Cognitive impairment in the community

Introduction Neurodegenerative disease is increasingly common, but neurology service utilisation by this population is unclear. This study presents an integrated metropolitan neurology clinic as a model of care, and examines care pathways and characteristics in patients with cognitive decline. Methods An audit of patients with dementia (n=136,51–96 yr,M:F1.1:1) and mild cognitive impairment (MCI)(n=28,56–83 yr,M:F0.6:1) over a 16 month period was performed using retrospective analysis of demographic characteristics, clinical information and frailty measures. Results The average duration of cognitive decline at presentation was 2.7 years in dementia (n=135,M=3.1,F=2.3) and 1.5 years MCI (n=28,M=1.7,F=1.3). Average age of patients with newly diagnosed dementia was 72 (M:F0.96:1) and MCI 70 (M:F1.03:1) with Alzheimer’s disease in 86(64%) dementia with Lewy bodies 13(10%) frontotemporal dementia 11(8%) and distinct overlap syndromes in 7(5%). Depression was associated with younger age at diagnosis(ave.60) versus anxiety(74) and agitation(75). Psychosis was in 14(10%) REM sleep behaviour disorder 6(5%). In the 12 months prior, falls were seen in 30(22%) and weight loss 29(21%). Allied health input occurred in 81% of dementia versus 68% MCI cases. Conclusions Delay in diagnosis from first clinical manifestation, high rate of psychological and medical comorbidity, presence of overlap syndromes, and allied health requirement, support the need for integrated neurological services in dementia.