The Copenhagen Memory Clinic at Rigshospitalet – Blegdamsvej offers diagnostic evaluation and treatment of patients with cognitive disorders and dementia and also receives referrals from general practitioners, private practice neurologists, psychiatrists and other hospitals in the Capitol Region of Denmark. Patients may
also be referred from other memory clinics for second opinion evaluations. Patients with rare, complex or familial disorders may be referred from other parts of Denmark (mainly Eastern Denmark) for treatment and follow-up, and genetic counselling is also offered for healthy at-risk family members.
In accordance with guidelines for local, regional and highly specialised medical services from the Danish Health and Medicines Authority, the Copenhagen Memory Clinic at Blegdamsvej has been approved as a highly specialised centre in the fields of dementia and neurogenetics in that it offers:
- Second opinion evaluations of patients with possible dementia and dementia with uncertain aetiology
- Diagnosis and treatment of developmental disorders with dementia
- Diagnosis and treatment of frontotemporal dementia
- Diagnosis and treatment of rare and late-onset hereditary neurodegenerative diseases, for instance: Alzheimer’s disease (AD), frontotemporal dementia (FTD), spinocerebellar ataxias (SCA), Huntington’s disease (HD)
- Clinical evaluation and lumbar perfusion and tap tests for patients with suspected normal pressure hydrocephalus (NPH)
Accordingly, specialist neurologists in the above areas, a clinical geneticist and a laboratory technician are also affiliated with the Blegdamsvej clinic.
The 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). 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.
Normal pressure hydrocephalus (NPH)
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 2017 there were ca. 300 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 CSF from the brain, may reverse some of the symptoms and restore functioning.
The Copenhagen Memory Clinic 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
All patients with mild cognitive impairment (MCI), and selected groups of patients with 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. For fragile patients with severe dementia home visits are an option.
For patients from the City of Copenhagen, the Copenhagen Memory Clinic at Blegdamsvej has specific collaboration programmes with the Departments of Geriatrics at Bispebjerg Hospital, the Mental Health Centre Copenhagen, general practitioners, and the care institutions and home care in the City of
Copenhagen and the City of Frederiksberg.
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 that contains 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.
GLOSTRUP MEMORY CLINIC
Glostrup Memory Clinic opened in 2010 after merging with various dementia units serving the southern districts of the Capital Region of Denmark. The clinic has an experienced multidisciplinary staff, many of whom worked in the previous dementia units based in neurology, geriatric psychiatry and geriatrics.
Patients are followed on an out-patient basis identical to the main programme at the Memory Clinic on Blegdamsvej. The Glostrup Memory Clinic also offers home visits as a service for fragile elderly patients. We also work closely with general practitioners and with the 10 local authorities in our catchment area, for instance, via half-yearly meetings with key dementia coordinators, but also through joint educational programmes for family caregivers of newly diagnosed patients.
Moreover, we are in frequent contact, either by telephone or electronic correspondence, with the dementia coordinators and with care staff in the patients’ local districts.
SPECIALIST SERVICE ON THE ISLAND OF BORNHOLM
A team of one consultant neurologist and one neuropsychologist from the Copenhagen Memory Clinic offers consultations one day a week every other week for 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. In 2018 the Copenhagen Memory Clinic will have its own satellite service on the island in collaboration with Bornholms Hospital.
INTRODUCING THE EPIC HEALTH CARE SYSTEM
The new electronic medical record software system by Epic had its first full year of operation in 2017 after gradually being implemented in the Capital Region of Denmark and in Region Zealand. Epic, which offers various advantages compared to previous software systems, has profoundly changed the way most clinical employees work, with clinicians now responsible for the time-consuming task of writing patient files instead of using dictation. Consequently, we see fewer patients per day but this has not prevented us from increasing the number of new patients referred and reducing the amount of time before their first visit to four weeks. This is partially due to the fact that telephone consultations have replaced a large number of patient contacts.
REGIONAL AND NATIONAL COLLABORATION
In 2011 the Capital Region of Denmark established guidelines for coordinating patient care pathways between hospitalbased memory clinics, mental health centres, other hospital departments, general practitioners and primary health care in its 29 municipalities. The guidelines are now under revision.
In 2016 the national quality registry for dementia was launched, based partly on a previous regional version from the Capital Region of Denmark established in 2006. The registry, which includes data from approximately 40 memory clinics in Denmark, is monitored by a national steering committee. Apart from contributing to the national dementia registry, the Copenhagen Memory Clinic is also an active member of the Network of Danish Memory Clinics.