A. J. Larner - Manual of Screeners for Dementia: Pragmatic Test Accuracy Studies

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This book emerges from a conjunction of interests first partially addressed in previous volumes. Just asDiagnostic Test Accuracy Studies in Dementia[3, 7], a general account of the theory and practice of diagnostic test accuracy studies (DTAS), developed from Chap.ofDementia in Clinical Practice: a neurological perspective3rd edition [5]. Specifically, it aims to highlight experience in undertaking pragmatic DTAS of screening instruments relevant to clinical practice in a dedicated cognitive disorders clinic (some of which have been included in systematic reviews, meta-analyses, and national dementia guidelines). The fact that a previous volume on cognitive screening instruments [4] achieved more than 15000 chapter downloads in less than 18 months from publication suggests an ongoing interest in and use for such tests. These constitute one aspect of a broader interest in the diagnosis of dementia and cognitive impairment [8].

To facilitate comprehension and assimilation, data are summarised in a (hopefully) easily accessible, succinct and user-friendly way by means of a structured tabular format, which should also permit ease of comparison between tests. The pragmatic study design ensures high external validity and generalisability of these test results.

These metrics are easy to calculate and, I suggest, may have heuristic value. Other infrequently used number needed metrics (to diagnose, to predict, to misdiagnose) are also covered as these may have more intuitive appeal for clinicians, as more indicative of clinical relevance to the individual patient, than measures such as sensitivity and specificity and likelihood ratios.

An introductory chapter says more about these new metrics as they may be unfamiliar to many clinicians. The text then progresses to chapters on specific screeners which may be used in the assessment of suspected dementia and cognitive impairment, including: single-item cognitive screening questions; neurological signs; cognitive screening instruments of various lengths which may be administered to either patients or to informants; screeners for depression, functional impairment and sleep disorders; and combination and conversion of screeners. A consideration of existing and novel unitary metrics concludes the volume.

The data presented should allow clinicians to make decisions on whether these screeners are fit for purpose in their specific practice settings, being based on pragmatic diagnostic test accuracy studies. These studies were largely defined by the nature of the material encountered in a career dominated by clinical service, rather than research, issues. All were performed in accordance with STARD [1] or STARDdem [12] guidelines. All errors or misconceptions which remain in this book are entirely my own work.