Brain Health Clinic – Remote clinical service

During the COVID-19 pandemic, Maudsley Charity funded several projects in response to the challenges posed by lockdown restrictions on access to in-person care.

These projects set out to build the Trust’s capacity to deliver care remotely, and where possible, improve the experience for patients. We particularly focused on those projects with the potential to have a sustained use or impact beyond the pandemic.

We funded the first phase of the pilot of the South London and Maudsley Brain Health Clinic, offering patients assessment and diagnosis of mild cognitive impairment using remote consultation and testing technologies. It successfully proved that a remote diagnostic clinic could provide an effective service for a greater and more diverse number of people and has continued to develop since our initial funding.

With age-related memory loss frequently accompanied by depression and anxiety, early identification of a mild cognitive impairment (MCI) can help to prevent poor mental health among older patients, as well as support the wellbeing of their family members and carers, who are often affected by the demands of their caring roles.

However, demand for assessment currently outstrips capacity, so many patients find themselves left on waiting lists and unable to access timely support. A diagnosis of MCI is often, but not always, a precursor to a diagnosis of dementia. Early detection can lead to earlier and more effective interventions, so the ability to rapidly and accurately assess patients with a suspected MCI is vital.

The pilot tested the effectiveness of remote assessments on patients who had an existing diagnosis of MCI and/or dementia with an uncertain cause. Patients were assessed via video call on Microsoft Teams, following which they were offered a range of cognitive, genetic, and physical tests, some of which are not commonly available on the NHS.

With just under half of the participants’ results studied, the project has so far shown that the clinic was able to accurately confirm existing diagnoses and provide more detailed information to patients regarding their current impairment and how it might progress, particularly vital for those at high risk of developing dementia. They were also able to rule out any serious cognitive impairment for others – relieving them of the anxiety that often accompanies uncertainty.

Patients with a low risk of developing dementia were discharged back to their local GPs, while those at higher risk were offered further assessments six and 12 months later, alongside referral to local support services as well as the clinic’s own weekly cognitive well-being and lifestyle groups, which provided peer support, tools and advice on physical health and nutrition.

Reviews of the Remote Brain Health Clinic from patients and carers have so far been overwhelmingly positive, with feedback suggesting that the use of digital technology improved accessibility for patients with impaired hearing and/or vision, as well as reducing language barriers (and by extension health inequalities) by facilitating the use of interpreters. It also made it possible for carers to support their loved ones at appointments without having to take time off from work.

In 2023, the clinic team was recognised by their peers at the South London and Maudsley Staff Awards, while a paper detailing the results of the pilot project is expected to be published in 2024. With plans to scale up assessments across south London, this project is an excellent example of how collaboration between our clinical and research partners can have an immediate and direct impact on services.