title: 'Doing things differently'--working towards distributed responsibility within memory assessment services.
abstract: OBJECTIVE
  To compare initial diagnostic hypotheses made by Allied Health Professionals (AHP) (mental health nurses, occupational therapists and social workers) with subsequent formal multidisciplinary formulation based upon the full possession of investigations, neuropsychological tests and brain imaging. Design Prospective analysis.
  
  
  METHODS
  Prospective analysis.
  
  
  METHODS
  Home-based assessments, secondary care based multidisciplinary memory clinic.
  
  
  METHODS
  90 consecutive referrals over a 3-month period.
  
  
  RESULTS
  Fifty eight patients (64.4%) were diagnosed by the multi-disciplinary team as having a dementia. Twenty (34%) were classified as Alzheimer's disease, 28 (49%) of mixed sub-type and 9 (16%) of vascular origin. Together, AHP's were able to detect dementia with 91% accuracy (Kappa 0.81) sensitivity was 0.88 and specificity 0.97. The diagnostic accuracy for each professional group ranged from 88% to 93% (Kappa 74-90%).
  
  
  CONCLUSIONS
  In this study, structured initial assessment by AHP's working in a Memory Assessment Service was shown to be an accurate method of determining a diagnosis of cognitive impairment, when compared with formal MDT judgment. It is suggested that such distributed responsibility affords a viable option for the future detection of early dementia.
authors.affiliation: Memory Assessment Service for Manchester, University of Manchester, Manchester, UK. sean.page@mhsc.nhs.uk
authors.forename: Sean
authors.initials: S
authors.lastname: Page
authors.forename: Kevin
authors.initials: K
authors.lastname: Hope
authors.forename: Chris
authors.initials: C
authors.lastname: Maj
authors.forename: Jose
authors.initials: J
authors.lastname: Mathew
authors.forename: Penny
authors.initials: P
authors.lastname: Bee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis; D003156:Community Mental Health Services / Q000458:organization & administration* / Q000592:standards; D003704:Dementia / Q000175:diagnosis*; D015140:Dementia, Vascular / Q000175:diagnosis; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D005851:Geriatric Nursing / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009786:Occupational Health Services / Q000458:organization & administration / Q000592:standards; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012949:Social Work, Psychiatric / Q000458:organization & administration / Q000592:standards