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En France, l'organisation de la prise en charge des patients atteints de troubles neurocognitifs repose sur le système des consultations et centres mémoire. Face à l'explosion démographique, la politique internationale de soins évolue. Notre étude s'intéresse au mode de fonctionnement actuel des réseaux de consultations mémoire (CM) français, la discussion abordant les évolutions possibles. Nous avons interrogé les Centres mémoire ressources et recherche (CMRR) et les Agences régionales de santé (ARS) sur les organisations, les difficultés, les innovations, les projets pour la prise en charge des patients atteints de maladie d'Alzheimer ou apparentées (MAMA). Vingt-sept entretiens semi-structurés ont été réalisés auprès des CMRR, dix entretiens avec les ARS. Les professionnels de terrain évoquent une maturité et une structuration efficace du système de soins liées à la labellisation des CMRR et aux différents plans Alzheimer. Toutefois ce système très spécialisé ne répond pas encore à l'exigence d'intégration des soins et devra évoluer pour s'adapter à l'augmentation de la prévalence. Pour cela, l'articulation avec les soins primaires est une réflexion émergente tant au plan national qu'international.

In France, the management of patients with neurocognitive disorders is based on a network of memory clinics. The current operating mode is presented with projects aiming to its improvement, and potential evolution. Interviews were conducted at Memory resources and research centers (CMRR) as well as at the Regional health authorities (ARS) on organization, difficulties, innovation and projects for care management of patients suffering from Alzheimer's disease or related disorder. Twenty-seven semi-structured interviews were performed at the CMRR, and ten with the ARS. The collaboration with the medico-social and associative sectors was unequal. All CMRR were involved in clinical research. The links between ARS and CMRR were sometimes difficult with a lack of dialogue on the projects. However, many innovative plans have been led by the memory clinics and have sometimes been supported by the Health authorities: a therapeutic education program for patients with mild cognitive disorders, deployment of tele-medicine consultations to diagnose neurocognitive disorders in nursing home residents, setting of a network for management of behavioral disorders, creation of a mobile team specialized in clinical research, and creation of a multidisciplinary consultation following diagnosis to work on a personalized care plan. Experienced professionals mentioned a mature and efficient structure of the care management system thanks to the CMRRs' labeling and the different Alzheimer's national plans. However, this highly specialized system does not meet the demands of integrated care and should adapt to the increasing prevalence of patients. Therefore, structuration of primary care should be an emerging subject of reflection at national and international level.