Developing, implementing, and evaluating the first national Memory and Cognition Clinic Guidelines in Australia

Abstract

INTRODUCTION

A lack of national consensus on the roles and responsibilities of Australian memory and cognition clinics contributes to the large variability seen across services. The introduction of guidelines and a quality assessment framework could facilitate greater harmonization and quality improvements.

METHODS

We used a modified Delphi process to develop the guidelines. Pilot clinics completed a self‐assessment, case‐note audit, and review meeting to evaluate their service against the guidelines.

RESULTS

The final guidelines included 160 standards on 14 different topics. Standards around maximum waiting times for an assessment and minimum post‐diagnostic care responsibilities were particularly controversial. Seven clinics participated in the pilot. On average, clinics achieved 56% of standards (range of 18% to 87%).

DISCUSSION

The Memory and Cognition Clinic Guidelines form the first step toward greater harmonization and quality improvements. Key learnings from the clinics’ feedback included reducing the number of secondary standards and streamlining data collection with the national dementia clinical quality registry.

Highlights

• We developed and implemented the first national consensus‐based best‐practice guidelines for memory and cognition clinics in Australia.

• The guidelines are based on consultation with 125 Australian health professionals and 89 Australians living with dementia and care partners.

• First‐time national agreement on standards around maximum waiting times for an assessment and minimum post‐diagnostic care requirements is presented in the guidelines.

• The guidelines were implemented in seven memory and cognition clinics from five different states.

• Clinicians' feedback included: reducing the number of secondary standards to increase conciseness and practicability should be considered for future iterations.

1. INTRODUCTION

The diagnosis of dementia, particularly in its early stages, is complex. ¹ It often requires a specialist multidisciplinary approach offered by memory and cognition clinics to achieve high diagnostic accuracy and facilitate timely access to care. ² For consistency the term “memory and cognition clinic” (abbreviated as MC clinic or clinic) rather than “memory clinic” will be used in this paper, as this was the term project agreed on. Internationally, MC clinics are considered the gold‐standard for providing a comprehensive dementia assessment. ³ , ⁴ , ⁵ In Australia, MC clinics have been endorsed as the ideal setting for a timely and highly accurate diagnosis of dementia and mild cognitive impairment (MCI) in the Clinical Practice Guidelines and Principles of Care for People with Dementia ⁶ and Australia's National Dementia Action Plan – Consultation Summary Paper. ⁷ Recent service mapping identified > 85 MC clinics across Australia, including > 50 public clinics. ⁸

Funding models for MC clinics vary across the six Australian states and two territories. The state of Victoria financially supports a state‐wide MC clinic network known as Cognitive, Dementia and Memory Services (CDAMS), ⁹ while funding in other states is decentralized with varying resources. ¹⁰ This affects the staffing, clinic frequency, and waiting times for an initial appointment. A recent Australian survey found the average waiting time for an MC clinic assessment is ≈ 10 weeks, ranging from 1 week to 1 year. Similarly, the frequency with which clinics were operating ranged from five times a week to once a year. ¹⁰ Guidelines for MC clinics were introduced for the Victorian CDAMS network in 2013, ⁹ but no nationally agreed MC clinic standards which would be applicable to MC clinic across all states and territories have been published yet. This contributes further to the large service variability in the country. As a result, Australian MC clinic patients probably do not receive consistent, high‐quality assessments and care.

The establishment of nationally agreed standards is the first step toward greater harmonization and an important basis to boost further quality improvements as demonstrated in other countries. ¹¹ Consequently, the development of Australia's first consensus‐based national best practice guidelines for MC clinics supplemented with a quality assessment framework facilitating self‐evaluation and guideline implementation was a priority for the memory clinics initiative of the Australian Dementia Network (ADNeT). ¹²

The Netherlands and the UK successfully implemented national MC clinic standards in 2008 and 2009, respectively. ¹¹ , ¹³ The UK also established the Memory Services National Accreditation Programme (MSNAP). Their 2023 report shows that most registered and accredited clinics were able to provide an initial appointment within 6 weeks, despite increasing their average number of annual new admissions by 130%. ¹⁴ , ¹⁵ In Australia, a minimum dataset and clinical quality indicators for the assessment and diagnosis of dementia and MCI was introduced in 2020 as part of the first Australian dementia Clinical Quality Registry. ¹⁶ , ¹⁷ The registry aims to ensure minimum dementia care standards and enables international benchmarking across all possible dementia assessment services. However, there are no MC clinic‐specific guidelines outlining the level of services to expect from a multidisciplinary, highly specialized clinic and no service‐level evaluation programs to assess the MC clinic's guideline adherence nor for the independent appraisal of these clinics.

The work presented in this study aimed to develop the first consensus‐based guidelines with broad consultation from Australian MC clinic clinicians and administrators, policy makers, and people living with dementia. The guidelines are envisaged as a living document which will require regular updates as new evidence and best‐practice recommendations emerge. Moreover, a self‐evaluation framework designed to facilitate guideline implementation and aiming to support the clinics’ advocacy for resources required to deliver gold‐standard services will be piloted. This pilot will also mark the first step on the way to developing a formal MC clinic accreditation program in Australia.

2. METHODS

2.1. Development of the guidelines

A modified Delphi process ¹⁸ , ¹⁹ was used to develop consensus‐based memory and cognition clinic guidelines. Ethics approval was obtained from University of New South Wales Human Research Ethics Committee (HC200394/HC200543). A schematic overview of the development process is displayed in Figure 1.

FIGURE 1.

Development process of Australia's first consensus‐based Memory and Cognition Clinic Guidelines.

First, a narrative literature review was completed to identify the key topics and quality indicators for MC clinics to be discussed with stakeholders. Based on the review, a 65‐question survey was developed in Qualtrics ²⁰ and distributed to 196 clinicians and administration staff working for MC clinics who registered on the ADNeT professional network. A detailed description of the survey methods and results is published elsewhere. ²¹ In brief, clinicians were asked about their current practices. They were then asked to indicate what they considered to be ideal practice and those responses were used to shortlist standards reflective of the ideal best practice for an MC clinic.

The research team invited 25 national clinical experts from different professions and jurisdictions with MC clinic experience to form a focus group. Two 3 hour focus group meetings were completed to discuss complex topics (e.g., capacity assessments) and topics with < 70% agreement in the Delphi survey (e.g., waiting times). Polls were used to measure agreement and facilitate the consensus process. The meetings were recorded and main outcomes protocolled and formed into potential guideline standards.

RESEARCH IN CONTEXT

1. Systematic review: Memory and cognition clinics (MC clinics) are regarded as the gold standard for a timely and accurate diagnosis of dementia. Australian MC clinic surveys show a large variability in service provision. The introduction of national guidelines has shown positive effects on the MC clinic accessibility, service quality, and overall harmonization. We drew evidence from national and international guidelines for MC clinics and dementia care and peer‐reviewed papers providing insights on best practice for the specialized assessment and care of people with dementia.

2. Interpretation: We identified 160 consensus‐based best practice standards for Australian MC clinics, including 23 recommendations that were particularly endorsed by patients and care partners. We further present a self‐evaluation framework aiming to facilitate guideline implementation and discuss the results of an implementation pilot.

3. Future directions: Work on the second iteration of the guidelines and a national MC clinic accreditation program based on the pilot study is under way.

After the focus group meetings, the standards were refined and incorporated into a feedback survey. The survey was distributed to 86 Delphi survey respondents who agreed to be contacted again. Respondents rated their level of agreement with each standard on a 7‐point Likert scale ranging from “entirely agree” to “entirely disagree” and could provide free text comments. Standards receiving a very high agreement rating (> 70% “entirely agree” rating) were identified as strong recommendations, standards reaching > 70% “somewhat” and “mostly agree” ratings were identified as recommendations, and all remaining standards were considered aspirational practice points.

In parallel to the health professional consultation process, we consulted people with living experience of dementia and care partners. With assistance from the national dementia advocacy organization Dementia Australia six people living with dementia and MCI and seven care partners with MC clinic experience were invited to participate in a focus group. Participants discussed their past diagnostic experiences and wishes or ideas for an ideal MC clinic assessment. This focus group meeting was recorded, main outcomes protocolled and then shortlisted as potential guidelines standards.

These standards were embedded in an online Qualtrics survey and sent to > 200 dementia advocates who registered with Dementia Australia. Dementia advocates were people living with dementia and MCI as well as care partners and included a large variety of diagnostic experiences. The survey was not limited to respondents with MC clinic experience as the advocates’ general views on the best possible service delivery were relevant to this study. Respondents rated each standard on a 3‐point Likert scale (not important – important – very important) and could provide free text comments. During the final consolidation phase, both expert groups came together to reach final consensus on contentious issues and review the “strength of recommendation” proposed for each standard.

2.2. Pilot study

Based on the stakeholder consultation and for purposes of this study, an MC clinic was defined as a specialist dementia assessment service with access to a multidisciplinary team, either within the clinic or via well established and proven referral pathways to partner services. Eighteen MC clinics representing all Australian states and territories were invited to participate in a pilot study to evaluate clinic's adherence to the guidelines and the feasibility and value of guidelines implementation. The pilot was further conducted to inform the design of a more comprehensive MC clinic accreditation program in the future. Invited clinics serviced both metropolitan and regional/remote areas and included public, private, and hybrid (e.g., using public and research funds). Ethics approval was obtained from the University of New South Wales (HC#220010) and site‐specific approval sought as required.

Participating clinics attended an online staff training session and received a user handbook outlining the evaluation process. A customized Microsoft Excel datasheet was developed to capture data. Each clinic was given 2 months to complete the data collection. Site‐specific details such as clinic type (public/private), service location (metropolitan/regional/remote), and staffing were captured as contextual information. Clinics completed a self‐assessment in which they rated adherence to each standard in the guidelines (see Figure 2).

FIGURE 2.

Excerpt of self‐assessment data collection tool.

An “achieved” rating was given when a standard was routinely met and “not achieved” when never met or when no evidence of achievement could be provided. A “not applicable” rating was available in case a standard was not relevant for the clinic. All ratings required a brief justification. Clinics uploaded documentary evidence (e.g., model of care, letter templates) supporting the clinic's self‐assessment to a REDCap ²² database via a secure unique URL.

Where applicable, for several standards, evidence of achievement was additionally demonstrated by a case‐note audit. A case‐note audit of the last eight newly diagnosed patients and two latest review patients was used to demonstrate that standards are implemented routinely. For each patient, the clinics selected if the standard was met (yes), not met (no) or not applicable (n/a, see Figure 3). For standards assessed by case‐note audit, all 10 patients were required to have met the standard (including reasonable n/a ratings) to “achieve” this standard.

FIGURE 3.

Excerpt of case‐note audit data collection tool.

The research team reviewed the data and evidence and prepared a site‐specific report outlining the percentage of achieved standards per guideline topic. Areas of achievement and those requiring improvement were identified. The report was discussed with the clinic team. An overarching de‐identified performance report that also included the clinics’ feedback and the research team's learnings was prepared and circulated to all participating clinics.

3. RESULTS

3.1. Guideline development

Research papers reporting on current practices of international specialized dementia assessment services from various countries including the UK, Italy, the Netherlands, and Ireland and gray literature including national and international policy and guideline documents published in English were reviewed. ⁶ , ⁹ , ¹¹ , ²³ , ²⁴ , ²⁵ , ²⁶ As a result, 17 topics were identified as potential key topics for a national MC clinic guideline and further discussed in the Delphi process.

Overall, 125 MC clinic health professionals (100 survey respondents and 25 focus group participants) participated in the Delphi process. Detailed results on the health professional Delphi survey have been reported elsewhere. ²¹ Additionally, 86 people living with dementia and care partners (13 focus group participants [6× diagnosed with dementia/MCI] and 73 survey respondents [15× diagnosed with dementia/MCI]) provided input. No detailed information about the diagnosis of people with dementia who participated in the process were obtained. All focus group participants had some extent of MC clinic experience, while survey respondents with dementia were diagnosed in various settings (6× MC clinic, 3× geriatric service, 2× neurology service, 2× general practitioner, 1× neuropsychologist, 1× in a research facility). The median age of diagnosis was 62. Participants came from five different states and were mostly well educated (80% > bachelor's degree).

The final guidelines included 160 standards across 14 main topics: “main functions,” “modes of assessment,” “referral process,” “prior to the assessment,” “clinical interview,” “diagnostic work‐up,” “neuropsychological assessment,” “diagnostic biomarkers,” “case conference,” “communicating the diagnosis,” “dignity, consent, capacity, and confidentiality,” “feedback and follow‐up,” “support/advice & care after the diagnosis,” and “pharmacological support.” Specific topics that were addressed within these topics and were controversially discussed in the consultation process include: non‐disclosure of a diagnosis, driving issues, financial and legal planning, capacity assessments, and the level of non‐pharmacological interventions (e.g., evidence‐based cognitive interventions) that should be offered by MC clinics. Standards specific to patients with diverse needs such as intellectual disability, culturally and linguistically diverse backgrounds, and Aboriginal and Torres Strait Islander People were not included in the first guidelines iteration due to a lack of expert input. For further details, please refer to the guidelines document: https://www.australiandementianetwork.org.au/initiatives/memory‐clinics‐network/adnet‐memory‐and‐cognition‐clinic‐guidelines/.

Overall, 115 standards were classed as strong recommendations, 31 standards as recommendations, and 14 as practice points (see Table 1). There was unanimous agreement that all 24 standards identified in consultation with people with living experience of dementia and care partners (see Appendix A in supporting information) should be included as strong recommendations to encourage implementation in 100% of MC clinics.

TABLE 1.

Examples for guidelines’ standards classes as strong recommendations, recommendations, and practice points.

Strong recommendation	Recommendation	Practice point
1.1.2 The clinic employs a multidisciplinary team.	1.1.3 The clinic provides general advice and support after the diagnosis as well as post‐diagnostic support in the form of evidence‐based programs, either at the clinic or via timely referral.	1.1.4 The clinic offers education on dementia to general practitioners and the general public.
5.1.2 Clinic staff arrange an interview with someone who knows the client well (informant).	5.2.17 During the clinical interview advanced care‐plans are discussed.	8.1.1 Where there is diagnostic uncertainty advanced neuroimaging, e.g., positron emission tomography (PET) is conducted.
13.1.1 The clinic provides written post‐diagnostic support recommendations to the client, the client's general practitioner (GP), the referring medical practitioner, and the post‐diagnostic support services, as available (*endorsed by people with lived experience).	13.2.2 The clinic offers follow‐up phone calls to assist the client with the care‐plan implementation.	13.1.4 The clinic provides support and advice to clients they did not initially assess or diagnose.

Several standards proved controversial in the discussion. For example, clinicians felt that waiting times for an appointment were mostly determined by external factors like staffing or clinic frequency. Agreement on a maximum of 30 days wait for high‐priority clients and 90 days for routine patients was only made after several consultation rounds involving all stakeholders. Moreover, the minimum post‐diagnostic care responsibilities of MC clinics lacked consensus. Currently, lack of resources and training were described as barriers for MC clinics to provide systematic post‐diagnostic care programs. This meant that specific recommendations for more post‐diagnostic care supported by the literature and strongly endorsed by people living with dementia (e.g., provision of evidence‐based cognitive interventions) were not included in the final guideline. Nonetheless, agreement was reached to include post‐diagnostic care standards that expand on the current common practice (e.g., follow‐up phone calls to assist care‐plan implementation; active relationships with local support service for referral) to encourage service improvements.

3.2. Pilot study

In total, eight clinics from six different states agreed to participate in the pilot study. One clinic later withdrew for administrative reasons. Based on location, five clinics were classified as metropolitan and two as inner regional. Two clinics were in socioeconomically disadvantaged areas (Index of Relative Socioeconomic Advantage [IRSAD] Quantile 1 and 2) and five in mostly advantaged areas (IRSAD Quantile 4 and 5). Five clinics were hospital‐based public, one a hospital‐based private, and one identified as a hybrid research clinic. Staffing levels averaged 3.0 full‐time equivalent (FTE) positions (range: 2.2–3.8 FTE) including an average of 0.65 FTE for medical specialists (range: 0.4–1.5 FTE). Importantly, one of the clinics was a single discipline clinic, thus not meeting the definition of an MC clinic. This clinic requested participation to familiarize themselves with the guidelines as they were hoping to establish an MC clinic in the future.

On average, the clinics achieved 56% of all standards (range: 18%–87%). This represented:

• 61% of the strong recommendations (range: 21%–89%)

• 49% of the recommendations (range: 13%–85%)

• 39% of the practice points (range: 0%–71%)

The topics “diagnostic work‐up” (95%), “pharmacological support” (76%), and “communicating the diagnosis” (75%) showed the highest achievement rates, while standards in the sections “case conference” (34%), “dignity, consent, capacity and confidentiality” (36%), and “neuropsychological assessment” (37%) were least achieved.

Funding, staffing, and time restrictions were the most common barriers to guidelines adherence. Two clinics also identified overarching hospital protocols (e.g., referral and intake processes) which were not aligned with the guidelines as a substantial barrier. A lack of training was an additional common barrier, when the provision of non‐pharmacological evidence‐based interventions was discussed. The most common suggestions for immediate service improvements provided by the research team were the development of pre‐assessment information packs and other written patient information materials.

All participating clinic staff members considered the guidelines helpful in identifying gaps in their service provision and a useful tool in harmonizing and improving services across Australia. However, they also provided feedback on how the guidelines could be improved. The most common criticism was the large number of secondary standards for many sections (e.g., referral, clinical interview, case conference). Clinicians noted that these were too detailed and not applicable for all patients, which made adherence difficult. Moreover, clinicians felt that they introduced an unfair bias on the clinic's overall performance rating. For example, a clinic that is not performing routine case conferences also failed to achieve all 16 secondary standards for case conferences, resulting in a substantially lower overall performance rating. Feedback identified that some standards were worded in an ambiguous fashion, making them difficult to implement. Suggested revisions are listed in Table 2.

TABLE 2.

Examples of changes made to guidelines after the pilot.

Revision suggested	Reason for revision
Section 1 – include a definition of a MC clinic rather than standards about its main functions	Currently, no nationally agreed and documented definition for MC clinics exists
Reduce number of secondary standards in Section 3 (Referral), Section 5 (Clinical Interview), Section 7 (Neuropsychology), and Section 9 (Case conference)	Secondary standards take away focus from main recommendations. They could be included as advice, as they are also not always relevant for all clients
Move Standard “behavioural assessments made available” to Section 6 (Diagnostic work‐up)	Its inclusion under Section 7 (Neuropsychology) was perceived as misleading
Remove ambiguous wording like 11.1.2 “… staff respect that wish [not to disclose diagnosis] as much as possible” OR 12.3.1 “The feedback session is conducted as soon as possible after the final diagnostic assessment.”	Standards must be measurable to enable implementation. Wording indicating ambiguous time frames was removed. Example: “The clinic conducts a separate feedback session to communicate and discuss the diagnosis and care plan.”
Add a standard addressing driving concerns.	Guidelines must match quality indicators of the National Dementia Clinical Quality Registry 16 to avoid confusion

Abbreviation: MC, memory and cognition.

Overall, six out of the seven clinics participating in the pilot evaluation reported that the framework was useful in helping to evaluate their clinical practice. One clinic reported that the documentary evidence requirements of the evaluation (e.g., written care summaries and education sessions for community/general practitioners) were “out of touch with the reality of current staffing levels in a public MC clinic” and a barrier to reflecting the MC clinic's service quality. The clinic suggested capturing more qualitative data through surveys and interviews for future iterations. In contrast, the clinic with the highest achievement rate reported that the evaluation results validated their work and used their site report to show the success of their clinic model to the hospital lead. One common point of critique was the completion time of the evaluation process. The case note audit was identified as the most time‐consuming part of the evaluation. Data collection, particularly for review patients, was reported as confusing due to different interpretations of required data among clinicians (e.g., data reflecting diagnostic processes at first assessment appointment versus diagnosis during the review appointment). One clinic reported that their data collection required about 40 hours of staff time, which will be prohibitive for clinics participating in the service evaluation in the future.

4. DISCUSSION

The study reports the development process for the first memory and cognition clinic guidelines in Australia and the implementation of these guidelines in seven clinics. The guidelines were developed to achieve national agreement on service standards for MC clinics and complement general dementia care standards in Australia (e.g., dementia clinical quality registry, ¹⁷ dementia care guidelines ⁶ ) to enable a specific service‐level evaluation and national harmonization.

The number and diversity of stakeholders consulted is a great strength of our guideline development process. With 125 health professionals and 86 people with living experience of dementia and care partners involved in the consultation, broad and representative stakeholder input was obtained. This high participation rate reflects the clinicians’ and communities’ interest in this work and is likely to facilitate implementation. The guidelines are further supported by the federal Department of Health and Aged Care and mentioned in their recent National Dementia Action Plan. ⁷ Among other goals, the plan highlights adherence to the guidelines as a 10‐year goal to improve dementia assessments and care in Australia.

Our pilot study revealed that minor edits to the guidelines and the service evaluation framework are necessary to increase their overall impact and long‐term usefulness. We introduced three different strengths of recommendation: strong recommendations, recommendations, and practice points. More than 70% of the standards were classified as strong recommendations and considered essential for all MC clinics. While this was done to encourage service improvements, striking a balance between ideal practice and what is considered achievable for all Australian MC clinics will be important when determining a threshold for passing a formal accreditation process.

Although feedback suggested that the evaluation was very time consuming, the high completion rate among the pilot clinics within the given time frame suggests the feasibility of such a program in Australia. In future iterations, greater integration with ongoing quality assurance programs (e.g., ADNeT Clinical Quality Registry ¹⁷ ) is envisaged to reduce the long‐term data entry burden for clinicians. Additional benefits for MC clinics completing the evaluation, such as an official accreditation as a high‐quality MC clinic, are further expected to increase acceptability.

Adding a peer review component to the evaluation, which is currently used as part of the UK's MSNAP, should be considered. An independent first‐hand review of clinical practices by fellow clinicians and people living with dementia will add qualitative data which was missing in the current evaluation framework. A peer review process may further reduce the potential rating bias inherent in a self‐evaluation processes. Receiving training as a peer reviewer and seeing how other MC clinics operate first hand would be an additional benefit for the program participants and would strengthen the national MC clinic network. The collection of qualitative data from patient, carer, and referring clinician surveys will add different perspectives to the service quality assessment and support a holistic MC clinic evaluation.

The pilot study was completed by a group of MC clinics that varied in staffing, resourcing, underlying hospital protocols, and state legislature. These contextual factors are important to consider as a potential influence on the clinic's evaluation performance. One main aim of the evaluation was to support the clinicians in their advocacy for the necessary resources to achieve gold‐standard services. Three of the pilot clinics have indicated that they will use the outcomes of this evaluation in negotiations with local health authorities and the hospital management to maintain and increase their resources.

We acknowledge several limitations of our study. While standards for patients with diverse needs were drafted, they were not included in the first version of the guidelines. The initial consultation process used did not generate sufficient expert input to ensure that high‐quality standards for patients with an intellectual disability, patients from culturally and linguistically diverse backgrounds, and Aboriginal and Torres Strait Islander People were developed. A specific expert consultation process will be conducted to include such standards in future iterations. The guidelines have always been intended to be a “living document” and regular reviews of care standards will be required to reflect the latest best practice.

Due to the small number of pilot clinics in our study, the results are not reflective of the broader clinical landscape in Australia. Participating clinics were already part of ADNeT and highly invested in quality improvement. Other clinics may feel less positive about the guidelines and the self‐evaluation process. Our sample did not include remote clinics and only one hospital‐based private clinic. The feasibility of implementing the evaluation framework in alternative settings will need to be tested in the future.

The clinicians’ feedback on the guidelines and evaluation pilot were collected in free discussions rather than structured interviews. While this was done to allow clinicians to lead the discussion and prioritize the issues they want to address, it impacted the data quality for reporting purposes. A systematic data collection approach to quantify the clinicians’ feedback will be required if further evaluation is sought in the future. Plans for the extension of this study to establish a national MC clinic accreditation program will consider these methodological issues and endeavor to incorporate the clinicians’ feedback to create a valuable addition to the Australian health service quality assurance efforts.

In conclusion, this study forms the first step in improving and harmonizing Australian MC clinic services and standards. The need for such work has been recognized by the need to consider guidelines’ adherence in the National Dementia Action Plan. ⁷ This acknowledgement could increase the guidelines’ impact and the likelihood of their national implementation, therefore greatly contributing to national harmonization of MC clinic care provision and care improvements. Importantly, future iterations should continually strive for even higher standards, which will necessitate Australian state and territory health providers to invest in the infrastructure and workforce for such practice improvements. Ongoing research and evaluations are required to track the impact of greater guideline adherence on general dementia care outcome measures like patient satisfaction, time to diagnosis, and hospitalization rates as well as general health economics (e.g., cost of care). This pilot study has demonstrated the feasibility of an MC clinic evaluation program and provided valuable information on areas for improvement for both the guidelines and the data collection framework. The wide heterogeneity of compliance with the standards suggests that a formalized accreditation process may be helpful. The adaptation of the pilot framework for the development of a national MC clinic accreditation program is currently under way.

CONFLICT OF INTEREST STATEMENT

The authors have no relevant conflict of interest to declare. Author disclosures are available in the supporting information.

ETHICS STATEMENT

Ethics approval was obtained by the University of New South Wales Human Research Ethics Committee (#HC200394/#HC200543/#HC220010). All human subjects in this study provided informed written or electronic consent.

Supporting information

Supporting Information

ICMJE Disclosure Form

Mehrani I, Paradise M, Low L‐F, et al. Developing, implementing, and evaluating the first national Memory and Cognition Clinic Guidelines in Australia. Alzheimer's Dement. 2025;11:e70031. 10.1002/trc2.70031