Living with Dementia February 2009

A pioneering memory service in Croydon is setting the standard for early diagnosis of dementia.

It is estimated that only one third of people with any form of dementia in the UK actually receive a formal diagnosis. Thanks to the work of the memory service in Croydon the picture is very different. Estimates suggest that more than two thirds of people in the borough are receiving a diagnosis*.

The service has demonstrated that an integrated approach from health and social care professionals can dramatically increase the number of people with dementia who are diagnosed. It is also helping people to access a range of services and treatments and take control of their illness.

The service was set up in 2004 by the local mental health trust, social services and Alzheimer's Society's Croydon branch. David Matthews is a consultant clinical psychologist who leads the memory service team. David says,

'The aim was to devise an overarching service to assess people who were worried about their memory, give a diagnosis and co-ordinate their treatment and care in the longer term.'

More control
An early diagnosis can make a big difference to the way people with dementia, and their carers, experience the illness. David says,

'If people are informed at an early stage their behavioural and cognitive symptoms are less apparent. They can maintain their independence and receive the support they need to live safely in the way they choose rather than go into care homes. Early diagnosis gives people a degree of control over the illness and how they manage their future care.'

Integrated approach
The memory service is funded by Croydon's primary care trust and local authority. The team includes social workers, clinical nurse specialists, a psychiatrist, psychologists and a specialist occupational therapist.

David says,

'It is a fully integrated service. Any member of the team can carry out the initial assessment and, following a team discussion of the case, make and give a diagnosis. They will then be responsible for managing the person's aftercare.'

This approach significantly increases the number of people the service is able to see because, unlike traditional mental health services, it does not rely solely on psychiatrists to make diagnoses. It has the added benefit of enabling the person with dementia to see the same worker throughout their time with the service.

Another advantage of the integrated approach is that team members from any discipline can directly commission ongoing care packages, for example making referrals to a day centre or organising care in a person's home, without the need to refer people on to another organisation.

The team approach
People who are worried about their memory are referred to the service by their GP. Two members of the memory service team then visit the person at home. One worker talks to the person with dementia and will become their long-term case worker. They take the person through a range of robust tests including intellectual, daily living and psychiatric assessments.

At the same time the other worker talks to the person's carer. This gives them the opportunity to hear the carer's perspective and to assess the carer's needs.

Following a discussion of the case with colleagues, a diagnosis is made. The case worker gives the person with dementia and their carer the diagnosis and discusses with them the various treatment and support options such as medication, talking therapies and help from social services. They also offer guidance on where to find information and local support.  

Since it was established the memory service has assessed 1,700 people. Zara Davies is one of them. Zara was referred to the memory service by her GP when she began to have memory problems and was diagnosed with Alzheimer's disease in 2007.

Zara says,

'From my point of view getting a diagnosis early has done wonders. Aricept has worked amazingly for me. I can do crosswords and puzzles again. I'm a busy lady again doing things that use my brain which I enjoy.'

Zara stresses the importance of getting help early. She says,

'When I received the diagnosis I felt empty and devastated. But I am so glad that I did get it otherwise my memory would have deteriorated and I'd have gone downhill.'

The diagnosis also means Zara can plan for the future, which she has begun to do with her husband.

The Croydon team's success has been widely acknowledged. A Department of Health study has shown that its services improve the well being of people with dementia and their carers. The government's national dementia strategy, which includes early diagnosis as one of its three key themes, cites the service as a model of good practice.

*Estimates are based on the prevalence of dementia within the UK population.

Read our factsheet on diagnosis and assessment