Early identification of cognitive impairment and dementia: Results from four years of the community consultation center.

The community consultation center was established as the core facility for a project entitled "Community Support Network for Citizens with Mild Cognitive Impairment (MCI) and Dementia." This study reports on our center's activity and user outcomes. Users consulted with medical staff regarding their memory problems and were self-screened using a touch-panel computer assisted screening tool (TPST). Dementia was suspected when the TPST score was 12 points or below, and the Mini-Mental State Examination (MMSE) was conducted by our onsite clinical psychologists, which served as the gold standard. All reports were provided to user's primary care physicians, or a nearby medical institute if users did not have a primary care physician. Patient outcomes were obtained from participating medical institutes. Informed consent was obtained for all users. In the four-year period, 2802 users visited the center. Of them, 1565 registered (men/women=519/1046; mean age, 74 years). Of 1354 people who used TPST, 622 (45.9%) scored 12 points or below. 409 confirmed diagnoses from the medical institutes revealed MCI in 11.2%, Alzheimer's disease in 37.1%, and vascular dementia in 8.0%. Among the 207 users who had no primary care physicians at consultation, 43 (20.8%) were diagnosed with MCI or dementia. Approximately half of the users who took the TPST were suspected of dementia following interview by a clinical psychologist. Both MCI and dementia were confirmed by the medical institutes in 59.6% of users. We conclude that our consultation center plays a pivotal role in early diagnosis of MCI and dementia.

Roles of consultation organizations in the early detection of dementia: from the practices of the Community Consultation Center for Citizens with Mild Cognitive Impairment and Dementia, Nippon Medical School.

BACKGROUND: As society ages, early detection of dementia is becoming increasingly important. Many hospitals have opened memory-loss clinics, and various new approaches for early examination and appropriate diagnosis are being tried. However, these memory-loss clinics are ultimately part of the hospital establishment, implying that, in addition to the burdens of time and effort to undergo examinations and consultations, patients might have a certain psychological resistance. With a grant from the Ministry of Education, Culture, Sports, Science and Technology, the Institute of Development and Aging Science at Nippon Medical School has opened a center called the Community Consultation Center for Citizens with Mild Cognitive Impairment and Dementia, which is a dementia-related center outside the regular hospital. This center has been developing a system that makes consultations easier. We performed a retrospective follow-up study that aimed to determine how much this approach contributes to the early detection of dementia compared with outpatient visits to university hospitals. METHODS: Persons who were found to have organic brain syndrome (defined as organic diseases related to dementia, including mild cognitive impairment) after visiting the Consultation Center during the survey period were referred to as the Consultation Center group, and persons who were found to have organic brain syndrome after an initial visit to the Department of Neurology at Nippon Medical School Musashi Kosugi Hospital were referred to as the Hospital group. We compared the groups in terms of sex, age, Mini-Mental State Examination (MMSE) score, and subclassification by means of the t-test and χ(2) test. RESULTS: Both the mean MMSE score (p<0.001) and percentage of subjects with an MMSE score of 24 points of higher (p=0.007) were significantly higher in the Consultation Center group than in the Hospital group. CONCLUSIONS: Consultations can be made more casually at the Consultation Center than at hospitals. Our results suggest that more casual consultations contribute to the early detection of dementia.