The Specialist-Based Memory Clinic Model Has Selling Points, Too

In 1992, neurologist Sharon Cohen was a sole practitioner at a satellite office of the North York Hospital Seniors Health Centre. Today, the Toronto Memory Program is an expansion of that private practice, housed on the top floor of a squat commercial building minutes from the hospital.

That new space is large, but as quiet as a library. One hallway leads to the research area, where clinical-trial participants spend time; another set of locked, glass doors leads to a lab and private area where patients have blood drawn and spinal taps performed (spinal and brain fluid are the same and offer insight into amyloid protein buildup).

Beyond that, you’ll find a lecture hall ringed with enormous north- and east-facing windows, and full of upholstered chairs where caregivers learn about meditation techniques and other coping strategies.

“Everything but the scans [MRI, PET] happens here,” says Cohen. “We’re trying not to send patients all over to different locations.”

Those patients are people with cognitive impairments, including Alzheimer’s. “We see people with very early symptoms to people who are very advanced. It’s a full range,” she says. “We follow them from point of contact till death or institutionalization.”

The on-site services include driving assessments, elder-care mediation and legal advice, speech therapy and psychiatry. Hospital- and family-practice-based memory clinics can make referrals for these services, but don’t generally offer them in-house.

There isn’t one organization, one resource where you can get all these things done.

“It is quite overwhelming for a family to receive a diagnosis [of Alzheimer’s] and be faced with a large number of tasks to be done that are dispersed,” says Cohen. “There isn’t one organization, one resource where you can get all these things done. So part of the role of a good memory clinic is to try and help a person or family navigate the system and be the point of contact.”

Patients need a referral from their GP. The clinic will repeat cognitive testing to determine progress or decline, they’ll talk with the team about the patients’ symptoms and the doctor may prescribe and review medications.

The clinic sends this information to the patient’s primary care provider. Most patients will have appointments at the clinic twice a year, but their caregivers are usually in touch with staff far more frequently than that.

“As the disease changes, or as family coping evolves or breaks down, you need a clinic that will have the capability to case-manage,” says Cohen.

What does the caregiver need to keep their loved one safe, to keep quality of life high and to keep the family functioning well? It’s the clinic’s social workers who help families manage those aspects of the disease.

“We’re often filling out forms, whether it’s for parking permits or drafting letters to say this person’s not capable of managing their finances anymore, or that they need a driving test,” says Michelle Martinez, Manager of Clinical Operations at the Toronto Memory Program. “If a caregiver is overwhelmed, we can call a service directly for them."

While some clinics focus on severely impaired, fragile elderly patients, others, like Cohen’s, are interested in prevention as well. That interest is why clinical trials are a cornerstone of the Toronto Memory Program.

“We are a big clinical trial centre,” she says, “so if someone has the opportunity and interest to participate in cutting edge research, to try new products that aren’t on the market yet, that’s something that we can make available.”

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Jasmine Miller

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