Offering diagnostic evaluation and treatment of patients with cognitive disorders and dementia, the clinic receives referrals from general practitioners, private practice neurologists, psychiatrists and other hospitals. Patients may also be referred from other memory clinics for second opinion evaluations. New patients are referred for diagnostic evaluation of cognitive, behavioural or other symptoms suggestive for a neurodegenerative condition. Patients with rare, complex or familial disorders may be referred for treatment and follow-up, and genetic counselling is also offered for healthy at-risk family members.
Diagnostic evaluation and treatment are managed by a multi-disciplinary team of consultant neurologists, a consultant psychiatrist, clinical geneticist, neuropsychologists, specialist nurses, a social counsellor, medical secretaries and a laboratory technician. The large majority of patients undergo the standard set of examinations and procedures, beginning with a detailed medical history. Cognitive functions are then assessed with the Mini-Mental State Examination and the Danish version of Addenbrooke’s Cognitive Examination. Physical and neurological examination, routine laboratory tests, ECG and structural CT or MRI of the brain are also performed. Other supplemental investigations are performed if clinically relevant, for example: fludeoxyglucose positron emission tomography (18FDGPET), routine and biomarker examination of cerebrospinal fluid (CSF), EEG, psychiatric evaluation and neuropsychological assessment.
After completion of the initial examinations and procedures, the multidisciplinary team prepares a standardised consensus report containing a classification of the cognitive profile, the primary underlying cause, concomitant conditions and a treatment plan. After the consensus meeting, the patient (and caregivers) is invited to meet with the neurologist and specialist nurse, where information is given on diagnosis and on the plan for treatment and care. A short summary is subsequently sent to the patient’s general practitioner. A monthly clinical conference is held with specialists from the imaging (MR and PET) departments and four annual conferences are held with the Movement Disorders Clinic at Bispebjerg Hospital.
Highly specialised services
In accordance with guidelines for local, regional and highly specialised medical services from the Danish Health and Medicines Authority, the Copenhagen Memory Clinic has been approved as a highly specialised centre in the fields of dementia and neurogenetics.
Its services include:
- Second opinion evaluation of patients with possible dementia/ dementia with uncertain aetiology
- Diagnosing and treating rare dementia diseases
- Diagnosing and treating hereditary neurodegenerative diseases, for instance: Alzheimer’s disease (AD), frontotemporal dementia (FTD), spinocerebellar ataxias (SCA), Huntington’s disease (HD))
- Clinical evaluation and lumbar perfusion tests for patients with suspected normal pressure hydrocephalus (NPH)
- Diagnostic evaluation of patients where brain biopsy is considered
These highly specialised services are performed in collaboration with several other specialist departments at Rigshospitalet, for example: the Department of Clinical Genetics; the Department of Neurosurgery; the Department of Neuropathology; the Department of Clinical Neurophysiology; the Department of Neuroradiology; and the Department of Clinical Physiology and Nuclear Medicine (the PET and Cyclotron Unit, Rigshospitalet).
Diagnostic evaluation of NPH is a complex task. The patients often have multimorbidity and characteristic symptoms such as: gait disturbance, urinary incontinence and cognitive decline, which are also common to various other diseases. Most patients are referred for possible NPH because their CT or MRI has demonstrated a dilated ventricular system. In 2016 there were 210 patients referred for a clinical evaluation of NPH, 107 of whom had a lumbar perfusion test after the clinical examination. All patients are discussed at a weekly conference with the NPH team at the Department of Neurosurgery, Rigshospitalet. The treatment, which can involve insertion of a shunt to drain excess cerebrospinal fluid from the brain, may reverse some of the symptoms and restore functioning.
The Copenhagen Memory Clinic also offers a programme for healthy at-risk family members from families with confirmed or suspected late-onset familial neurodegenerative diseases referred for clinical genetic evaluation and counselling. This service is executed in collaboration with Department of Clinical Genetics at Rigshospitalet and includes an evaluation by our specialist in clinical genetics, as well as a consultation with a trained psychologist before genetic testing is considered. The clinic also offers post-genetic test counselling when needed.
Follow-up programme for patients and families
The follow-up programme currently monitors 2,183 patients. All patients with mild cognitive impairment (MCI), dementia or specific neurodegenerative disorders are offered counselling and follow-up in collaboration with primary health care. Patients with conditions of uncertain aetiology and healthy mutation carriers may also be offered follow-up in the memory clinic. The majority of patients in the follow-up programme have MCI, AD, Dementia with Lewy bodies (DLB), FTD, HD, SCA, NPH, Down’s syndrome with dementia or other neurodegenerative/neurogenetic conditions. Most patients are accompanied by their family caregivers when visiting the clinic, and the social counsellor, specialist nurses, psychologists and medical doctors also offer counselling for the caregivers as an integral part of the follow-up programme.
Courses for patients and caregivers
As part of its services the clinic offers courses for patients and caregivers. • Early-phase AD patients are offered a course run by a neuropsychologist focusing on the maintenance of cognitive functions as well as an introduction to compensatory techniques related to cognitive deficits. • A two-session course run by multi-disciplinary staff with weekly meetings is offered four times a year for family caregivers and includes information on symptoms and treatment; legal issues and social services; and treatment, care, communication and practical daily-life issues.
Specialist service on the island of Bornholm
Every other week, for one day, a team of one consultant neurologist and one neuropsychologist from the Copenhagen Memory Clinic sees patients on Bornholm. Patients with possible dementia and other cognitive disorders are managed in close collaboration with the staff at the local psychiatric department. Consultants from the Copenhagen Memory Clinic have also contributed to educational services for health care professionals on Bornholm.