title: Clinical history for diagnosis of dementia in men: Caerphilly Prospective Study.
abstract: BACKGROUND
  Diagnosis of dementia often requires specialist referral and detailed, time-consuming assessments.
  
  
  OBJECTIVE
  To investigate the utility of simple clinical items that non-specialist clinicians could use, in addition to routine practice, to diagnose all-cause dementia syndrome.
  
  
  METHODS
  Cross-sectional diagnostic test accuracy study. Participants were identified from the electoral roll and general practice lists in Caerphilly and adjoining villages in South Wales, UK.
  
  
  METHODS
  Participants (1225 men aged 45-59 years) were screened for cognitive impairment using the Cambridge Cognitive Examination, CAMCOG, at phase 5 of the Caerphilly Prospective Study (CaPS). Index tests were a standardised clinical evaluation, neurological examination, and individual items on the Informant Questionnaire for Cognitive Disorders in the Elderly (IQCODE).
  
  
  RESULTS
  Two-hundred and five men who screened positive (68%) and 45 (4.8%) who screened negative were seen, with 59 diagnosed with dementia. The model comprising problems with personal finance and planning had an area under the curve (AUC) of 0.92 (95% confidence interval [CI] = 0.86 to 0.97), positive likelihood ratio (LR+) of 23.7 (95% CI = 5.88 to 95.6), negative likelihood ratio (LR-) of 0.41 (95% CI = 0.27 to 0.62). The best single item for ruling out was no problems learning to use new gadgets (LR- of 0.22, 95% CI = 0.11 to 0.43).
  
  
  CONCLUSIONS
  This study found that three simple questions have high utility for diagnosing dementia in men who are cognitively screened. If confirmed, this could lead to less burdensome assessment where clinical assessment suggests possible dementia.
authors.affiliation: NIHR academic clinical fellow in general practice;
authors.forename: Sam
authors.initials: S
authors.lastname: Creavin
authors.affiliation: Department of Neurology, Musgrove Park Hospital, Taunton.
authors.forename: Mark
authors.initials: M
authors.lastname: Fish
authors.affiliation: Department of Primary Care and Public Health, Cardiff University, Cardiff.
authors.forename: John
authors.initials: J
authors.lastname: Gallacher
authors.affiliation: Department of Primary Care and Public Health, Cardiff University, Academic Centre, University Hospital Llandough, Cardiff.
authors.forename: Antony
authors.initials: A
authors.lastname: Bayer
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Ben-Shlomo
mesh_terms: D019540:Area Under Curve; D003430:Cross-Sectional Studies; D003704:Dementia / Q000175:diagnosis* / Q000453:epidemiology; D058006:General Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008487:Medical History Taking / Q000379:methods*; D008875:Middle Aged; D009483:Neuropsychological Tests; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012015:Reference Standards; D012017:Referral and Consultation; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014852:Wales / Q000453:epidemiology
keywords: cohort studies; dementia; diagnostic tests; general practice; sensitivity and specificity