Patient attitudes towards remote memory clinic assessment

Objective:To determine whether day length affects cognitive performance in rural and remote memory clinic patients.Methods:A rural and remote memory clinic in Saskatoon, Saskatchewan provided an opportunity to examine how cognitive performance on the Mini-Mental State Exam (MMSE) is influenced by day length. Saskatchewan is an ideal location to test this association as day length varies greatly both seasonally and geographically. Following an initial assessment by the Rural and Remote Memory Clinic (RRMC) team in Saskatoon, patient follow-up appointments were performed either in-person or via telehealth videoconference. At each follow-up appointment the clinic neurologist administered the MMSE. The relationship between day length and MMSE scores at the sixweek follow-up appointment was analyzed in 154 patients. The mean daily temperature was controlled for in the analysis. Bivariate correlate and linear regression analyses were conducted.Results:There was no significant association between MMSE scores and either minutes of day length or mean daily temperature.Conclusion:Day length does not appear to have significant effect on cognitive performance of rural and remote memory clinic patients.

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Characteristics of Young-Onset and Late-Onset Dementia Patients at a Remote Memory Clinic

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2020.8 ◽

2020 ◽

Vol 47 (3) ◽

pp. 320-327

Author(s):

Jennifer F. W. Wong ◽

Andrew Kirk ◽

Landon Perlett ◽

Chandima Karunanayake ◽

Debra Morgan ◽

...

Keyword(s):

Late Onset ◽

Remote Memory ◽

Memory Clinic ◽

Rural And Remote ◽

Caregiver Support ◽

Young Onset ◽

Highly Educated ◽

Dementia Patients ◽

Patient Groups ◽

Late Onset Dementia

ABSTRACT:Background:Young-onset dementia (YOD) is defined as the onset of dementia symptoms before the age of 65 years and accounts for 2–8% of dementia. YOD patients and their caregivers face unique challenges in diagnosis and management. We aimed to compare the characteristics of rural YOD and late-onset dementia (LOD) patients at a rural and remote memory clinic in Western Canada.Methods:A total of 333 consecutive patients (YOD = 61, LOD = 272) at a rural and remote memory clinic between March 2004 and July 2016 were included in this study. Each patient had neuropsychological assessment. Health, mood, function, behaviour and social factors were also measured. Both groups were compared using χ2 tests and independent sample tests.Results:YOD patients were more likely to be married, employed, current smokers and highly educated. They reported fewer cognitive symptoms, but had more depressive symptoms. YOD patients were less likely to live alone and use homecare services. YOD caregivers were also more likely to be a spouse and had higher levels of distress than LOD caregivers. Both YOD and LOD patient groups were equally likely to have a driver’s licence.Conclusions:Our findings indicate YOD and LOD patients have distinct characteristics and services must be modified to better meet YOD patient needs. In particular, the use of homecare services and caregiver support may alleviate the higher levels of distress found in YOD patients and their caregivers. Additional research should be directed to addressing YOD patient depression, caregiver distress and barriers to services.

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Feasibility of remote Memory Clinics using the plan, do, study, act (PDSA) cycle

Age and Ageing ◽

10.1093/ageing/afab173 ◽

2021 ◽

Author(s):

Jemima T Collins ◽

Biju Mohamed ◽

Antony Bayer

Keyword(s):

Remote Memory ◽

Service Improvement ◽

Attendance Rate ◽

Memory Clinic ◽

Improvement Project ◽

Face To Face ◽

Pdsa Cycle ◽

Diagnosis Of Dementia ◽

Memory Clinics ◽

To Come

Abstract Introduction A timely diagnosis of dementia is crucial for initiating and maintaining support for people living with dementia. The coronavirus disease (COVID) pandemic temporarily halted Memory Clinics, where this is organised, and rate of dementia diagnosis has fallen. Despite increasing use of alternatives to face-to-face (F2F) consultations in other departments, it is unclear whether this is feasible within the traditional Memory Clinic model. Aims The main aim of this service improvement project performed during the pandemic was to explore feasibility of telephone (TC) and videoconference (VC) Memory Clinic consultations. Methods Consecutive patients on the Memory Clinic waiting list were telephoned and offered an initial appointment by VC or TC. Data extracted included: age, internet-enabled device ownership, reason for and choice of Memory Clinic assessment. We noted Montreal Cognitive Assessment-Blind (TC) and Addenbrooke’s Cognitive Examination-III (VC via Attend Anywhere) scores, and feasibility of consultation. Results Out of 100 patients, 12 had a home assessment, moved away, been hospitalised, or died. 45, 21 and 6 preferred F2F, VC and TC assessments respectively. 16 were not contactable and offered a F2F appointment. The main reason for preferring F2F was non-ownership, or inability to use an internet-enabled device (80%). VC and TC preference reasons were unwillingness to come to hospital (59%), and convenience (41%). Attendance rate was 100% for VC and TC, but 77% for F2F. Feasibility (successful consultations) was seen in 90% (VC) and 67% (TC) patients. Conclusion For able and willing patients, remote Memory Consultations can be both feasible and beneficial. This has implications for future planning in dementia services.

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P.002 Quality of life across types of dementia in rural and remote memory clinic patients

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.104 ◽

2019 ◽

Vol 46 (s1) ◽

pp. S14

Author(s):

M Kushneriuk ◽

A Kirk ◽

C Karunanayake ◽

DG Morgan ◽

ME O’Connell

Keyword(s):

Quality Of Life ◽

Lewy Body Dementia ◽

Remote Memory ◽

Memory Clinic ◽

Rural And Remote ◽

Patient Demographics ◽

Included Patient ◽

Patient Variables ◽

One Way Anova

Background: Quality of life (QOL) is of great importance in dementia. We examined QOL across types of dementia in patients presenting to a rural and remote memory clinic (RRMC). Methods: This analysis included 343 RRMC patients seen between 2004 and 2016. Patients were diagnosed with mild cognitive impairment (MCI, n=74), frontotemporal dementia (FTD, n=42), Alzheimer’s disease (AD, n=187), vascular dementia (VD, n=22), or Lewy Body dementia (DLB, n=18). Patients and caregivers completed questionnaires at their initial visit. Data collection included patient-rated patient QOL (QOL-PT), caregiver-rated patient QOL (QOL-CG), MMSE score, age, and other patient demographics. Statistical analysis assessed patient variables and differences in QOL across types of dementia using one-way ANOVA, χ2 tests, and t-tests. Results: QOL-PT did not differ by diagnosis, whereas QOL-CG did. QOL-CG was significantly higher in MCI (34.6±7.1) compared to FTD (30.9±5.2) and AD (31.7±5.9). QOL-PT and QOL-CG differed in certain dementia types. QOL-PT was significantly higher than QOL-CG in MCI (QOL-PT=37.3±5.0, QOL-CG=35.3±7.3), FTD (QOL-PT=37.2±6.1, QOL-CG=31.7±5.5), and AD (QOL-PT=37.0±9.7, QOL-CG=32.1±5.9). Conclusions: We found that QOL-PT does not differ across dementia types, QOL-CG is higher in MCI compared to FTD and AD, and patients rate their own QOL higher than their caregivers do in MCI, FTD, and AD.

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Less Education Predicts Anticholinesterase Discontinuation in Dementia Patients

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s031716710001492x ◽

2013 ◽

Vol 40 (5) ◽

pp. 684-690 ◽

Cited By ~ 8

Author(s):

Solin Saleh ◽

Andrew Kirk ◽

Debra G. Morgan ◽

Chandima Karunanayake

Keyword(s):

Logistic Regression ◽

Cholinesterase Inhibitor ◽

Formal Education ◽

Remote Memory ◽

Outcome Variable ◽

Drug Discontinuation ◽

Memory Clinic ◽

Dementia Patients ◽

Functional Factors ◽

Institutionalized Patients

Abstract:Objective:We investigated patient socio-demographic, clinical and functional factors predicting cholinesterase inhibitor discontinuation by patients presenting to a memory clinic in Saskatoon, Saskatchewan.Methods:Data collection began in March 2004 at the Rural and Remote Memory Clinic where family physicians referred their non-institutionalized patients. Neurological and neuropsychological assessment, patient and caregiver questionnaires provided the socio-demographic, clinical and functional variables. Univariate logistic regression analysis was used to examine possible associations between each independent variable and the binary outcome variable of treatment discontinuation. Multivariate logistic regression was used to determine predictors of cholinesterase inhibitor discontinuation within six months of drug initiation.Results:Our sample consisted of the first 63 patients (60.3% female) for whom we prescribed a cholinesterase inhibitor. The mean age at clinic day was 74.56 years (SD=7.78). We found that years of formal education was the only variable significantly associated with cholinesterase inhibitor discontinuation by six months. The more years of formal education, the lower the rate of drug discontinuation by six months.Conclusions:Likelihood of cholinesterase inhibitor discontinuation by six months was predicted by fewer years of formal education.

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P.019 Trends in medication use over eleven years in patients presenting to a rural and remote memory clinic

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.125 ◽

2016 ◽

Vol 43 (S2) ◽

pp. S25-S26

Author(s):

R Verity ◽

A Kirk

Keyword(s):

Medication Use ◽

Significant Decline ◽

Remote Memory ◽

Anticholinergic Medication ◽

Memory Clinic ◽

Rural And Remote ◽

Anticholinergic Medications ◽

To Come ◽

Spearman’S Correlation ◽

Over Time

Background: Anticholinergic and sedating medications are generally contraindicated in those with cognitive decline. We examined trends in medication use by patients presenting to a rural and remote memory clinic (RRMC) between March 2004 and June 2015 to determine whether patterns of medication use have changed. Methods: The first 445 patients seen at the RRMC between 2004 and 2015 were included in this analysis. Medication lists were collected at the patient’s initial visit, and it was noted whether patients were taking anticholinergic or potentially sedating drugs. Statistical analysis (Spearman’s Correlation) was conducted to examine trends in medication use over time. Results: Ninety-one patients (20.5%) were taking at least one anticholinergic medication. There was a statistically significant decline (25.0% in 2004 to 12.5% in 2014) in percentage of patients presenting with anticholinergic medications over the eleven years of this study (Spearman’s correlation coefficient=-0.64, p=0.035). Conclusions: The most encouraging statistic to come from this study is a decline in anticholinergic medication use in this rural population. Prescribers must be properly informed to ensure that the number of medications per patient does not continue to rise, that medications are used only as necessary, and that potentially deleterious medications are avoided.

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Differences between men and women referred to a rural and remote memory clinic

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.1889 ◽

2017 ◽

Vol 381 ◽

pp. 671

Author(s):

A. Kirk ◽

O. Philippon ◽

C. Karunanayake ◽

D. Morgan

Keyword(s):

Remote Memory ◽

Memory Clinic ◽

Rural And Remote ◽

Men And Women

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Predictors of Cognitive Impairment Severity in Rural Patients at a Memory Clinic

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100015602 ◽

2012 ◽

Vol 39 (6) ◽

pp. 774-781 ◽

Cited By ~ 3

Author(s):

Catherine Lacny ◽

Andrew Kirk ◽

Debra G. Morgan ◽

Chandima Karunanayake

Keyword(s):

Cognitive Impairment ◽

Formal Education ◽

Brief Symptom Inventory ◽

Remote Memory ◽

Cognitively Impaired ◽

Memory Clinic ◽

Early Assessment ◽

Age And Gender ◽

And Gender ◽

Impairment Severity

Objective:Patients with dementia benefit from early assessment and diagnosis. In an attempt to identify factors leading to delay in referral, we investigated socio-demographic, clinical, and functional predictors of greater severity of cognitive impairment in dementia patients presenting to a memory clinic in Saskatoon, Saskatchewan.Methods:Data collection began in 2004 at the Rural and Remote Memory Clinic in Saskatoon, where non-institutionalized patients were referred by their family physicians. The patient and caregiver questionnaires and assessments administered at the clinic day appointment provided the socio-demographic, clinical, and functional patient variables, as well as the caregiver stress and burden variables. The dependent variable was patient cognitive impairment, as measured by Modified Mini-Mental State Examination (3MS) scores. Variables underwent univariate linear regression with 3MS scores in order to determine possible associations. A multiple regression analysis was conducted to determine predictors of cognitive impairment severity at clinic presentation.Results:Our sample included 198 patients (62% female). The mean age was 73.9 years (SD=9.2). We found that an age and gender interaction, years of formal education, Functional Activities Questionnaire score, and Brief Symptom Inventory score were significantly associated with 3MS scores (p<0.05).Conclusions:Increased cognitive impairment at presentation was predicted by fewer years of formal education, poorer functional ability, and less caregiver psychological distress. There was a significant interaction between age and gender: younger females were more cognitively impaired than younger males at clinic day, while in older patients, males were more cognitively impaired than females.

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