Joint Geriatric-Psychogeriatric Cognitive Clinic in Hong Kong-A Review of the First 31 Cases (1994)

SUMMARY The first cognitive clinic in Hong Kong was started in May 1993. This paper described the characteristics of the first 31 clients and the interventions by the clinic. The diagnosis is based on DSM III R. More female than male attended the clinic (1.6.1) and the female were older in age (80:76.3). Many of the clients came from old age homes in Sai Kung area but 2046 were either referred by the relatives or self referred. Poor memory was the major presenting symptom in the clinic. 26% of the patients were diagnosed to be suffering from dementia and Alzheimer's disease was the predominant disease among the demented patients seen. 299% of patients were either diagnosed as borderline dementia or benign senescent forgetfulness. Another important group included affective disorder (2996). Many patients had co-morbid medical conditions. Satisfaction with the services was highly regarded by carers despite the lack of clinical improvement in many frail elderly. Keywords: cognitive clinic, Haven of Hope Hospital, multidisciplinary assessment INTRODUCTION Cognitive Dysfunction and Alzheimer's Disease are conditions of major significance in the elderly of industrially advanced countries. Hong Kong is beginning to face a similar problem by virtue of her graying population. While 9% of our population is at present aged 65 and above, 11.5% will be expected at 2001 (Census and Statistics Department). Although earlier reports indicated Alzheimer's Disease and dementia were relatively uncommon in the Chinese, reliable epidemiological database constructed upon a bi-national survey in Shanghai in 1989 established rates of cognitive impairment in 66 years and above to be 6.99% for severe cases and 19.9% for mild cases. The Chinese female rate for cognitive Impairment was about 3 times as high as those reported in the Yale-New Haven study for the same age group (Liu et al, 1993). Medical clinics specifically for dementia have existed in the United States of America United Kingdom and Australia. The objects of these memory clinics are four-fold (Frarer, 1992); (1) To forestall deterioration In dementia by means of early diagnosis and treatment. (2) To identify and treat any disorders other than dementia which might be causing memory impairment it (3) To evaluate new therapeutic agents in the treatment of early dementia. (4) To reassure those who are worried that they are losing their memory, when, in fact no morbid deficits are found; and to provide rarer support. Since May, 1993 and for the first time in Hong Kong, a cognitive clinic has been operating at Haven of Hope Hospital, collaboratively by the Kwai Chung Psycho-geriatric Team and the Geriatric Assessment and Rehab-ilitation Unit of Haven of Hope Hospital (HOHH). This paper describes: the operation of such a clinic in Hong Kong, the demography and clinical characteristics of the first 31 clients assessed from May 1993 to March, 1994, the interventions provided by the clinic and discussion on some findings on the clients. OPERATION OF THE CLINIC The clinic is operated once per month, on the first Thursday of each month. The clinic smarts with a client interview and examination by the geriatric team with a geriatrician and a geriatric nurse at HOHH at 9:00 am. Attention is paid to comorbid physical illnesses and review of medications, and soliciting a brief account of the cognitive complaint The Kwai Chung Psychogeriatric Team arrives at HOHH at 10:00 am. The clinical condition of the cases are discussed between the two teams. The psychogeriatrician then performs a detailed psychiatric assessment and ascertain further clinical and psychosocial information from the accompanying carer. Instruments for cognitive assessment in the clinic Include the Mini-Mental State Examination and Silver's test. At the end of the assessment, a consensus diagnosis on the mental (according to DSM IIIR) and physical condition is made and a joint management plan is formulated. …