1. Wrexham and Flintshire memory service Presenters: DR. SHARMI BHATTACHARYYA, Consultant IAN DAVIES ABBOTT, Clinical Nurse Specialist ROWENNA SPENCER, Manager Memory Service Diagnosis of mild cognitive impairment (MCI) in memory service and subsequent interventions

2. Mild cognitive impairment is a syndrome defined as cognitive decline greater than expected for an individual's age and education level, which does not interfere notably with activities of daily living (DOH, 2006). It is not a diagnosis of dementia of any type, although it may lead to dementia in some cases.

3. Standards (as identified by NICE Guidance) 1.3.3 Early identification of dementia 1.3.3.1 : Primary healthcare staff should consider referring people who show signs of mild cognitive impairment (MCI) for assessment by memory assessment services to aid early identification of dementia, because more than 50% of people with MCI later develop dementia. 1.3.3.3 : Memory assessment services that identify people with MCI (including those without memory impairment, which may be absent in the earlier stages of non- Alzheimer's dementias) should offer follow- up to monitor cognitive decline and other signs of possible dementia in order to plan care at an early stage

4. Aims, Objectives & Methods Aims: To audit time to diagnosis and interventions provided by Memory Service (East) for people with MCI Objectives: 100% compliance with standards was expected To improve waiting times and provision of interventions for those with MCI Methods: Retrospective audit of case notes and 1000 lives documentation to identify people with ‘ No diagnosis’ or MCI between September 2013 to August 2014. 79 case notes ( No Diagnosis) : 18 identified as MCI or MCI (V)

5. Information collected Gender. Diagnosis. Average Age. Average time between referral and diagnosis. Who was the diagnosis disclosed to? Outcome (was a follow-up appointment made?) Was the person referred to a memory management group? What information was provided at diagnosis?

6. Findings 2 diagnosis were identified – MCI and MCI (V). No significant finding with regards to age at diagnosis or with regards to Gender and specific diagnosis. More males ( 11/18- 61%) were identified as having MCI Diagnosis of MCI (V) was more common (10/18 – 55% ) Average Age (80), M (78), F (80), MCI (80), MCI-V(78) People given a diagnosis of MCI (V) had slightly shorter waiting time ( 6 months vs 3 months)

7. Gender Split ( n=18) & by diagnosis

8. Average time between referral and diagnosis (months) People given a diagnosis of MCI(V) had a significantly shorter waiting time between referral and diagnosis ( 3mths compared to 6mths). No significant difference between the waiting time between referral and diagnosis regarding gender.

9. Diagnosis disclosed to: The majority of diagnoses were delivered to the client and relative. This result corresponds to the earlier audit of diagnosis preferences of people with dementia using North Wales memory services.

10. Outcome The likelihood of being discharged is slightly more raised if given a diagnosis of MCI (V). Those noting subsequent deterioration or with a MCI diagnosis are more likely to be offered follow up appointments to monitor any further changes.

11. Referred to memory group

12. Information provided X1 = provided information regarding one of Diagnosis, Support Services or Memory Strategies X2 = provided information regarding two of Diagnosis, Support Services or Memory Strategies X3 = provided information regarding all three areas

13. Key findings Those diagnosed with MCI (V) have a shorter waiting time between referral and diagnosis than those diagnosed as MCI. Just over half (61%) of those diagnosed with MCI or MCI (V) received information regarding their diagnosis. Less than half (39%) of the clients received information regarding support services or memory strategies.

14. Recommendations Results of Audit to be fed back to memory Service teams and clinical staff - reaudit. Better provision of post diagnostic information. Better recording of interventions and offer of interventions in case notes.

15. THANK YOU ANY QUESTIONS