Organization of memory centers and prospects.

The concept of memory centers is based on a multidisciplinary approach to m emory disorders and dementia, especially Alzheimer's disease, a public heal th challenge. The first memory centers were established in the 80s in the U S and the British Isles. The aims of these centers are to make a diagnosis (and to reassure the 'worried well'), to detect dementia, to provide a serv ice for their management, to educate care takers, to evaluate new therapies , and to contribute to clinical and basic research. Follow-up is crucial. T he first memory centers all experienced long delay to diagnosis of dementia and found that Alzheimer's disease was the first cause of consultation. Th ese observations led to the creation of such centers in many countries. A s urvey of 20 French memory centers defined the "ideal memory center": an ide ntified structure with a clinic and a day-care unit for diagnosis and follo w-up, with neurological, psychological, psychiatric, and geriatric skills. It must be part of a medical and social network for the management of demen tia and participate in a network of memory centers at the regional and nati onal level. Relationships between dementia and somatic diseases, frequent i n demented patients, are still poorly known. Dementia interferes with the c linical expression, the management, and the prognosis of somatic diseases, some of which, such as cardiovascular conditions, are possibly linked with dementia. Conversely, somatic diseases may rapidly worsen the cognitive sta te and induce delirium, leading to hospitalization. Medical wards are not a il appropriate. Memory centers must also be involved in these care, educati onal and research issues.