The Mind and Movement clinic: developing a new integrated cognitive-neuropsychiatric service for Lewy body dementia.

BACKGROUND

Lewy body dementia (LBD), including Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB), is common but under-recognised and poorly supported in the Irish healthcare system. This study evaluates the 'Mind and Movement Clinic' at St James's Hospital, Dublin, developed to address the needs of this population.

OBJECTIVES

To analyse the demographic, cognitive, and neuropsychiatric profiles of 99 consecutive referrals and to map the care pathway for individuals with Parkinson's disease (PD), PD with mild cognitive impairment (PD-MCI), PDD, and DLB.

METHODS

A cohort study of the first 99 referrals to the clinic was conducted, including clinical, demographic, cognitive, motor, and neuropsychiatric data.

RESULTS

The sample included 36 individuals with PD-MCI, 9 with PD, and 48 with LBD (11 PDD, 37 DLB). Main referral reasons were cognitive impairment (64.65%), psychotic symptoms (30.30%), and affective symptoms (44.44%). LBD patients had significantly higher rates of hallucinations (75% vs. 26.7%) and delusions (31.25% vs. 4.44%) compared to those without dementia (p < 0.001). Medication interventions included cholinesterase inhibitors, antidepressants, and adjustments to dopaminergic therapy. Significant service needs were reflected in referrals to 16 different services.

CONCLUSIONS

Patients with LBD have complex care requirements, supporting the need for a specialised service integrating memory and movement disorder care. Development of a core outcome set for LBD and an integrated care pathway, including post-diagnostic support, is recommended in the Irish context.