Dementia Clinic in General Hospital Settings

Article excerpt

Byline: K. Shaji, Thomas. Iype, K. Praveenlal

Background: There is a need to develop specialised dementia care services in developing countries. Materials and Methods: We used the existing infrastructure of a general hospital to start a weekly dementia clinic.

Results: We were able to support home-based care, even in patients with advanced disease. This new service gave us opportunity to train clinicians and researchers interested in dementia. Conclusion: It is feasible to start weekly dementia clinics using existing infrastructure in developing countries. Networking of such centres can generate a database capable of guiding service development.

Introduction

Dementia is an emerging public health problem in developing countries. However, it remains a hidden problem due to low levels of public awareness. There are no specialized services for older people in most of these countries. General practitioners are not trained to identify and manage dementia as the undergraduate medical curriculum has very little emphasis on geriatrics and dementia.

We started a monthly dementia clinic at the local primary health centre in October 1999 to provide services for cases identified during research undertaken by the 10/66 Dementia Research Group.[sup] [1],[2],[3] However, such services may be more feasible in general hospitals than in primary care settings. Clinicians with expertise in dementia care are mostly attached to general hospitals, which are often located in urban areas. The public awareness about dementia may also be better among the more literate people living in the urban areas.

So we started a new dementia care service in a general hospital using the existing infrastructure. This paper describes socio demographic and clinical details of the patients who availed this new out patient service and our experience in running it. The assessment and management of these patients will also be described.

Materials and Methods

We started a weekly Dementia Clinic at Medical College, Thrissur, in the South Indian state of Kerala in April 2002. Consultants from the department of neurology (TI) and psychiatry (SKS) lead the service. Diagnosis of dementia was made according to DSM IV criteria.[sup] [4] Additional diagnostic criteria were used for diagnosing dementia with Lewy bodies (DLB),[sup] [5] and frontotemporal dementia (FTD).[sup] [6] A trained clinician, administered instruments like Mini Mental State Examination (MMSE),[sup] [7] Everyday Abilities Scale for India (EASI),[sup] [8] Clinical Dementia Rating scale (CDR)[sup] [9] and Neuropsychiatric Inventory (NPI)[sup] [10] to all patients. Following this initial assessment, we gave the caregiver the option of bringing the patient to the clinic for follow up or to come without the patient. The main aim of Dementia Clinic was to support home-based care. The follow up data of patients recruited in the year 2004 was examined to assess the acceptance of this new service.

Results

The study recruited all new cases attending the dementia clinic at Medical College, Thrissur, from April 2002 to February 2004. A total of 202 patients were screened during this period and 137 of them (78 males, 59 women) received a diagnosis of dementia. Their mean age was 67.4 years (range 38 to 89), and the mean age of onset of dementia was 65.6 years.

The main subtypes of dementia were Alzheimer's disease (36.5%), Vascular Dementia (27%) and Dementia with Lewy Bodies (9.5%). Eleven patients (8%) had treatable causes. There were two cases each of meningioma, vitamin B 12 deficiency, neurosyphilis, normal pressure hydrocephalus and one case of subdural haematoma.

Fifty-eight (42.3%) patients had the onset of dementia before the age of 65 years. The main subtypes in both pre-senile and senile onset subgroups are given in [Table 1]. A quarter of patients in both the groups had Vascular Dementia.

Caregivers and family members took part in out patient sessions providing information and education about dementia. …