Introduction

+ - Executive summary

Memory and Cognition Clinics (hereafter: MC Clinics) were introduced in Australia in the early 1980s to offer multidisciplinary and specialised assessment of dementia and cognitive decline. They are internationally recognised as the gold-standard for comprehensive dementia assessment and are particularly recommended for people with a complex symptom presentation or a younger disease onset.

There exists substantial variation in the service delivery scope and organisational structure of Australian MC Clinics. This depends on several factors, including the funding model and geographical location of the MC Clinic. For example, in Victoria, MC Clinics were established under the Victorian Department of Health’s Health Independence Program in the early 1990s. This centralised approach is not mirrored in other Australian states and territories. Consequently, considerable variability exists in the operational and assessment processes applied at Australian MC Clinics.

To address this variability, ADNeT has developed the first national service Guidelines for MC Clinics that are based on the overarching principles of person-centred care, equity, and respect. The Guidelines provide consensus-based, best-service recommendations for MC Clinics. These recommendations were developed in consultation with researchers, health professionals and Lived Experience Experts, and cover the following areas: pre-assessment considerations, modes of assessment, referral, the clinical interview and diagnostic work-up, neuropsychological assessment, diagnostic biomarkers, case conferencing and communication of diagnosis.

The Guidelines identify common standards for post-diagnostic support and care that should ideally be provided by MC Clinics. The lack of clear post-diagnostic care pathways for people who have recently been diagnosed with dementia is evident in Australia. During the development of these Guidelines, stakeholders agreed that MC Clinics could play an important role in supporting a person after their diagnosis. It was acknowledged that in many cases, a lack of funding impedes the provision of post-diagnostic services. The sections within these Guidelines titled ‘Feedback and follow-up’ (Section 12) and ‘Support, advice, and care after the diagnosis’ (Section 13) outline the minimum post-diagnostic support a MC Clinic should provide, as well as aspirational criteria that may require increased funding.

Following the publication of these Guidelines, a monitoring and quality improvement pilot program will be conducted by the ADNeT-Memory Clinics initiative. A sample of Clinics from across Australia will be recruited to participate in the program, which will incorporate a process of self-assessment, review, and quality improvement.

Overall, these Guidelines aim to ensure that all Australian MC Clinics provide the highest quality of assessment and post-diagnostic care to people with cognitive decline and dementia.

+ - Introduction
Scope

These Guidelines were developed to establish National Service recommendations for “Memory and Cognition Clinics” across Australia. For the purpose of these Service Guidelines, “Memory and Cognition Clinic” (hereafter: MC Clinic) is defined as a multidisciplinary, specialist assessment service for dementia and cognitive decline. The multidisciplinary team may either be employed within the clinic or engaged via established and timely referral networks.

It is acknowledged that dementia is diagnosed in multiple clinical settings, including hospitals, private specialist clinics, memory clinics, general practices, community health services, and residential care. The first Australian Clinical Guidelines and Principles of Care for People with Dementia recommend a referral to ‘memory assessment specialists or services for a comprehensive assessment’ to all people with a suspected diagnosis of dementia (recommendation 25). Multidisciplinary, dedicated MC Clinics are internationally regarded as the gold-standard for a comprehensive dementia assessment. These Guidelines are aimed at all existing MC Clinic models and settings in Australia, including metropolitan and regional, public, and private, hospital-based, and community / primary care- based, and research clinics.

Rationale and aims of the Guidelines

There are currently no National Service Guidelines that seek to standardise and harmonise the clinical practice and diagnostic processes across Australian MC Clinics. Harmonisation of services and guidelines are important to 1) ensure equity of access to care, 2) communicate expected standards of care and 3) assist with the development and expansion of services to meet international standards. Thus, the primary aim is to foster best-practice and standardisation of services.

Nature of the Guidelines

The proposed Guidelines represent the consensus of a group of stakeholders including:

  1. Australian health professionals working at specialised dementia assessment services,
  2. Leading national dementia experts, and
  3. People with the lived experience of dementia and their care partners.

Importantly, these Guidelines represent ‘ideal’ or best-practice service provision. Consequently, it is not expected that all MC Clinic would currently meet all Guidelines. The Guidelines also cover the seven major Clinical Quality Indicators (CQIs), which were developed following a separate scoping review and a modified Delphi process for the ADNeT Registry. CQIs are specifically defined, measurable items which provide an indication of the quality of care. They are used to assess health care processes and outcomes, and to monitor, evaluate, benchmark, and improve the quality of patient care and interventions that impact patient outcomes. The CQIs support the ADNeT Registry in its aim to collect and analyse data to monitor and enhance the quality of care for people diagnosed with either dementia or MCI in Australia.

Further to the quality assurance work performed by the ADNeT Registry, these Guidelines aim to provide a basis, on which barriers and opportunities for further service development or improvement can be identified, quantified, and reported. To facilitate this process, an evaluation program will be developed and launched via a pilot stage following the publication of the Guidelines. The Guidelines should always be used in the context of the overarching principles that guide every assessment (outlined below).

Overarching principles

A) This document offers general recommendations and standards for MC Clinics. Each service should provide a person-centred assessment, care and intervention that is tailored to each client’s unique personal needs.
B) MC Clinics strive to ensure equal access to the assessments, care, and interventions for all people with a suspected dementia or cognitive decline irrespective of gender, age, ethnicity, sexual orientation, intellectual ability, as well as developmental, socio-economic, cultural, and linguistic background.
C) MC Clinics ensure that each client is treated with respect. Each clinician acknowledges and respects the client’s wishes, recognising that every individual has a unique experience of dementia or cognitive decline and will be affected differently.

Intended users

The Guidelines are intended for all medical specialists, nurses, aged care workers, and allied health professionals with expertise in dementia, who are regularly involved in the assessment and care of people with cognitive decline and dementia as part of a specialist multidisciplinary team. It is also applicable to clinic managers and administrators.

Clinical Population

The clinical population covered in the Guidelines are people with cognitive decline or dementia and their care partners. Please note that cognitive impairments that are neurodevelopmental, stable after an acute brain insult, or in association with a primary psychiatric disorder (such as traumatic brain injury, schizophrenia, bipolar disorder, depression, etc.) are not covered in these Guidelines. Each Clinic should utilise its own discretion regarding the circumstances in which such individuals may be assessed and supported. The clinical population further extends to people living in Residential Aged Care, Nursing Homes, Assisted Living and Retirement villages who may need a specialised, multi-disciplinary assessment.

The Guidelines recognise the distinct and diverse needs of Aboriginal and Torres Strait Islander people, people with a culturally and linguistically diverse (CALD) background, people with an intellectual disability, and the Lesbian, Gay, Bisexual, Transgender, Questioning / Queer, Intersex, Asexual and other non-cisgender (LGBTQIA+) community. It is important to highlight that all Guidelines equally apply to these groups. However, to ensure that their specific needs are sufficiently addressed, the ADNeT-Memory Clinics team will be conducting further scoping work for these population groups to expand the Guidelines accordingly for the next iterations.

Background

Dementia currently affects approximately between 386,200 and 472,000 people in Australia. In the coming decades, the prevalence is projected to grow exponentially due to the increasing ageing population. Dementia is the single greatest cause of disability in older Australians and the second leading cause of death in Australians. It constitutes a major healthcare, psychological, societal, and economic burden. The rising incidence of dementia highlights the need for tools and systems to support earlier diagnosis and interventions.

Dementia care is varied and inconsistent across Australia, with significant heterogeneity in service accessibility, diagnostic processes, assessment procedures, and effectiveness of clinical care. Additionally, dementia is currently diagnosed in several settings outside of MC Clinics, including general practitioners (GPs), hospitals, private specialist practices (e.g., geriatricians, old age psychiatrists, neurologists), community health services, and in residential care. The lack of a clear diagnostic pathway and access to information and support often leads to delays in the diagnostic process. Early stages of the disease, young onset dementia, and dementia types other than Alzheimer’s disease are particularly likely to receive a delayed diagnosis and are often underdiagnosed in primary care settings. To achieve better diagnostic and care outcomes in early and complex symptom presentations, evidence supports a multidisciplinary, specialist approach. The Australian Clinical Practice Guidelines and Principles of Care for People with Dementia particularly recommend referral to comprehensive memory services for dementia diagnosis.

MC Clinics are specialised multidisciplinary services established for the comprehensive assessment of patients with dementia and cognitive decline. The number of MC Clinics has continuously increased since their first appearance in Australia in the 1980s. However, MC Clinics significantly differ in their organisation, funding, staffing, diagnostic protocols, and levels of service across the country. Patients living in rural and remote Australia do not have easy access to specialist services and multidisciplinary teams. Their care needs are often inadequately addressed by the current models of care, and delivering standardised, consistent services nation-wide remains a significant challenge.

Most MC Clinics, like the state-funded Cognitive Decline and Memory Services (CDAMS) in Victoria, are explicitly commissioned to focus on diagnostic assessment with little to no funding for post-diagnostic care. Australian health service data shows that there are no clear post-diagnostic referral pathways. Specialists and primary care services involved in the ongoing care of people with dementia display little collaboration or awareness of available programs. Accordingly, the patients’ access to appropriate health service information, support, and interventions is impeded. Given the specialist knowledge of MC Clinic clinicians and their close relationship to research, MC Clinics are ideally situated to offer broader dementia health education, non-pharmacological interventions, and referrals to existing post-diagnostic support programs. However, to optimise their service provision, MC Clinics would require further funding, coupled with greater harmonisation and agreement on service standards.

Over the past decade, various publications have been released in Australia to improve the quality of dementia assessment and care, in particular the above-mentioned Clinical Practice Guidelines and Principles of Care for People with Dementia1 and the Cognitive Dementia and Memory Service Best Practice Guidelines: Service Guidelines for Victorian Cognitive Dementia and Memory Services. While these publications have sought to improve the quality and consistency of care, there is no nationally consistent guideline or accompanying auditing framework. To meet the healthcare needs of the growing cohort of people with dementia and cognitive decline, boosting multidisciplinary collaboration and establishing networks between MC Clinics and primary healthcare services, aged care, dementia, and other relevant support services is crucial.

The ADNeT ‘National Service Guidelines for Specialised Dementia and Cognitive Decline Assessment Services in Australia’ is an attempt to provide a coordinated approach to circumvent the key barriers highlighted above. It is published with an overarching view to optimise care quality, support continuity of care, and improve patient outcomes and quality of life. The Guidelines aim to bring about greater harmonisation of MC Clinic procedures, including the diagnostic standards and post-diagnostic support pathways. This will endeavour to offer services that are best equipped to provide consistent, evidence-based, and high-quality care to all patients, regardless of their geographic location and socio-economic circumstances.
An auditing framework, which is currently under development and will be published after the Guidelines. It will provide an overview on how far Australian MC Clinics are able to implement these Guidelines. This data will be valuable to identify resource needs and service gaps and could be used to inform policy changes.

+ - Approach to developing the Guidelines
Overview

The provided Guideline recommendations have been developed based on a literature review and extensive consultations with a range of relevant stakeholders.

Literature Review 

Published literature pertinent to memory services and dementia care, including previously published guidelines, was thoroughly reviewed. The following publications were of particular relevance:

  • UK Memory Service National Accreditation Programme (MSNAP) Standards for Memory Services (Abhayaratne, Blanchard, Greally, & Rogers, 2020);
  • Clinical Practice Guidelines and Principles of Care for People with Dementia (NHMRC Partnership Centre for Dealing with Cognitive and Related Functional Decline in Older People, 2016);
  • Cognitive Dementia and Memory Service (CDAMS) Best Practice Guidelines (Victorian Department of Health, 2013).

The review focused on publications after the 2016 CDPC comprehensive systematic literature review. This ensured that the Guidelines represented the already agreed-upon practice standards, as well as recent developments in dementia assessment and post-diagnostic care.

Stakeholder Consultation

The Delphi method is commonly used to obtain expert opinion on topics that are not subject to empirical research (e.g., agreement on methods, guidelines, and definitions by experts in the field). Delphi methods employ questionnaires to gather expert opinion, interspersed with rounds of feedback, until consensus is reached on all items.

Four (4) rounds of alternating input (in the form of questionnaires) and feedback (in the form of questionnaires and consensus meetings) were conducted with the relevant stakeholder groups. The guideline development employed two separate processes based on the input of the target groups:

  1. Health Professionals working in MC Clinic settings;
  2. Lived experience experts

Sub-dividing the Delphi process allowed us to tailor the material to each stakeholder group and ensure that their input is used most effectively. The two processes were then consolidated in the final stage of the developmental process.

Health Professional Delphi Process

Based on the literature review, we developed an online questionnaire that was administered in Round 1 of the Health Professional consultation process. Here, we obtained information on the current clinical landscape of Australian MC Clinics and the clinicians’ opinions on ideal practices, thus allowing to identify gaps in the current clinical practice. The questionnaire targeted topics related to the definition of a MC Clinic, their organisational structure (e.g., clients’ profile, waiting times), assessment procedures (e.g., assessment protocols, diagnostic decision making) and post-diagnostic care (e.g., follow-up appointments, cognitive interventions). We distributed the questionnaire through the ADNeT’s wide professional network, Dementia Australia, and the Queensland state-wide Dementia Network, and received a total of 100 responses.

Since the full complexity of each topic could not be covered by a questionnaire, the items were further discussed during the Round 2 Expert Panel meetings. We invited 25 national experts from the existing ADNeT professional network to participate in this discussion. These experts came from six different states (NSW, QLD, SA, TAS, VIC, and WA) and covered a variety of professions including geriatricians, psychologists, neurologists, neuroscientists, general practitioners, registered nurses, and a range of allied health professionals. Two 3-hour virtual meetings were conducted.

Based on the results of Rounds 1 and 2 and a complementary literature review, an initial list of service Guidelines was developed. Round 3 involved a feedback survey, which aimed to receive feedback on all recommendations and reach agreement on the previously contentious items. This survey was distributed to participants who completed the Round 1 survey and consented to be involved in Round 3.

Lived Experience Experts Delphi Process

In a parallel Delphi process, we obtained input and feedback from lived experience experts. In Round 1, we invited 13 lived experience experts to one 90-minute virtual Focus Group meeting. The lived experience experts were known to us through their engagement in the NNIDR-Community and Consumer Involvement Reference Group (CCIRG). We additionally recruited through Dementia Australia and within the network of the ADNeT Consumer Involvement Officer. The participants discussed their assessment experience, the way the diagnosis was communicated to them, and the support they received in the year post-diagnosis. They were further questioned about how their experience could have been improved.

Based on these discussions, we formulated 24 potential recommendations regarding the assessment process, post-assessment feedback, and ongoing post-diagnostic support. The recommendations were reviewed by the Focus Group members and embedded in a questionnaire that constituted Round 2 of the Lived Experience Experts Delphi process. With the help of Dementia Australia and Alzheimer’s Western Australia, the survey was widely distributed across Australia. The survey was completed by a total of 73 participants. Recommendations that reached 70% agreement were incorporated into the preliminary Guidelines draft.

Unlike the Health Professional Delphi, the Lived Experience Experts process did not involve subsequent feedback round, as the participants were able to provide sufficient input during Round 1, followed by a high level of agreement on all items during Round 2. Final approval of these recommendations took place during the final Consensus and Consolidation Meetings.

Final Consensus and Consolidation Meetings

The last Delphi round comprised two 90-minute consolidation meetings, the purpose of which was to reach agreement on a final list of Guidelines among all stakeholders. The meetings were attended by 1) the Expert Panel members from Round 2, 2) the members of the Lived Experience Expert Focus Group, and 3) the ADNeT-Memory Clinics research team. Any items that remained contentious following the meeting were reworked and sent back to all stakeholders via short REDCap polls. The feedback from the meetings and the polls was implemented to form the final set of Guidelines.

+ - Implementation and Evaluation Plan

Broad implementation of the Guidelines is crucial to achieve an overall improvement and a greater harmonisation of MC Clinics. Following publication of the Guidelines, a pilot monitoring and quality improvement program will be conducted by the ADNeT-Memory Clinics team. At least one (1) MC Clinic from each state and territory will be engaged to pilot the self-review process.

The pilot program will include a mix of government and privately funded MC Clinics, located in metropolitan or regional areas. The sample will include MC Clinics with a multidisciplinary team and those that utilise an established referral network to offer multidisciplinary assessments and interventions.
Following the recruitment phase, an online training session will be conducted for the participating pilot Clinics. This will provide Clinic staff with additional information about the purpose of the pilot program, its methodology, the self-assessment and quality improvement frameworks, and the reporting process that ADNeT will use.

The pilot Clinics will then undertake a self-assessment process using an online framework. For each Guideline, Clinics will be asked to report the extent to which it has been achieved using one of four pre-determined indicators: achieved / in progress / not achieved / not applicable. The framework will also allow the Clinics to upload relevant documentation as evidence of their adherence to the recommendations (or progress toward meeting).

If a Clinic is unable to meet a recommendation or deems it not applicable, they will be asked to provide a reason. This information will assist ADNeT to identify barriers to service delivery within the MC Clinic setting and discuss opportunities for future improvement. The framework will also incorporate a quality improvement section. ADNeT will aim to review Clinics based on these planned improvements approximately one-year after completion of the initial self-assessment process.

The Clinics will be supported throughout the pilot program by staff from the ADNeT-Memory Clinics initiative. When the data has been collated and reviewed by ADNeT, an online meeting will be convened with the pilot Clinics to share the initial findings. This meeting will also allow for discussion about adjustments to the Guidelines, as well as the accompanying audit methodology and tools. A summary report will be prepared and disseminated to each pilot Clinic and an overarching evaluation report will be published by ADNeT. Following the pilot program, a nation-wide roll out of a monitoring and quality improvement program for all MC Clinics is planned.

Guidelines

+ - Section 1: Main Functions of a Memory and Cognition Clinic

+ - 1.1 A specialised Memory and Cognition Clinic is characterised by several main functions that make it distinct from other services that provide assessments of dementia and cognitive decline (e.g., GP services)
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

1.1.1 The clinic offers specialist assessment of dementia and cognitive decline.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

1.1.2 The clinic employs a multidisciplinary team.

Guidance: When required, a comprehensive and multidisciplinary assessment may be offered either via 1) the multidisciplinary team employed within the clinic, or 2) cross-referrals within the established referral networks (e.g., neuropsychologists, nurses, allied health professionals) in the local catchment area. 


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

1.1.3 The service is able to provide general advice and support after the diagnosis as well as post-diagnostic support in the form of evidence-based programs, either at the clinic or via timely referral to other services and allied health support.

Guidance:  Please refer to Section 13 “Support and advice” for further guidance around the provision of post-diagnostic care.


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

1.1.4 The service offers education on dementia to general practitioners and the general public.

+ - Section 2: Modes of assessment

+ - 2.1 Memory and Cognition Clinic offers different modes of appointments to make its services as accessible as possible:
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

2.1.1 Face-to-face appointments


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

2.1.2 Appointments via Telehealth*

Guidance: Lived experience experts particularly endorse this option when they cannot get to the clinic easily. Telehealth includes telephone, videoconferencing or other communication media that permit remote assessments and care.


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

2.1.3 A roving clinical service

Guidance:  A roving clinic describes a clinical service that operates at different locations to offer easily accessible specialist services in mostly regional and remote areas.

Memory and Cognition Clinics are encouraged to consider how to improve their service accessibility for people in the regional and remote areas within their catchment area.

It is suggested that a face-to-face appointment with a client in the regional or remote area is followed-up with a Telehealth appointment, if possible and appropriate.

+ - Section 3: Referral Process

+ - 3.1 Accepting referrals
Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

Memory and Cognition Clinic has clear guidelines for accepting referrals and a framework for prioritising the accepted referrals.

Guidance: For example, clinics may choose to decline a referral if the cognitive problems are clearly within the context of a psychiatric disorder, non-progressive brain disease with no evidence of decline, traumatic brain injury and/or alcohol dependence, etc.

+ - 3.2 Referrals to Memory and Cognition Clinic can be accepted from multiple sources:
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.2.1 GP or a medical specialist

Guidance: This is the preferred referral source.


Recommendation
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

3.2.2 Self-referrals

Guidance: The GP’s endorsement of the self-referral or general involvement of the GP should be encouraged to ensure ongoing support after the Memory and Cognition Clinic assessment.


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

3.2.3 Other health professionals

Guidance: This may include, but is not limited to, nurse practitioners, allied health and the Aged Care Assessment Team (ACAT).

+ - 3.3 A highly specialised Memory and Cognition Clinic assessment is only warranted under specific circumstances.

Triggers for a Memory and Cognition Clinic assessment include:

Guidance: Generally, a Memory and Cognition Clinic assessment would not be indicated for clients who have received a prior dementia diagnosis and for whom their dementia has progressed well past the early/mild stage, their dementia subtype was considered clear, and for which there are no novel referral questions.

Clients who present with non-dementia related cognitive decline (e.g., which can be clearly associated with an acute stroke or traumatic brain injury) may be referred on to a different diagnostic service.

However, accepting these clients is left up to the discretion of the Memory and Cognition Clinic. 

Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.3.1 A client presents with a potential diagnosis of young onset dementia


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.3.2 A differential diagnosis of dementia (e.g., specific syndrome) is required.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.3.3 A client shows a complex symptom presentation.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.3.4 Longitudinal tracking of cognitive problems at potentially prodromal stages of dementia / MCI is required.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.3.5 A client presents with behavioural and/or personality changes.

Guidance: This includes behavioural and psychological symptoms of dementia (BPSD) such as, but not restricted to, depressive symptoms, anxiety, apathy, agitation, sleep problems, psychosis irritability and wandering.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.3.6 There is evidence of risk factors for dementia in the presence of subjective cognitive complaints.

Guidance: Examples of risk factors may include a strong family history of dementia, diabetes, history of smoking, heavy alcohol use or other substance use.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.3.7 There is evidence for rapid cognitive decline.


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

3.3.8 A client presents with progressive cognitive problems and / or progressive cognitive problems are reported by a family member, care partner or other informant close to the client.

Guidance: This may include subjective memory complaints.

+ - 3.4 To adequately process a referral, Memory and Cognition Clinic ensures that all relevant information is received, including:

Guidance: This includes information that is required to assess the appropriateness of a referral, as well as prioritisation. The information can be received from various sources, including the referring health professional, client, and care partner.

Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.4.1 Demographic information


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.4.2 Client’s preferred spoken language, language abilities, and the need for an interpreter


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.4.3 Main symptoms


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.4.4 Progression of symptoms (e.g., rapid decline, no decline noticed)


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.4.5 Medical and psychiatric history


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.4.6 A list of current medications


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

3.4.7 Family history


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

3.4.8 Presence of behavioural and / or psychological symptoms

Guidance: This includes BPSD such as, but not restricted to depressive symptoms, anxiety, apathy, agitation, sleep problems, irritability and wandering.


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

3.4.9 Blood test results

Guidance: Core blood tests are undertaken ideally within 3 months or within a maximum of 12 months prior to referral or at the time of the diagnosis.

This also forms a Clinical Quality Indicator for the ADNeT Clinical Quality Registry.


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

3.4.10 Imaging results

Guidance: Structural neuroimaging is completed ideally within 3 months or within a maximum of 12 months prior to referral or at the time of the diagnosis.

This also forms a Clinical Quality Indicator for the ADNeT Clinical Quality Registry.


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

3.4.11 Reports by other specialists or previous investigations


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

3.4.12 Information about safety concerns for the client or family/ carer


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

3.4.13 Results of cognitive screening


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

3.4.14 Information regarding the clients support network

Guidance: This may include information about the client’s living situation (e.g., living alone, home care), as well as information about the actual and potential carer burden.


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

3.4.15 Hearing status

Guidance: This includes information about the need for hearing aids or other hearing impairments that might affect the assessment.


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

3.4.16 Vision

Guidance: This includes information about the need for glasses or other visual impairments that might affect the assessment.

+ - 3.5 Memory and Cognition Clinic is encouraged to prioritise the referrals they receive to optimise the case flow.

Under the following circumstance a referral is regarded as “high priority”:

Guidance: Any of the criteria from 3.5.1 to 3.5.7 in isolation could be considered sufficient to define the client as "high priority". The precise criteria for a “high priority client” are up to the discretion of the Memory and Cognition Clinic staff and may change depending on evolving circumstances and the capacity of the clinic. Conversely, the definition of a "routine priority" client may similarly evolve.

Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.5.1 Safety concerns in the current living situation (for client or family/carer)


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.5.2 Suspected self-neglect or abuse


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.5.3 Clients who care for others (e.g., parents of young children, carers of a person with disability, etc.)


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.5.4 Rapid cognitive decline


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.5.5 Significant carer burden and stress


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.5.6 Other safety concerns (e.g., driving, depression symptoms)


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.5.7 Clients with a suspected diagnosis of young onset dementia

+ - 3.6 Memory and Cognition Clinic ensures timely access to assessment and diagnosis.

For high priority clients, Memory and Cognition Clinic provides an initial appointment:

Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

3.6.1 Within 30 days of referral *

Guidance: Lived experience experts highlighted that an appointment should be provided within a month after they first contact the Memory and Cognition Clinic.

Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

3.6.2 Ideally, within 14 days of referral


For routine priority clients, Memory and Cognition Clinic provides an initial appointment:
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

3.6.3 Within 90 days of referral *

This also forms a Clinical Quality Indicator for the ADNeT Clinical Quality Registry.

Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

3.6.4 Within 60 days of referral


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

3.6.5 Ideally, within 45 days of referral

+ - Section 4: Prior to the assessment

+ - 4.1 Prior to the assessment, Memory and Cognition Clinic provides written information about the assessment process to their clients.*
This information includes:
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

4.1.1 Types and purpose of the assessment


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

4.1.2 Waiting times

Guidance: If a booking has not been made, the Memory and Cognition Clinic staff should provide approximate waiting times to the clients with a brief explanation of potential delays. Staff members should emphasise to the clients that the waiting times depend on a variety of factors, and, thus, can vary from the suggested ones.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

4.1.3 Assessment costs and duration


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

4.1.4 General information relevant to the appointment.

Guidance: This includes information about:

• The names of staff members the client will see on the day
• Location and parking or public transport access (e.g., map)
• What to bring for the appointment (especially glasses, hearing aids, and medication)

+ - 4.2 Memory and Cognition Clinic supports clients and care partners during the waiting time for an initial assessment, if required.
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

4.2.1 Memory and Cognition Clinic can provide a referral to an experienced counsellor, in case the client or care partner expresses distress during the waiting time for the initial assessment and requires support.

+ - Section 5: Initial clinical interview

+ - 5.1 Memory and Cognition Clinic ensures that a clinical interview is conducted.
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.1.1 Memory and Cognition Clinic staff arrange an interview with the client to identify their needs, hopes, and wishes for the Memory and Cognition Clinic assessment independently from others (e.g., separate interview from the carer).

Guidance: This should not occur if the client declines the opportunity and wishes for their carer/informant to remain with them for the duration of the interview.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.1.2 Memory and Cognition Clinic staff arrange an interview with someone who knows the client well (informant).

Guidance: This only occurs if the client consents to the clinic staff speaking with the informant, who was preferably identified by the client. This interview should also identify the family’s / carer's hopes and wishes for the Memory and Cognition Clinic assessment.

+ - 5.2 The clinical interview is conducted to obtain relevant information about the client to inform the diagnosis and the post-diagnostic care-plan.
Topics for the initial clinical interview include:
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.1 Demographic information

Guidance: This includes information about the client’s place of birth, spoken languages, education, relationship status, and employment.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.2 Detail of the nature, onset, and progress of cognitive complaints


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.3 Medical and psychiatric history

Guidance: Details of conditions associated with cognitive impairment are particularly pertinent. This may include but is not limited to: vascular risk factors, head injury, neurological disorders, depression, and thyroid abnormalities.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.4 Possible risk factors

Guidance: Examples of risk factors may include a strong family history of dementia, diabetes, history of smoking, and heavy alcohol or other substance use.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.5 Presence of depression or anxiety symptoms

Guidance: Where possible, an assessment of depression should be completed using a standard screening tool in addition to the clinical interview.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.6 Presence of psychotic symptoms including hallucinations and delusions

Guidance: It is also recommended to screen for the presence of other BPSD such as, but not restricted to, apathy, agitation, irritability, and wandering.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.7 Sleep disturbance

Guidance: Where possible, a sleep assessment should be completed using a standard screening tool in addition to the clinical interview.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.8 Nutrition / diet

Guidance: Where possible, a malnutrition risk assessment should be completed using a standard screening tool and, if indicated, a referral made to a dietitian-nutritionist with expertise in dementia and preferably an Accredited Practising Dietitian (APD).


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.9 Mobility and falls


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.10 Current medications

Guidance: Staff is generally encouraged to confirm the information on current medications provided at the time of referral and obtain any missing information. Staff is further encouraged to discuss the ability to manage medications safely and review the use of any dosing aids.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.11 Family History

Guidance: Particularly relevant is the family history of mental health issues, neurological disorders, dementia, as well as the corresponding ages of onset.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.12 Client's social support


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.13 Client’s everyday functioning


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.14 Driving


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

5.2.15 Legal issues

Guidance: This point pertains only to potential legal issues that may influence the assessment and the post-diagnostic care-plan. Informed consent should be sought for the assessment and development of a care-plan and, if needed, the capacity of the client with regard to this should be tested (see 7.2.8). Clinic staff should inquire about the presence of a current substitute decision maker. Other forms of capacity, including testamentary capacity, would generally not be assessed during the clinical interview.


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

5.2.16 Advance care-plans


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

5.2.17 Physical activity engagement and routine

+ - Section 6: Diagnostic work-up

+ - 6.1 Memory and Cognition Clinic offers a holistic diagnostic work-up.
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

6.1.1 Multiple cognitive domains are tested.

Guidance: Cognitive testing needs to be tailored to the client’s cultural and educational backgrounds and to their presenting symptoms. 

Assessments by a neuropsychologist should be considered as required (see section 7.2 for further guidance around the circumstances that may warrant a neuropsychological assessment).

This also forms a Clinical Quality Indicator for the ADNeT Clinical Quality Registry.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

6.1.2 A person’s ability to undertake personal and instrumental activities of daily living (IADL) are assessed.

Guidance: Under some circumstances, an occupational therapist with expertise in dementia is consulted to conduct a standardised performance-based assessment to clarify domains and extent of functional impairment. These circumstances include but are not limited to 1) a client presents with mild functional impairment and good cognitive test scores; 2) reliable information on the client’s IADL is not available.

This also forms a Clinical Quality Indicator for the ADNeT Clinical Quality Registry.


6.1.3 Result  of all investigations including neuroimaging should be considered when making the diagnosis.

+ - Section 7: Neuropsychological assessment

+ - 7.1 Memory and Cognition Clinic is able to offer neuropsychological services within the clinic or via established referral pathways to an accessible, available, and timely service.
The following neuropsychological services are made available:
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

7.1.1 Specialised neuropsychological assessment for diagnosis

Guidance: This includes but is not limited to the assessment of multiple cognitive domains as well as mood, behaviour, sleep, and everyday functioning.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

7.1.2 Behavioural assessments

Guidance: While specialised neuropsychological assessment includes a general assessment of behaviour changes via questionnaires and/or clinical interview, a behavioural assessment is a more detailed, individualised breakdown of the client’s BPSD including contexts, triggers, consequences (such as the A-B-C model of Antecedent, Behaviour, Consequence). A behavioural assessment informs post-diagnostic intervention strategies with individualised recommendations and education for the client, family, carers, and allied health professionals.


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

7.1.3 Non-pharmacological post-diagnostic support

Guidance: This may include evidence-based cognitive interventions and cognitive or memory strategies.

+ - 7.2 Neuropsychological services may not be required for every client.
It is suggested that neuropsychological testing is undertaken in the following circumstances:
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

7.2.1 Where there is diagnostic uncertainty or for the purpose of differential diagnosis


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

7.2.2 If a client presents with complex or unusual symptom pattern


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

7.2.3 In the presence of functional decline despite ‘normal’ scores on gross screening tools, especially if the client has a high level of education


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

7.2.4 If a client presents with pronounced speech and language difficulties (e.g., suspected primary progressive aphasia)

Guidance: In many cases, speech pathology diagnostic assessment should be preferred over neuropsychological testing. Consultation with a speech-language pathologist is generally encouraged when a client presents with significant language difficulties.

Speech Pathology diagnostic assessment should, therefore, be particularly considered when a detailed testing of language functions (e.g., semantic, phonological, syntactic functioning) is required; for differential diagnosis; in the presence of re-emerging motor speech vs. phonological difficulties, or social communication changes and eating/swallowing/hyperorality changes.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

7.2.5 If a client presents with suspected young onset dementia

Guidance: Young onset dementia is defined here as a diagnosis of dementia in clients under the age of 65. It may have highly varied and complex symptom presentation that does not necessarily include memory decline.  


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

7.2.6 If there is a need to understand the cognitive profile to inform treatment and management

Guidance: This may include determining whether decline in cognitive domains (such as memory, executive functioning, or language) is sufficient to interfere with the client’s adherence to treatment or compromise the likely success of treatment. A detailed neuropsychological profile may be informative regarding the client’s cognitive strengths and weaknesses, which in turn can inform management plans.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

7.2.7 If a client presents with pronounced behavioural changes

Guidance: This may include apathy, suspected behavioural variant frontotemporal dementia, etc.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

7.2.8 If there is a need to conduct a specific capacity assessment (e.g., capacity to make informed decisions on finances, treatment, care-plan, placements into residential aged care)

Guidance: This standard refers to situations where more information about cognitive abilities would be beneficial to determine the client’s capacity for these specific forms of capacity.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

7.2.9 If a client presents with subtle cognitive changes

Guidance: This may include subjective cognitive complaints and mild cognitive impairment. In this instance, neuropsychological assessment may be required, as it is more sensitive to subtle changes in cognition than cognitive screening measures.

+ - Section 8: Diagnostic Biomarkers

+ - 8.1 If appropriate resources and expertise are available, Memory and Cognition Clinic includes the evaluation of diagnostic biomarkers to provide the most accurate diagnosis.
Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

8.1.1 Where there is diagnostic uncertainty and/or detailed diagnostic information is required, advanced neuroimaging, e.g., Positron Emission Tomography (PET) is conducted.

Guidance: To be considered based on out-of-pocket costs for the client, expertise of staff, and access.


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

8.1.2 Lumbar puncture is undertaken for more complex cases, including the use of CSF markers of amyloid and tau pathology.


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

8.1.3 Testing of common genetic polymorphisms and/or mutations associated with dementia onset and/or progression can be conducted where considered to provide additional diagnostic value.


Note: Once the validity and prognostic utility have been demonstrated for Australian clinics and appropriate training is provided to clinicians, obtaining blood-based biomarkers may form part of the diagnostic work-up.

+ - Section 9: Case-conference

+ - 9.1 On completion of all assessment procedures, a Memory and Cognition Clinic is able to conduct an interdisciplinary case conference that includes all available team members involved in a particular assessment, including leave replacement staff.

Interdisciplinary case-conferences are conducted:

Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.1.1 For complex cases with an unclear diagnosis


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

9.1.2 For every client

+ - 9.2 A case conference may be conducted at different time points:
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.2.1 After the initial assessment


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

9.2.2 After the follow-up session, as required

+ - 9.3 During the case-conference the assessment results, diagnosis, and care-plan are discussed.
Specific topics for discussion include:
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.1 Assessment results (e.g., cognitive test results)


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.2 Imaging results


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.3 Consensus diagnosis


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.4 Medical prognosis


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.5 Early support

Guidance: The immediate support needs of the client and care partner should be identified during the case-conference.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.6 Client's strengths, weaknesses, and available resources


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.7 Possible care strategies for the client


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.8 Pharmacological intervention options


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.9 Risk factor modification


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.10 Driving capabilities


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.11 Risk of abuse


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.12 Counselling needs


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.13 Education needs


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.14 Suitability for pharmacological and non-pharmacological research studies


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.15 Cognitive intervention options


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

9.3.16 Legal and financial capabilities

+ - Section 10: Communicating the diagnosis

+ - 10.1 Memory and Cognition Clinic clinicians communicate the diagnosis in a timely, empathic, and easily understandable manner.
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

10.1.1 Memory and Cognition Clinic clinicians inform the client of the diagnosis as soon as all the investigations are completed. *

Guidance: Dementia Lived Experience Experts especially stressed the importance of providing the information in both verbal and written forms.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

10.1.2 When communicating the diagnosis, the preferred terms are “dementia” and “mild cognitive impairment”.

Guidance: Stakeholders involved in the Delphi process preferred the use of these terms, as opposed to the DSM-5 “major and minor cognitive disorder”. Communicating the dementia subtype is encouraged, at the discretion of the clinician. 


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

10.1.3 If the diagnosis of dementia is uncertain, clients are given an easy-to-understand written explanation of the results and the next steps.*

 


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

10.1.4 Memory and Cognition Clinic offers a lay person summary of the client’s test result reports.*

Guidance: This would ideally include scan reports, neuropsychological reports, biomarker analyses, etc. A copy of the test results reports may be provided to the client upon request.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

10.1.5 The appointment during which the diagnosis is communicated is long enough for the client to process the information and ask questions. *

Guidance: The length and format of the appointment(s) should be determined based on the clinical judgement and may vary according to the client’s preference. Clinicians should consider providing an opportunity for a break within the appointment or offering an additional appointment to continue discussing the diagnosis where required, especially if the client seems confused or distressed.
More recommendations about the feedback session during which the diagnosis is communicated can be found in section 12 “Feedback and Follow-up”.

+ - Section 11: Dignity, consent and capacity, and confidentiality

+ - 11.1 The Memory and Cognition Clinic ensures that the client’s wishes regarding the confidentiality of their diagnosis are respected.
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

11.1.1 The assessing clinician confirms if the client wishes to know the diagnosis.

Guidance: The client should be informed about the benefits of learning their diagnosis, including how their quality of life may be improved.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

11.1.2 If a client does not wish to know the diagnosis, the medical practitioner and other Memory and Cognition Clinic staff respect that wish as much as possible.

Guidance: Wherever possible, clinicians should seek to understand the client’s preference and act in accordance with it. If the client does not wish to know their diagnosis, clinicians should use their clinical judgement to determine whether the client’s family/care partner should be informed of the diagnosis, considering factors such as autonomy, capacity, confidentiality, and risk/safety.
The clinician should aim to provide education to reduce the stigma of the diagnosis and outline the benefits of knowing the diagnosis to ensure that the client receives all the needed support.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

11.1.3 The assessing clinician asks the client if and with whom the outcome of the assessments should be shared.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

11.1.4 If the client does not have capacity to decide whether to receive their diagnosis, the decision of their proxy decision maker (known as a Person Responsible in most states) should be respected and further discussed over time.

Guidance: Where possible, the clinician should provide education to outline the benefits of knowing the diagnosis. 

+ - Section 12: Feedback and Follow-up

+ - 12.1 Following the completion of all assessments and diagnosis formulation, Memory and Cognition Clinic organises the feedback and post-feedback follow-up sessions in the following fashion:

Guidance: Recommendations for the follow-up sessions apply after a diagnosis of dementia or MCI classification is established and may apply for clients with subjective cognitive complaints, if required (e.g., monitoring risk factors).

Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

12.1.1 A separate feedback session to communicate or discuss the diagnosis, start on the care-plan, and organise a care coordinator (if available) *

Guidance: In some cases, two shorter feedback sessions may be necessary to allow sufficient time for the client to process the diagnosis. Please refer to Section 10 for more guidance.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

12.1.2 A minimum of one post-feedback follow-up session to assess the status of the care or referral plan's implementation *


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

12.1.3 If necessary, at least one additional follow-up session to provide further support and to monitor and adjust the care-plan

+ - 12.2 The clinical specialist who assessed the client has a leading role in the initial post-diagnostic process
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

The clinical specialist who assessed the client has a leading role in the initial post-diagnostic process (i.e., feedback session and care-plan development).

Guidance: This may include medical specialist, nurses, and allied health professionals.

+ - 12.3 Memory and Cognition Clinic ensures timely scheduling of the feedback session(s).
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

12.3.1 The feedback session is conducted as soon as possible after the final diagnostic assessment.

Guidance: Ideally, a feedback session is conducted within 4 weeks of the initial assessment, provided that all assessments have been completed and the results of all investigations are received.

+ - 12.4 The feedback session during which the diagnosis is communicated should be attended by all relevant parties.

This includes the assessing clinicians and the client and may also include the following:

Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

12.4.1 Support person or care partner (with client’s consent)


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

12.4.2 Allied health professionals

+ - 12.5 Memory and Cognition Clinic offers follow-up sessions to evaluate the client’s progression and care-plan implementation.
Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

12.5.1 Memory and Cognition Clinic follows up all clients with a diagnosis of dementia at least once every 12 months and thereafter based on the client’s need for review.

Guidance: Follow-ups should be based on the client’s needs. Ideally, they are offered within the 12 months after the diagnosis, particularly if the client cannot be followed-up and supported by other clinical services.

Clinics with limited resources, who are unable to offer follow-up sessions for all clients with an established dementia diagnosis, should ensure an appropriate follow-up mechanism by linking the client into appropriate services.


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

12.5.2 Memory and Cognition Clinic follows up all clients with a diagnosis of MCI at least once every 12-18 months based on the clinical judgement and thereafter based on the client’s need for review.

This also forms a Clinical Quality Indicator for the ADNeT Clinical Quality Registry.

+ - Section 13: Support, advice, and care after the diagnosis

+ - Definition

Directly after the diagnosis, Memory and Cognition Clinic provides support and advice to enable clients to better understand, adjust to, and live well with their diagnosis. This includes:

  1. Educating the client about their diagnosis or opportunities for risk reduction with the aim of reducing stigma;
  2. Developing a clear post-diagnostic care-plan;
  3. Providing information about and referring to support services with dementia expertise, depending on their diagnosis and need (e.g., Dementia Australia, legal services, social worker, relevant community health services);
  4. Providing or referring to evidence-based programs and interventions.

The following tables outlines services and items that should be ideally:

  1. Discussed with the client;
  2. Provided at the clinic; or
  3. Offered via referral to external services.
+ - 13.1 Memory and Cognition Clinic ensures that the client receives all relevant information post-diagnosis and assists with developing the care-plan.
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

13.1.1 Memory and Cognition Clinic provides written post-diagnostic support recommendations to the client, the client’s GP, the referring medical practitioner (if other than the GP) and the post-diagnostic support service(s), as applicable *

Guidance: If a client was not referred by a GP, Memory and Cognition Clinic should encourage the client to involve a GP to ensure ongoing support after the Memory and Cognition Clinic assessment.  


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

13.1.2 The client, their care partner(s), and all assessing clinicians (e.g., medical practitioner, neuropsychologist) are actively involved in the client's care-planning.


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

13.1.3 For clients with MCI or early signs of dementia, Memory and Cognition Clinic provides personalised risk reduction information to the client, GP, or other referring medical practitioner, if required.

Guidance: Such information may also be provided to clients with subjective cognitive complaints, if required.


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

13.1.4 Memory and Cognition Clinic provides support and advice to clients they did not initially assess and diagnose.

Guidance: This may apply to clients with a recent diagnosis, who, for example, have recently moved into the catchment area and seek advice on ongoing support, or clients with a recent diagnosis, who were unable to access relevant advice and information about local post-diagnostic support.


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

13.1.5 Memory and Cognition Clinic assures the client and their family / care partner(s) that further advice and assistance can be sought after the discharge.

Guidance: For example, this may include information about local support services with dementia expertise.

+ - 13.2 Memory and Cognition Clinic facilitates the care-plan implementation.
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

13.2.1 Memory and Cognition Clinic has active relationships with relevant support services to refer as appropriate (e.g., support group for carers).


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

13.2.2 Memory and Cognition Clinic offers follow-up phone calls to assist the client with the care-plan implementation. *

+ - 13.3 Where appropriate, directly after the diagnosis, Memory and Cognition Clinic provides advice, information, and support regarding the following issues:
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

13.3.1 Education about dementia (e.g., psychoeducation) provided to the client, family, and carers *


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

13.3.2 Carer support*


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

13.3.3 Beneficial lifestyle changes*


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

13.3.4 Behaviour management interventions


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

13.3.5 Risk reduction education


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

13.3.6 Management of safety concerns


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

13.3.7 Written personalised strategies to help the client live with dementia day-to-day, e.g., use of calendars, medication boxes and phone reminders *


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

13.3.8 Involvement in research and clinical trials (where appropriate)


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

13.3.9 Recruitment into the ADNeT Clinical Quality Registry (for eligible clients)

Guidance: This only applies for Memory and Cognition Clinics that participate in the ADNeT Clinical Quality Registry. Click here for further information.

+ - 13.4 If Memory and Cognition Clinic is unable to provide more detailed post-diagnostic support (e.g., due to a lack of resources), it refers clients to relevant, available, and timely services with dementia expertise.

Where appropriate, these services include:

Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

13.4.1 Provision of psychological support (e.g., management of depression / anxiety) *


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

13.4.2 Nursing Support

Guidance: This may include care coordination.


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

13.4.3 Occupational therapy


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

13.4.4 Speech and language therapy


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

13.4.5 Group based programs focused on improving well-being (e.g., Day Centres with leisure activities, Meeting Centre Support Programs, etc.) *


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

13.4.6 Dietetic advice

Guidance: Provided by a dietitian with expertise in dementia, preferably an Accredited Practising Dietitian (APD).


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

13.4.7 Exercise programs

Guidance: Provided by an exercise physiologist or physiotherapist with expertise in dementia.


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

13.4.8 Provision of interventions for poor sleep-wake functioning (e.g., Cognitive Behaviour Therapy, sleep hygiene, interventions to treat obstructive sleep apnoea)


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

13.4.9 Home-based multidisciplinary reablement programs


Practice point
This recommendation represents an aspirational criterion that might not apply to every Memory and Cognition Clinic or a criterion that may not currently be feasible, given the high variability of staffing and financial resources of Memory and Cognition Clinics across Australia.

13.4.10 Evidence-based cognitive interventions (e.g., computerised or memory strategy training) via face-to-face appointments or via Telehealth

Guidance: Dementia Lived Experience Experts particularly endorse the option of Telehealth, if they cannot get to the service easily.

+ - 13.5 Where appropriate, Memory and Cognition Clinic connects clients to the following services, after the diagnosis is communicated:
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

13.5.1 Driving assessments


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

13.5.2 Dementia Australia


Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.
Consumer Recommendation
Recommendation developed during the Delphi process of people with the lived experience of dementia and their care partners.

13.5.3 Community Care Services *

 


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

13.5.4 Legal and financial counselling

+ - Section 14: Pharmacological Support 

+ - 14.1 Where appropriate, Memory and Cognition Clinic provides advice on pharmacological treatments.
This may include the following elements: 
Strong recommendation
This recommendation achieved the highest level of agreement and was identified as a fundamental aspect of a good Memory and Cognition Clinic.

14.1.1 Medication review (e.g., where medications may potentially contribute to cognitive impairment)


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

14.1.2 Dementia specific medications


Recommendation
This recommendation achieved a high rate of agreement and represents an additional criteria deemed to further increase the quality of Memory and Cognition Clinics.

14.1.3 Pharmacological interventions for BPSD

Guidance: BPSD include but are not restricted to: depressive symptoms, anxiety, apathy, agitation, sleep problems, psychosis, irritability, and wandering.

+ - Glossary and Abbreviations
Glossary of Terms
Term Definition
Allied Health University qualified health professionals specialised in a particular area that help to prevent, diagnose, and treat impairments and diseases, but who are not part of the medical, dental, or nursing profession (e.g., dietitian-nutritionists, exercise physiologists, occupational therapists, physiotherapists, psychologists, social workers, and speech pathologists).
Australian Dementia Network (or ADNeT) Clinical Quality Registry A mechanism employed for monitoring and enhancing the quality of healthcare delivered to people diagnosed with either dementia or mild cognitive impairment through the collection, analysis, and reporting of relevant demographic and clinical data.
Biomarkers Molecules, genes, and their derived products that could be found in body fluids or tissues (e.g., cerebrospinal fluid and blood) and are signs of a biological process or a disease. Deficit or accumulation of some of these components are associated with dementia.
Blood-based biomarkers Proteins (e.g., beta amyloid, tau protein, neurofilament light etc) or other molecules which can be found in blood and are signs of the disease process. Their abnormal quantities inform us about the presence of disease or the risk of developing it in the future.
Capacity A legal concept which describes client’s awareness and understanding of their situation, actions, and the consequences of said actions, and the ability to make informed decisions regarding any of the assessments and diagnostic procedures based on their understanding.
Care-plan A written document developed by the Memory and Cognition Clinic staff that contains information related to the client’s diagnosis, disease management, and the post-diagnostic support recommendations. The care-plan is based on the completed assessments and the needs and wishes of the client and their family/carer (if applicable).
Carer / Care partner A paid or unpaid person who provides care and assistance with activities of daily living to the client, to whom they may or may not have a family relation.
Case conference A meeting between the health professionals involved in an assessment to discuss diagnosis, a care-plan and strategies for post-diagnostic care.
Client A person with cognitive complaints presenting to a Memory and Cognition Clinic for assessment and support.
Clinical Quality Indicator A specifically defined, measurable item that provide an indication of the quality of care.
Delphi method A method commonly used to obtain expert opinion on topics that are not subject to empirical research (e.g., agreement on methods, guidelines, and definitions by experts in the field).
DSM-5 Fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. DSM-5 classes dementia as a ‘major neurocognitive disorder’ (although retained the term dementia in parentheses) and recognises the earlier stage of cognitive decline as ‘mild neurocognitive disorder’ (which is similar to the commonly used term ‘mild cognitive impairment’ [MCI]).
Feedback session The appointment during which the diagnosis is communicated to the person who had been assessed at the Memory and Cognition Clinic, and the first discussion of post-diagnostic care-planning takes place
Follow-up session The appointment during which assessment of the status of the care-plan or referral plan occurs
Informant A family member or carer that provides information about the client.
Lived Experience Expert A person with lived experience of dementia and their care partners, who provided expert input to the Guidelines
Memory and Cognition Clinic A multidisciplinary, specialist assessment service for dementia and cognitive decline. The multidisciplinary team may be employed within the Clinic or engaged via established referral networks.
Memory and Cognition Clinic clinicians Health professionals working at a Memory and Cognition Clinic.
Multidisciplinary team A multidisciplinary team is comprised of three or more health professionals of different disciplines, who work collaboratively and cooperatively to address multiple aspects of a client’s assessment and care needs.
Post-diagnostic support Support and advice provided to clients after the diagnosis that enables clients to better understand, adjust to, and live well. It includes education and support, the care-plan, and evidence-based programs and interventions that are provided at the clinic or via referral to external services.
Practice points These recommendations represent aspirational criteria that might not apply to every Memory and Cognition Clinic or criteria that may not currently be feasible, given the high variability in staffing and financial resources of Memory and Cognition Clinics. – more detailed explanations on the strength of recommendation can be found in chapter 1.10. 1 “Type of Recommendations”.
Recommendation Recommendations that achieved high rates of agreement from health professionals and lived experience experts during development of these Guidelines. They represent additional criteria deemed to further increase the quality of Memory and Cognition Clinics – more detailed explanations on the strength of recommendation can be found in chapter 1.10. 1 “Type of Recommendations”.
Roving service A clinical service that operates at different locations to offer easily accessible specialist services in mostly regional and remote areas.
Strong recommendation Recommendations that achieved the highest level of agreement from health professionals and lived experience experts during the development of these Guidelines. They represent the fundamentals of a good Memory and Cognition Clinic – more detailed explanations on the strength of recommendation can be found in chapter 1.10. 1 “Type of Recommendations”.
Telehealth Means of administering clinical care remotely using mediums such as the telephone, videoconferencing, or text-based internet messaging.
Abbreviations
Abbreviation Explanation
ACAT Aged Care Assessment Team
ADNeT Australian Dementia Network
AI Associate Investigator
APD Accredited Practicing Dietitian
BPSD Behavioural and Psychological Symptoms of Dementia
CDAMS Cognitive Dementia and Memory Service
CSF Cerebrospinal fluid
CI Clinical Investigator
CT Computer Tomography
DSM-5 Diagnostic and Statistical Manual of Mental Disorders, 5th edition
GP General Practitioner
IADL Instrumental Activities of Daily Living
LGBTQIA+ Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual and other non-cis gendered identities
MCI Mild Cognitive Impairment
MRI Magnetic Resonance Imaging
MSNAP Memory Service National Accreditation Programme
NHMRC National Health and Medical Research Council
NNIDR National Health and Medical Research Council’s National Institute for Dementia Research
PET Positron Emission Tomography
PP Practice Point
R Recommendation
SR Strong Recommendation

+ - Acknowledgements
ADNeT-Memory Clinics Steering Committee
Members ADNeT Role and Affiliations
Prof Sharon Naismith Chair Steering committee, Lead ADNeT-Memory Clinics; Clinical Neuropsychologist; Leonard P Ullmann Chair in Psychology; Healthy Brain Ageing Program, University of Sydney, NSW
Prof Perminder Sachdev Co-Lead ADNeT-Memory Clinics, Co-Director ADNeT; Neuropsychiatrist; Co-Director of the Centre for Healthy Brain Aging (CHeBA) at the University of New South Wales, NSW; Clinical Director of the Neuropsychiatry Institute, Prince of Wales Hospital, NSW
Prof Susan Kurrle Memory Clinics and Regional Clinics Stakeholder; Geriatrician; Director of Cognitive Decline Partnership Centre and Current Professor in Health Care of Older People Northern Clinical School, Faculty of Medicine and Health, University of Sydney NSW
Prof Lee-Fay Low Post-diagnostic Care Expert; Psychologist; Professor in Aging and Health at University of Sydney, NSW
Prof James Vickers Memory Clinics Representative; Director of Wicking Dementia Research and Education Centre at the University of Tasmania, TAS
Prof Susannah Ahern ADNeT Clinical Quality Registry Representative; Academic Lead ADNeT Clinical Quality Registry; Head, Clinical Outcomes Data Reporting and Research Program, School of Public Health and Preventative Medicine, Monash University, VIC
Dr Nicole Kochan Neuropsychology Representative; Clinical Neuropsychologist; Senior Research Fellow at the Centre for Healthy Brain Aging (CHeBA), University of New South Wales, NSW
Elizabeth Rand Occupational Therapy Representative; Occupational Therapist; Manager at Caufield Cognitive Dementia and Memory Service (CDAMS), Alfred Health, VIC
Robert Day Representative, Department of Health, ACT
Kaele Stokes Representative, Dementia Australia; Executive Director advocacy and Research at Dementia Australia, VIC
Deborah Remfry Consumer Representative, VIC

ADNeT-Memory Clinics Research team
Members ADNeT Role and Affiliations
Prof Perminder Sachdev Co-Director ADNeT, University of New South Wales, NSW
Prof Sharon Naismith Lead ADNeT Memory Clinics, University of Sydney, NSW
Prof Susan Kurrle Associated Investigator ADNeT, University of Sydney, NSW
Prof Lee-Fay Low Associated Investigator ADNeT, University of Sydney, NSW
Dr Nicole Kochan Associated Investigator ADNeT, University of New South Wales, NSW
Dr Inga Mehrani National Project Manager ADNeT-Memory Clinics, University of New South Wales, NSW
Katrina Fyfe State Coordinator ADNeT, University of Western Australia, WA
Dr Johannes Michaelian Project Officer ADNeT, University of Sydney, NSW
Gemma Jahn State Coordinator ADNeT, Edith Cowan University, WA
Valerie Arsenova State Coordinator ADNeT, University of New South Wales, NSW
Krupa Krishnaprasad State Coordinator ADNeT, Monash University, VIC
Dr Adam Bentvelzen Research Fellow ADNeT, University of New South Wales, NSW
Dr Matthew Paradise Medical Fellow ADNeT, University of New South Wales, NSW
Sladana Pavkovic PhD Candidate ADNeT, University of Tasmania, TAS

Health Professional Expert Panel
Members Health Professional Background and Location
Dr Rebekah Ahmed Neurologist, NSW
Dr Jane Alty Neurologist, TAS
Prof Elizabeth Beattie Nurse Practitioner, QLD
Prof Henry Brodaty Psychiatrist, NSW
Dr Veronika Canning Clinical Psychologist, QLD
Prof Lindy Clemson Professor of Occupational Therapy, NSW
Dr Stephanie Daly General Practitioner, SA
Judy Deimel Nurse Practitioner, SA
Daniella Kanareck Social Worker, NSW
Prof Paul Maruff Neuropsychologist, VIC
Dr Kannan Natarajan Geriatrician, QLD
Prof Peter Nestor Neurologist, QLD
Dr Fiona O’Leary Dietitian-Nutritionist, NSW
Elizabeth Rand Occupational Therapist, CDAMS Clinical Coordinator, VIC
Prof Cathy Short Neurologist, SA
Prof Maria Fiatarone Singh Geriatrician, NSW
Dr Hamid Sohrabi Neuroscientist/Neuropsychologist, WA
Kym Torresi Speech Pathologist, VIC
Dr Stephanie Ward Geriatrician, NSW
Prof Michael Woodward Geriatrician, VIC
Therese Woodward Registered Nurse, NSW
Prof Michael Valenzuela Neuroscientist, NSW
Consumer Panel
Members Location
Margo Bryan TAS
Dennis Frost NSW
Conny Gard ACT
Bryan Gard ACT
Cath Hall SA
Glenys Petrie QLD
John Quinn QLD
Bobby Redman NSW
Susie White VIC