%). There was an increase in the use of NPA, while the use of neuroimaging, CSF, and EEG/ECG decreased by 8% to 15% since 2009. Conclusions Since 1998, MCs have developed substantially and outgrown the primarily research‐based university settings. They are now accepted as regular care facilities for people with cognitive problems.

Neuropsychological assessment and diagnostic disclosure at a memory clinic: A qualitative study of the experiences of patients and their family members

“…MRI, blood tests, and NPA). Previous research showed that providing the patient and family with extensive feedback on the neuropsychological findings was not a universal service in Dutch MCs (Gruters et al, 2019). However, providing patients with feedback on their cognitive performance was shown to lead to improved quality of life and social adjustment (Rosado et al, 2018).…”

“…In the Dutch healthcare system, it is mandatory to be referred by a doctor for it to be covered by the insurance companies. The proportion of patients who remained in care of Dutch MCs varied between 10% and 100% (Gruters et al, 2019). However, most clinics do not offer a second consultation shortly after the diagnostic disclosure, which might be related to financial barriers or procedures within the clinics themselves.…”

“…In addition, Dutch MCs focus on the diagnostic assessment, and for additional treatment, the patient is often referred back to the general practitioner or to other organizations (e.g. mental health institutions or local care organizations) (Gruters et al, 2019). In the case of a dementia diagnosis, an appointed case manager might be helpful.…”

“…Memory clinics (MCs) focus on a timely diagnosis of dementia, and one of the most often used assessment tools in Dutch MCs is a neuropsychological assessment (NPA) (Gruters et al, 2019). The proportion of patients who undergo an NPA varies, but the most common reason to administer an NPA in these clinics is to support the diagnosis and to collect information for a differential diagnosis.…”

“…The proportion of patients who undergo an NPA varies, but the most common reason to administer an NPA in these clinics is to support the diagnosis and to collect information for a differential diagnosis. NPAs are not carried out when there is evidence of severe dementia (Gruters et al, 2019). An NPA provides insight into the nature and severity of cognitive impairment (Lezak et al, 2012).…”