Referral Patterns

  • A. J. Larner


It is a truth universally acknowledged that dementia is now a major global public health issue, set to increase as the world population ages (Ferri et al. 2005). A recent global cost of illness study suggested a “base case option” figure of US $604 billion, equivalent to the 18th largest national economy in the world (between Turkey and Indonesia) and larger than the revenue of the world’s largest companies (Wal-Mart, Exxon Mobil). In high-income countries, which accounted for 89% of the costs but only 46% of dementia prevalence, this is mostly due to direct costs of social care, while in low- and middle-income countries, which accounted for only 11% of the costs but 54% of dementia prevalence, this is mostly due to informal care costs (Wimo and Prince 2010). The need to address these issues is obvious, from the human as well as the economic standpoint, and will require governments to make dementia a priority, with the development of policies, investment in chronic care, and funding of research.


Vascular Cognitive Impairment Dementia Diagnosis Referral Letter Exxon Mobil Dementia Prevalence 
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  1. Association of British Neurologists. Acute neurological emergencies in adults. London: Association of British Neurologists; 2002.Google Scholar
  2. Audit Commission. Forget me not. Developing mental health services for older people in England. London: Audit Commission; 2002.Google Scholar
  3. Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a cognitive “vital signs” measure for dementia screening in ­multi-lingual elderly. Int J Geriatr Psychiatry. 2000;15:1021–7.PubMedCrossRefGoogle Scholar
  4. Brodaty H, Pond D, Kemp NM, et al. The GPCOG: a new screening test for dementia designed for general practice. J Am Geriatr Soc. 2002;50:530–4.PubMedCrossRefGoogle Scholar
  5. Brodaty H, Low LF, Gibson L, Burns K. What is the best dementia screening instrument for general practitioners to use? Am J Geriatr Psychiatry. 2006;14:391–400.PubMedCrossRefGoogle Scholar
  6. Brooke P, Bullock R. Validation of a 6 item Cognitive Impairment Test with a view to primary care usage. Int J Geriatr Psychiatry. 1999;14:936–40.PubMedCrossRefGoogle Scholar
  7. Department of Health. Living well with dementia: a National Dementia Strategy. London: Department of Health; 2009.Google Scholar
  8. Department of Health/Alzheimer’s Society. Understanding dementia. A resource pack for GPs and patients. London: Alzheimer’s Society; 2009.Google Scholar
  9. Fearn S, Larner AJ. Have Quality and Outcomes Framework Depression Indicators changed referrals from primary care to a dedicated memory clinic? Ment Health Fam Med. 2009;6:129–32.PubMedGoogle Scholar
  10. Ferran J, Wilson K, Doran M, Ghadiali E, Johnson F, Cooper P, et al. The early onset dementias: a study of clinical characteristics and service use. Int J Geriatr Psychiatry. 1996;11:863–9.CrossRefGoogle Scholar
  11. Ferri CP, Prince M, Brayne C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005;366:2112–7.PubMedCrossRefGoogle Scholar
  12. Fisher CAH, Larner AJ. FAQs: memory loss. Practitioner. 2006;250(1683):14–6, 19,21.PubMedGoogle Scholar
  13. Fisher CAH, Larner AJ. Frequency and diagnostic utility of cognitive test instrument use by general practitioners prior to memory clinic referral. Fam Pract. 2007;24:495–7.PubMedCrossRefGoogle Scholar
  14. Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.PubMedCrossRefGoogle Scholar
  15. Hodkinson HM. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing. 1972;1:233–8.PubMedCrossRefGoogle Scholar
  16. Hussey D, Foy K, Meehean K. Quality of dementia referrals to later life psychiatry service. Psychiatr Bull. 2009;33:154–5.CrossRefGoogle Scholar
  17. Larner AJ. Two simple questions in the identification of dementia. J Neurol Neurosurg Psychiatry. 2005a;76:1317 (abstract 023).CrossRefGoogle Scholar
  18. Larner AJ. An audit of the Addenbrooke’s Cognitive Examination (ACE) in clinical practice. Int J Geriatr Psychiatry. 2005b;20:593–4.PubMedCrossRefGoogle Scholar
  19. Larner AJ. Neurologists still have a role in the dementia care pathway. Clin Med. 2007a;7:528–9.PubMedGoogle Scholar
  20. Larner AJ. Addenbrooke’s Cognitive Examination (ACE) for the diagnosis and differential diagnosis of dementia. Clin Neurol Neurosurg. 2007b;109:491–4.PubMedCrossRefGoogle Scholar
  21. Larner AJ. Neuropsychological neurology: the neurocognitive impairments of neurological disorders. Cambridge: Cambridge University Press; 2008.CrossRefGoogle Scholar
  22. Larner AJ. Impact of the National Institute for Health and Clinical Excellence and Social Care Institute for Excellence’s dementia guidelines in a neurology-led memory clinic. Clin Med. 2009a;9:197–8.PubMedGoogle Scholar
  23. Larner AJ. Quality of dementia referrals. Psychiatr Bull. 2009b;33:316.CrossRefGoogle Scholar
  24. Larner AJ. ACE-R: cross-sectional and longitudinal use for cognitive assessment. In: Fisher A, Hanin I, editors. New trends in Alzheimer and Parkinson related disorders: ADPD 2009. Collection of selected free papers from the 9th International Conference on Alzheimer’s and Parkinson’s disease AD/PD. Prague, Czech Republic, March 11–15, 2009. Bologna: Medimond International Proceedings; 2009c. p. 103–7.Google Scholar
  25. Larner AJ. Impact of the National Dementia Strategy in a neurology-led memory clinic. Clin Med. 2010;10:526.PubMedGoogle Scholar
  26. Larner AJ. Screening utility of the Montreal Cognitive Assessment (MoCA): in place of or as well as the MMSE? Int Psychogeriatr. 2012;24:in press.Google Scholar
  27. Larner AJ, Coles AJ, Scolding NJ, Barker RA. The A-Z of neurological practice. A guide to clinical neurology. 2nd ed. London: Springer; 2011.Google Scholar
  28. Menon R, Larner AJ. Use of cognitive screening instruments in primary care: the impact of national dementia directives (NICE/SCIE, National Dementia Strategy). Fam Pract. 2011;28:272–6.PubMedCrossRefGoogle Scholar
  29. Milne A, Culverwell A, Guss R, Tuppen J, Whelton R. Screening for dementia in primary care: a review of the use, efficacy and quality of measures. Int Psychogeriatr. 2008;20:911–26.Google Scholar
  30. National Institute for Health and Clinical Excellence/Social Care Institute for Excellence. Dementia: supporting people with dementia and their carers in health and social care. NICE Clinical Guidance 42. London: National Institute for Health and Clinical Excellence (, 2006.
  31. O’Connor DW, Pollitt BA, Hyde JB, et al. Do general practitioners miss dementia in elderly patients? BMJ. 1988;297:1107–10.PubMedCrossRefGoogle Scholar
  32. Wimo A, Prince M. World Alzheimer Report 2010. The global economic impact of dementia. London: Alzheimer’s Disease International; 2010.Google Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • A. J. Larner
    • 1
  1. 1.Cognitive Function ClinicWalton Centre for Neurology and NeurosurgeryLiverpoolUK

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