'Complex' referral criteria delay dementia diagnosis

Complex and time-consuming referral criteria are contributing to delays in the diagnosis of dementia, according to a paper published in the Journal of the Royal Society of Medicine.

Scientists from Imperial College London found that the strict 10-minute consultation time limit is insufficient for GPs to carry out even the briefest of cognitive tests.

Dr Benedict Hayhoe from the School of Public Health at Imperial College London, lead author on the paper, said: “GPs have difficulty assessing patients with memory problems in strict accordance with guidance within a 10-minute consultation.

“In our experience a significant proportion of available consultation time can be taken up by carrying out just one of the brief cognitive tests.”

He suggested that with current workload pressures on primary care, complex criteria involving multiple investigations are likely to provide a significant disincentive for referral.

Referral criteria are set by individual memory clinics and these can vary considerably. Imperial College scientists argue that the requirements set by some clinics exceed national guidelines, thus further complicating and hindering the process.

Additional assessments, such as physical examinations and blood tests are not possible for GPs to carry out alongside cognitive testing in the allotted 10-minute appointment time, according to the study.

A third of people with dementia 'left in the dark'

The number of people thought to have dementia far exceed those with a formal diagnosis, so early diagnosis has become a pressing concern for the Government and the NHS.

George McNamara, head of policy at Alzheimer’s Society, said: “While there has been a notable improvement in diagnosis rates, there are still a third of people with dementia who are left in the dark without a formal diagnosis.

“The condition can be incredibly complex to diagnose, potentially requiring multiple tests and assessments – it would be rare for a diagnosis to be made in one 10-minute visit to the GP.

“The health system must to be able to respond to this complexity and anything that could cause delays to someone receiving a diagnosis needs to be urgently reviewed.”

Authors of the study offered alternative approaches. Dr Hayhoe said: “A primary care led process, perhaps staffed by practice nurses carrying out assessments according to protocols, may speed up diagnosis while reducing pressure on GPs and specialists.”

He also proposed people with memory concerns should be allowed direct access to memory clinics.

'Timely diagnosis is crucial'

Dr Matthew Norton, director of policy at Alzheimer’s Research UK, said: “It’s absolutely crucial that people with dementia should be able to get a timely diagnosis without delay.

“A diagnosis not only helps people to make sense of the symptoms they are experiencing; it opens the door for them to access existing treatments and support to help manage their condition.

“Many people with dementia tell us they struggled to get a diagnosis, and although there has been a welcome increase in the diagnosis rate, we should continue to seek improvements in the way a diagnosis is made.”

Dr Hayhoe concluded: “A system that discourages or delays referral for dementia is highly counterproductive; an urgent review of this area is necessary to establish a system that effectively supports patients and clinicians in early diagnosis, treatment and prevention.”

The study ‘General practitioner referrals to memory clinics: Are referral criteria delaying the diagnosis of dementia?’ by Benedict Hayhoe, Azeem Majeed and Robert Perneczky was published in the Journal of the Royal Society of Medicine on 9 November.