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The Cognitive Disorders Service runs in parallel with the Dementia Research Centre (DRC), part of the Department of Neurodegenerative Disease at the UCL Institute of Neurology (ION).
The clinical and research components form a national centre of excellence for diagnosis and treatment of patients with cognitive problems, and the group is recognised internationally for ground-breaking research in dementia.
All forms of cognitive disorder are seen; however, we have particular expertise in young onset dementia, familial dementias and unusual degenerative diseases. Progressive disorders such as Alzheimer’s disease (AD), vascular dementia or frontotemporal dementia are commonly seen, but other less common disorders also assessed including limbic encephalitis, hereditary leukodystrophies and acquired cognitive problems such as amnesia, aphasia, visuospatial problems, apraxia, facial recognition and executive dysfunction due to varying aetiologies.
- What the Clinic Visit Involves
Multi-Disciplinary Approach
Patients are assessed in a consultant-led multidisciplinary clinic, which benefits from the input from specialists in neurology, psychiatry, psychology, speech and language, neuroimaging and neurophysiology.The Clinic Appointment
The Cognitive Disorders Clinic assessment begins with a face-to-face appointment at the National Hospital for Neurology and Neurosurgery with a specialised clinician. The clinician will ask questions about the patient’s symptoms to understand the pattern of their cognitive difficulties. They may ask them to undergo some brief tests to measure their memory and thinking skills. To aid the appointment, it is usually helpful to bring someone with you who knows you well, such as a family member, friend or carer.Clinical Investigations
Depending on the clinical situation, it may be beneficial to conduct some investigations to help reach a diagnosis. Investigations are conducted at the same hospital site, and, if possible, may take place on the same day as the clinic appointment.
The investigations we most frequently perform are blood tests, an MRI brain scan and Neuropsychological testing.Bloods Tests: A panel of tests may be performed to check that there is not a medical problem which is causing cognitive symptoms to appear.
MRI: This is a scan of your brain which takes place within a specialist (loud) machine. Prior to the scan, you will be asked some questions to make sure there is no reason why you cannot have a scan (e.g. you have a cardiac pacemaker). The scan will usually take place in under an hour. Scan images will be reviewed by a specialist neuro-radiologist to examine for any abnormalities.
Neuropsychology Testing: These are a set of more detailed tests of memory and thinking, conducted by a specialist neuropsychologist. The full set of tests may take around one and a half hours to complete.
If indicated by the clinical situation, the following investigations may also be performed:EEG: This test records the brain’s electrical activity. It involves special electrodes being painlessly attached to the scalp. The test may take up to an hour.
Lumbar Puncture: This procedure is performed to obtain a sample of cerebrospinal fluid. It involves inserting a hollow needle in the lower back to drain a small amount of fluid, which is sent to the laboratory for analysis. The appointment usually lasts about 2 hours, which includes time for consent for the procedure, the procedure itself, taking blood and rest. This procedure would take place in the Day Case Unit at the National Hospital for Neurology and Neurosurgery.
- Counselling and Diagnosis in Dementia (CANDID) Service
Counselling and Diagnosis in Dementia (CANDID) is a nurse-led information and advice service offering advice on how to access information on legal and financial matters, and the role of statutory and voluntary support services.
The CANDID service is run by Frankie O’Shea, Anna Balones and Sophia Beltran (Anadel Espinosa covering mat leave until Sept 2024) and is available to patients and families registered with an NHS specialist Cognitive Clinic and associated healthcare professionals. It aims to enhance mutual understanding between patients and doctors through:
- Face to face consultations at clinic appointments
- A telephone helpline service between appointments and following discharge to local services
- Nurse led therapeutics appointment