Alzheimer’s Disease Center: Innovation model of outpatient assistance for the elderly patients with cognitive disorders and dementia

Background. The demographic phenomenon of «ageing» of the population resulted in the growth of late age dementias frequency, which brought about the development of new organizational forms of assistance for the patients with dementia.The aim of the study was to investigate the structure of the contingent of MHRC Alzheimer's Disease Center patients and to determine the parameters of the Center work efficacy.The materials of the study were demographic and medical data on the patients, who had consulted Alzheimer's Disease Center specialists from 2004 to 2013.Methods were used as follows: the clinical method, neuroimaging (CT/MRI), and psychometric method.Results. The number of initial consultations made up 2620 (68% females), average age of the patients was 70.4 years. As regards the diagnostic distribution, Alzheimer’s type dementias (65,3%) of various degrees of severity were the most frequent, in 42% cases the presence of psychopathological and behavioral symptoms was revealed. In 21% of patients with cognitive impairments the disorders came to nothing more than the syndrome of mild cognitive decline. Over the decade from 2004 to 2013 the data on the dynamics of medical aid appealability to Alzheimer's Disease Center were obtained. The growth of appealability on the whole was shown. The number of initial consultations increased twofold, the number of repeated consultations increased threefold. During the studied period significant growth of the part of patients with mild dementia (from 28.8% to 41.2%) and with the syndrome of mild cognitive decline (from 13,4% to 15,1%) was noticed, which demonstrated distinct tendency towards making a diagnosis at the initial stages of the disease.Conclusion. The complex of tasks and the total volume of the effective activity of Alzheimer’s Disease Center afford a basis for singling it out as an independent link of specialized outpatient gerontopsychiatric assistance for the patients with cognitive disorders and dementia.

поздний возраст, деменция, мягкое когнитивное снижение, диагностика, Альцгеймеровский центр, обращаемость, old age, dementia, mild cognitive impairment, diagnostics, Alzheimer’s Disease Center, appealability

1. Dementia: a public health priority. WHO 2012, 100 p. http://www.who.int/mental_health/publications/demen- tia_report_2012/en/

2. Prince M., Bryce R., Albanese E. et al. The global prevalence of dementia: A systematic review and metaanalysis. Alzhei- mer's & Dementia. 2013;9(1):63-75. doi: 10.1016/j.jalz.2012.11.007

3. Dubois B., Feldman H., Jacova C. et al. Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 cri- teria. Lancet Neurology, 2014;13(6):614-629 DOI: http://dx.doi.org/10.1016/S1474-4422(14)70090-0

4. Harr is R. Addressing global dementia The Lancet, 2014;383(9936):2185. DOI: http://dx.doi.org/10.1016/S0140-6736(14)61066-7

5. Khachaturian Z.S. Perspectives on Alzheimer’s Disease: Past, Present and Future. Advances in Biological Psychiatry. Alz- heimer’s Disease - Modernizing Concept, Biological Diagnosis and Therapy. 2012;28:179-188. DOI:10.1159/isbn.978-3-8055-9803-3

6. Philpot M.P., Levy R. A memory clinic for the early diagnosis of dementia. Int. J. Geriatr. Psychiatry. 1987;2:195-200

7. Van der Cammen T., Simpson J., Fraser R., et al. The Memory Clinic. A new approach to the detection of dementia. Br. J. Psychiatry. 1987;150:359-364

8. Almeida O.P., Hill K., Howard R. Demographic and clinical features of patients attending a memory clinic. Int. J. Geriatr. Psychiatry. 1993;8:497-501

9. Verhey F.R.J., Jolles J., Ponds R. et al. Psychiatric Disorders in Patients Attending an Outpatient Memory Clinic. Int. J. Geriatr. Psychiatry. 1995;10:899-900

10. Wright N., Lindesay J. A servey of memory clinics in the British isles. Int. J. Geriatr. Psychiatry. 1995;10:379-385

11. Wright N., Lindesay J. A servey of memory clinics in the British isles. Int. J. Geriatr. Psychiatry. 1995;10:379-385

12. Picard C., Pasquier F., Martinaud O., et al. Early Onset Demen- tia. Characteristics in a Large Cohort From Academic Memo- ry Clinics. Alzheimer Dis. Assoc. Disord. 2011;25(3):203-205. doi:10.1097/WAD.0b013e318211c6c9

13. Mccarten J.R., Hemmy L.S., Rottunda S.J. et al. Patient Age Influence Recognition of Alzheimer’s Disease. J. Gerontol. 2008;63a(6):625-628

14. Гаврилова С.И., Калын Я.Б., Герасимов Н.П. и др. Новая форма специализированной помощи пожилым больным с деменцией (организационные и фармако-экономические аспекты). Социальная и клиническая психиатрия. 2008;2:36-40

15. Калын Я.Б., Гаврилова С.И., Михайлова Н.М. и др. Фармако- экономические аспекты болезни Альцгеймера. Современная терапия в психиатрии и неврологии. 2014;2:10-15

16. Steenland K., Macneil J., Bartell S., Lah J. Analyses of Diag- nostic Patterns at 30 Alzheimer’s Disease Centers in the US. Neuroepidemiology. 2010;35(1):19-27. DOI:10.1159/000301714

17. Пизова Н.В., Данилова М.В. Когнитивные нарушения в клинической практике и анализ работы кабинета нарушений памяти в Ярославле (амбулаторный прием). Неврология, нейропсихиатрия, психосоматика. 2014;3:32-37. DOI: 10.14412/2074-2711-2014-3-32-37

18. Ротштейн В.Г. Состояние стационарной и полустационарной помощи психически больным позднего возраста. Психиатрия. 2014;61(4):36-42

19. Abner E.L., Kryscio R.J., Caban-Holt A.M., Schmitt F.A. (USA) Baseline Subjective Memory Complaints Associate with In- creased Risk of Incident Dementia: The PREADVISE Trial. J. Prev. Alz. Dis. 2015;2(1):11-16. http://dx.doi.org/10.14283/jpad.2015.37

20. Wucherer D., Eichler T., Kilimann J., et al. Antidementia Drug Treatment in People Screened Positive for Dementia in Primary Care. JAD. 2015;44(3):1015-1021

21. Гаврилова С.И., Колыхалов И.В. Разработка стандарта терапии болезни Альцгеймера. Современная терапия в психиатрии и неврологии. 2012;1:5-9

22. Колыхалов И.В. Пути повышения эффективности терапии болезни Альцгеймера. Психиатрия. 2014;61(1):44-48

23. Cohen C.I., McKenzie Sh.E., Rahmani M. et al. Historical Changes in the Severity of Dementia and Accompanying neuropsychiatric Symptoms in Persons Presenting for Eval- uation in a Multiracial Urban Dementia Center. Alzheimer Dis. Assoc. Disord. 2012;26(4):352-357. doi:10.1097/WAD.0b013e31823cfbdd

24. O’Kelly A., Richards G. Comparison of a memory service da- tabase with primary care dementia registers. Progress in Neurology and Psychiatry. 2011;15(4):26-28. DOI: 10.1002/pnp.207

25. Benbow S.M., Jolley D., Greaves I. Ch. Improving diagnosis of dementia in primary care. Progress in Neurology and Psy- chiatry. 2015;19,10.1002/pnp.361. eScholarID:261974

26. Josefsson S., Kjellmark M., Adenmark P., Karlsson E., strand R., Trell E. Memory Brought to Mind. Five-Year Follow-Up of Case Finding and Intervention of Dementia in a Swedish Pri- mary Health Care District. J. Prev. Alz. Dis. 2015;2(1):17-23. http://dx.doi.org/10.14283/jpad.2015.43