title: Towards improving diagnosis of memory loss in general practice: TIMeLi diagnostic test accuracy study protocol.
abstract: People 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.
  
  
  
  We 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.
  
  
  
  Our 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.
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK. Sam.Creavin@bristol.ac.uk.
authors.forename: Sam T
authors.initials: ST
authors.lastname: Creavin
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Cullum
authors.affiliation: North Bristol NHS Trust Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK.
authors.forename: Judy
authors.initials: J
authors.lastname: Haworth
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Wye
authors.affiliation: Division of Population Medicine, Cardiff University School of Medicine University Hospital Llandough, Penarth, CF64 2XX, UK.
authors.forename: Antony
authors.initials: A
authors.lastname: Bayer
authors.affiliation: Department of Neurology, Musgrove Park Hospital, Taunton, Somerset, TA1 5DA, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Fish
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Purdy
authors.affiliation: School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Ben-Shlomo
mesh_terms: D000368:Aged; D060825:Cognitive Dysfunction / Q000175:diagnosis*; D003704:Dementia / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005080:Exercise Test; D017144:Focus Groups; D058006:General Practice / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008279:Magnetic Resonance Imaging; D008569:Memory Disorders / Q000175:diagnosis* / Q000209:etiology; D059906:Neuroimaging; D009483:Neuropsychological Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012107:Research Design; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D063189:Symptom Assessment
keywords: Dementia; Diagnostic tests; General practice; Primary care; Sensitivity and specificity