Congratulations Jon and colleagues!

I’d really like to applaud your almost single-handed attempts to reintroduce “wick” into the modern lexicon. When one of your characters said it on a R4 play I heard it absolutely made my day

Perhaps the larger problem is that when you establish memory clinics galore that many parts of the system don’t adequate look beyond memory

I don’t know to be honest. You would assume that, in the most part, they’re doing neuro exams either - so there would be a knock on effect on sensitivity. I do think that quality of care is too often conflated with diagnostic rates - and it is in the former that the MDT comes into its own

Could you expand on what you mean by “less skilled clinical staff”?

I do think “sketchy” is a bit harsh. Every specialty & service has its blind spots. Fluctuations tricky at best of times & RBD requires bed partner informant for recognition. in routine practice - especially in older populations - there is no shortage of comorbidities& complicating factors

Parkinsonism not necessarily late-emerging. And DaTScans not 100% necessary in all cases but crucial in some. The failure to detect Parkinsonism or have an abnormal DaT can be the difference between an AD diagnosis and a DLB one.

Patients with DLB are certainly not all referred to neuro - when you look for the symptoms in “memory clinic” populations, they’re there…

It’s because psychiatry led services are much less likely to do a neuro exam and therefore more likely to miss Parkinsonism. Anecdotally may be less likely to detect fluctuations or RBD. Access to DaTScans varies a lot geographically and so do clinicians’ diagnostic thresholds