RUSSEL H. SWERDLOW, MD, Services Initiative Chair reports that the Virtual Memory Disorders Clinic has held a successful second "session."

As the service component of AlzPossible, the “Virtual Memory Disorders Consultative Clinic” (VMDCC) attempts to provide primary care internists, psychiatrists, and neurologists with access to tertiary dementia sub-specialist expertise, without actually referring the patients themselves.  In the Commonwealth of Virginia, demand for tertiary level dementia resources currently exceeds its availability.  It is hoped this service will provide an alternative mechanism through which primary physicians can obtain desired tertiary-level assistance for questions that arise during the course of diagnosing or managing persons with cognitive disorders. 

We recognize the challenges primary physicians face when caring for persons with dementia may vary between different regions of the Commonwealth.  The impact of an AD diagnosis on an individual and their family is influenced by education and financial factors, as well as by the availability of various ancillary services such as adult day care.  Therefore, a secondary intent of this virtual clinic will be to identify on a state regional basis the most immediate needs of persons with dementia, their families, and their medical providers.

To our knowledge, this Virtual Memory Disorders Consultative Clinic is the first of its kind.  For the pilot version which we had devised, the state will be divided into distinct geographic districts.  A “clinic hour” for each district is specified.  Advance notice of the clinic hour is then disseminated to district physicians.  During the hour, district physicians with questions about dementia diagnosis/management issues are able to join a telephone conference call lead by a tertiary care dementia sub-specialist.  In this manner, primary physicians can seek input from the specialist on individual patients felt not to require formal referral, but who might nevertheless still benefit from expert advice.

In the pilot version, this virtual clinic is “staffed” by the three memory disorder sub-specialists of the University of Virginia (Drs. Swerdlow, Geldmacher, and Brashear).  Staffing centralization will help the organizers identify practical limitations inherent to the model, as well as facilitate format adjustments. 

We have also been using our Services Initiative workgroup to leverage our outreach (our many thanks to Marilyn Pace Maxwell for her tireless efforts!).

Participants can use the one-hour session to ask general questions they may have about dementia diagnosis/management.  Ideally, it is hoped that the springboard for any didactic discussions will stem from reviews of actual patients that participants are caring for. 

In our one-hour sessions, 5-7 cases can be presented and discussed.  In this way, participants can get instant "curbside consultation" regarding real-life patient-care issues they are being faced with.  Those presenting a patient can take a few seconds or minutes to present their case.  The focused questions the clinician has for the patient being presented are framed and then addressed as best as possible.

Rationale for Consultative Memory Disorders Clinics

Clinical care of persons with dementia is not restricted to any one medical specialty.  Diagnostic and management services can be provided through family physicians/internists, psychiatrists, or neurologists.  Within each discipline, it is possible to identify a group of sub-specialists with additional training and expertise in the cognitive disorders.  For internists and psychiatrists, sub-specialists are identifiable through their participation in post-graduate geriatric training programs.  For neurologists, dementia sub-specialization is defined by post-graduate training that emphasizes the neuroanatomy, neurophysiology, and neurochemistry of brain cognitive functions.

In the 1980’s, the National Institute of Aging (NIA) of the National Institutes of Health (NIH) established regional centers designed to enhance our understanding of Alzheimer’s disease (AD), the most common form of late-onset dementia.  This lead to the development of clinics dedicated to the care of persons with memory disorders.  To staff these clinics, it was necessary to concentrate dementia sub-specialists at tertiary referral centers.

Due to the ongoing expansion in the number of persons with dementia, as well as the increasing complexities in the diagnosis and care of these persons, during the 1990’s a need for additional tertiary referral memory disorders clinics was identified.  These clinics provide essential services that otherwise might not be available to the public.  For patients and their families, they allow for expert “second opinions”, and provide access to investigational treatments.  For primary care providers, memory disorders clinics represent a diagnostic resource for cases in which a diagnosis is unclear, and can provide state-of-the-art assistance with patient management issues.

The University of Virginia Memory Disorders Clinic 

In 1996, a dedicated Memory Disorders Clinic (MDC) was established at the University of Virginia (UVA) Health System.  The clinic pooled appropriate expertise within the UVA Department of Neurology.  This expertise included (but was not limited to) two cognitive disorders sub-specialist neurologists, a neuropsychologist, a dedicated nurse coordinator, and social worker.  Multiple members of the group were experienced in the conduct of AD drug trials.

Since its inception, the UVA MDC has fulfilled essential clinical, educational, and investigational services to the Commonwealth.  The multidisciplinary clinic is held each Thursday from 8 AM to 12 PM, at the Fontaine Research Complex in Charlottesville, VA.  Physicians in internal medicine, psychiatry, and neurology residency/fellowship training programs regularly rotate through the clinic as part of their post-graduate medical training.  Clinic staff is regularly recruited for continuing medical education and patient education events.  Because of its large patient base and professional resources, the MDC has been asked to participate in numerous industry and federally sponsored AD and vascular dementia drug trials.  Here in the Commonwealth, it serves as the principle gateway of dementing individuals to experimental therapies.      

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