Tackling dementia together via the Australian dementia network (ADNeT): A summary of initiatives, progress and plans

In 2018, the Australian Dementia Network (ADNeT) was established to bring together Australia\u27s leading dementia researchers, people with living experience and clinicians to transform research and clinical care in the field. To address dementia diagnosis, treatment, and care, ADNeT has established three core initiatives: the Clinical Quality Registry (CQR), Memory Clinics, and Screening for Trials. Collectively, the initiatives have developed an integrated clinical and research community, driving practice excellence in this field, leading to novel innovations in diagnostics, clinical care, professional development, quality and harmonization of healthcare, clinical trials, and translation of research into practice. Australia now has a national Registry for Mild Cognitive Impairment and dementia with 55 participating clinical sites, an extensive map of memory clinic services, national Memory and Cognition Clinic Guidelines and specialized screening for trials sites in five states. This paper provides an overview of ADNeT\u27s achievements to date and future directions. With the increase in dementia cases expected over coming decades, and with recent advances in plasma biomarkers and amyloid lowering therapies, the nationally coordinated initiatives and partnerships ADNeT has established are critical for increased national prevention efforts, co-ordinated implementation of emerging treatments for Alzheimer\u27s disease, innovation of early and accurate diagnosis, driving continuous improvements in clinical care and patient outcome and access to post-diagnostic support and clinical trials. For a heterogenous disorder such as dementia, which is now the second leading cause of death in Australia following cardiovascular disease, the case for adequate investment into research and development has grown even more compelling

Organisational aspects and assessment practices of Australian memory clinics: an Australian Dementia Network (ADNeT) Survey

Objectives Conducting a national survey of clinicians and administrators from specialised dementia assessment services (memory clinics) in Australia to examine their current organisational aspects and assessment procedures and inform clinical tool harmonisation as part of the Australian Dementia Network—memory clinics project.Design A cross-sectional survey.Setting Public and private memory clinics across Australia.Participants 150 individual clinicians completed the survey between May and August 2019. Responses could be given anonymously. Most clinics were publicly funded services (83.2%) and in metropolitan regions (70.9%).Outcome measures Descriptive data on organisational aspects of memory clinics (eg, waiting times, staffing); the three most commonly used assessment tools per assessment type (eg, self-report) and cognitive domain (eg, attention).Results Since the last national survey in 2009, the number of memory clinics across Australia has increased substantially but considerable variability has remained with respect to funding structure, staffing and assessment procedures. The average clinic employed 2.4 effective full-time staff (range 0.14–14.0). The reported waiting time for an initial assessment ranged from 1 week to 12 months with a median of 7 weeks. While most clinics (97%) offered follow-up assessments for their clients, only a few (31%) offered any form of cognitive intervention. We identified over 100 different cognitive assessment tools that were used at least ‘sometimes’, with widespread use of well-established core screening tools and a subset of common neuropsychological tests.Conclusion This paper presents a current snapshot of Australian memory clinics, showing considerable heterogeneity with some common core elements. These results will inform the development of national memory clinic guidelines. Furthermore, our data make a valuable contribution to the international comparison of clinical practice standards and advocate for greater harmonisation to ensure high-quality dementia care

Implementation of Cognitive (Neuropsychological) Interventions for Older Adults in Clinical or Community settings: A Scoping Review

Despite compelling evidence that cognitive interventions for older adults improve cognition, mood, and everyday function, few are implemented in clinical or community practice. This scoping review aims to understand the implementation frameworks and methods used and their contribution to implementation success of cognitive interventions for older adults. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-S), and searched CINAHL, EMBASE, MEDLINE, and PSYCINFO databases, using terms related to cognitive interventions, implementation, and older adults. This resulted in 5002 studies, of which 29 were included following an iterative process. Most studies reported on cognitive stimulation for people with dementia. Only four studies used implementation frameworks: three used RE-AIM, and one a process evaluation using complexity theory. The most frequently addressed implementation concepts were Acceptability, Feasibility, and Effectiveness, while Cost, Cost-Effectiveness, and Maintenance were rarely reported. Solutions to common barriers included good stakeholder relationships and engagement, a manualised intervention flexible enough to adapt to the context, and ensuring facilitators were well-trained, confident, and enthusiastic

Characterising Australian memory clinics: current practice and service needs informing national service guidelines

Abstract Background Memory clinics (MCs) play a key role in accurate and timely diagnoses and treatment of dementia and mild cognitive impairment. However, within Australia, there are little data available on current practices in MCs, which hinder international comparisons for best practice, harmonisation efforts and national coordination. Here, we aimed to characterise current service profiles of Australian MCs. Methods The ‘Australian Dementia Network Survey of Expert Opinion on Best Practice and the Current Clinical Landscape’ was conducted between August-September 2020 as part of a larger-scale Delphi process deployed to develop national MC guidelines. In this study, we report on the subset of questions pertaining to current practice including wait-times and post-diagnostic care. Results Responses were received from 100 health professionals representing 60 separate clinics (45 public, 11 private, and 4 university/research clinics). The majority of participants were from clinics in metropolitan areas (79%) and in general were from high socioeconomic areas. While wait-times varied, only 28.3% of clinics were able to offer an appointment within 1-2 weeks for urgent referrals, with significantly more private clinics (58.3%) compared to public clinics (19.5%) being able to do so. Wait-times were less than 8 weeks for 34.5% of non-urgent referrals. Only 20.0 and 30.9% of clinics provided cognitive interventions or post-diagnostic support respectively, with 7.3% offering home-based reablement programs, and only 12.7% offering access to group-based education. Metropolitan clinics utilised neuropsychological assessments for a broader range of cases and were more likely to offer clinical trials and access to research opportunities. Conclusions In comparison to similar countries with comprehensive government-funded public healthcare systems (i.e., United Kingdom, Ireland and Canada), wait-times for Australian MCs are long, and post-diagnostic support or evidence-based strategies targeting cognition are not common practice. The timely and important results of this study highlight a need for Australian MCs to adopt a more holistic service of multidisciplinary assessment and post-diagnostic support, as well as the need for the number of Australian MCs to be increased to match the rising number of dementia cases