Identifying patterns of communication in patients attending memory clinics: a systematic review of observations and signs with potential diagnostic utility

Abstract

BackgroundSubjective cognitive complaints are commonly encountered in primary care and often result in memory clinic referral. However, meta-analyses have shown that such concerns do not consistently correspond to objective memory impairment or predict future dementia. Memory clinic referrals are increasing, with greater proportions of patients attending who do not have dementia. Studies of interaction during memory clinic assessments have identified conversational profiles that can differentiate between dementia and functional disorders of memory. To date, studies exploring communication patterns for the purpose of diagnosis have not been reviewed. Such profiles could reduce unnecessary investigations in patients without dementia.AimTo identify and collate signs and observable features of communication, which could clinically differentiate between dementia and functional disorders of memory.Design and settingThis was a systematic review and synthesis of evidence from studies with heterogeneous methodologies.MethodA qualitative, narrative description and typical memory clinic assessment were employed as a framework.ResultsSixteen studies met the criteria for selection. Two overarching themes emerged: 1) observable clues to incapacity and cognitive impairment during routine assessment and interaction, and 2) strategies and accounts for loss of abilities in people with dementia.ConclusionWhether the patient attends with a companion, how they participate, give autobiographical history, demonstrate working memory, and make qualitative observations during routine cognitive testing are all useful in building a diagnostic picture. Future studies should explore these phenomena in larger populations, over longer periods, include dementia subtypes, and develop robust definitions of functional memory disorders to facilitate comparison.