Towards improving diagnosis of memory loss in general practice: TIMeLi diagnostic test accuracy study protocol

Abstract

BackgroundPeople with cognitive problems, and their families, report distress and uncertainty whilst undergoing evaluation for dementia and perceive that traditional diagnostic evaluation in secondary care is insufficiently patient centred. The James Lind Alliance has prioritised research to investigate the role of primary care in supporting a more effective diagnostic pathway, and the topic is also of interest to health commissioners. However, there are very few studies that investigate the accuracy of diagnostic tests for dementia in primary care.MethodsWe will conduct a prospective diagnostic test accuracy study to evaluate the accuracy of a range of simple tests for diagnosing all-cause-dementia in symptomatic people aged over 70 years who have consulted with their general practitioner (GP). We will invite eligible people to attend a research clinic where they will undergo a range of index tests that a GP could perform in the surgery and also be assessed by a specialist in memory disorders at the same appointment. Participating GPs will request neuroimaging and blood tests and otherwise manage patients in line with their usual clinical practice. The reference standard will be the consensus judgement of three experts (neurologist, psychiatrist and geriatrician) based on information from the specialist assessment, GP records and investigations, but not including items in the index test battery. The target condition will be all-cause dementia but we will also investigate diagnostic accuracy for sub-types where possible. We will use qualitative interviews with patients and focus groups with clinicians to help us understand the acceptability and feasibility of diagnosing dementia in primary care using the tests that we are investigating.DiscussionOur results will help clinicians decide on which tests to perform in someone where there is concern about possible dementia and inform commissioning of diagnostic pathways.

Clinical judgment of GPs for the diagnosis of dementia: a diagnostic test accuracy study

“…Secondly, sampling unselected people attending general practice regardless of symptoms, which is more akin to screening. The aim of this study was to address these limitations of earlier studies and investigate the prospective diagnostic accuracy of GP clinical judgement for the diagnosis of dementia syndrome in symptomatic people over 70 years (23).…”

Cognitive tests to help diagnose dementia in symptomatic people in primary care and the community

“…A prospective test accuracy study based in primary care is currently under way that will evaluate the accuracy of a range of tests for diagnosing dementia in a symptomatic group of people recruited from primary care. 6 …”

Análisis Rasch del Mini Mental State Examination (MMSE) en adultos mayores de Antioquia, Colombia

“…Sin embargo, dadas las condiciones de dependencia local de los ítems de Atención y Cálculo es difícil determinar la validez de generar una segunda medida a partir del MMSE relacionada con estos procesos, la cual sea complementaria a la medida de funcionamiento general que originalmente propone el instrumento. Teóricamente, dada la importancia de las funciones de memoria en la evaluación del adulto mayor, ésta pudiese ser una alternativa válida y útil (Creavin et al, 2016). Se sugiere explorar esta situación con mayor detalle en futuras investigaciones.…”