Summary of studies and quality assessment scores
| Study | Measurements | Type of study | Gold standard or diagnostic comparison | Focus and analysis | QA score, % |
|---|---|---|---|---|---|
| Elsey et al, 201524 | Video and audio | Observation, naturalistic, cohort | Clinical consensus: MDT discussion based on neurologist assessment, history, ACE III, MRI | Conversation analysis of communication to develop profiles to differentiate dementia and FMD. Verbal ‘I don’t know’ responses and head turning subject to Fisher’s exact test. Attending alone subject to χ2 test. | Mixed methods: 79.2 |
| Fukui et al, 201132 | Observation | Observation, naturalistic, cohort of consecutive outpatients | Diagnosis based on established diagnostic criteria:
| HTS during cognitive testing with Hasegawa Dementia Rating Scale, with caregiver seated 1 m behind patient. HTS positive if patient turned back to caregivers and asked for help implicitly or explicitly. HTS also scored in terms of severity. Comparison between subtypes of dementia | Quantitative: 71.4 |
| Ghadri-Sani and Larner, 201333 | Observation | Observation, naturalistic, cohort of consecutive outpatients | Cognitive impairment (either dementia or mild cognitive impairment [MCI]) was defined according to clinical diagnostic criteria (respectively DSM-IV-TR and modified Petersen) | HTS during history taking as a sign of cognitive impairment. HTS judged to be present if patient turned their head away from interlocutor and towards accompanying person when first invited to describe symptoms (for example, ‘Tell me about the problems you’re having with your memory’) HTS later in consultation (that is, during cognitive testing) was not considered | Quantitative: 57.4 |
| Hasselkus, 199234 | Audio | Observational, naturalistic, selection of patients likely to be attending with companions | Diagnostic process not described | Qualitative analysis of geriatric outpatient patient, doctor and caregiver interactions, quantitative analysis according to level of impairment | Mixed methods: 66.7 |
| Hasselkus, 199435 | Audio | Observational, naturalistic, selection of patients likely to be attending with companions | Diagnostic process not described | Discourse analysis for self-care behaviours as a marker of adult status in the older patient in geriatric outpatients. Data then categorised into degree of impairment | Qualitative: 61.9 |
| Hesson and Pichler, 201636 | Audio | Verilogue corpus, cohort of patients undergoing testing with MMSE | Clinician rating of mild, moderate, or severe impairment. Individual MMSE scores not reported | Conversation analysis with specific focus on ‘I don’t know’ or other variations in speech during MMSE administration, analysis of surrounding talk, context, and meaning in mild, moderate, and severe cognitive impairment | Mixed methods: 66.7 |
| Jones et al, 201623 | Video and audio | Observational, naturalistic, cohort study | Gold standard diagnosis made by consultant neurologist, based on assessment, ACE R, detailed neuropsychological battery, and MRI | Conversation analysis with focus on history-taking part of assessment to identify interactional features that discriminate between neurodegenerative disorders and non-neurodegenerative disorders | Qualitative: 81.0 |
| Karnieli-Miller et al, 201237 | Video and audio | Observational, naturalistic, cohort study | Diagnostic process not described. | Discourse analysis focusing on triadic and dyadic exchanges during the process of memory assessment and diagnosis delivery | Mixed methods: 72.9 |
| Larner, 200538 | Observation | Observational, naturalistic, cohort/audit study | Dementia diagnosed based on DSM-IV criteria, established by clinical interview, neuropsychological assessment, and neuroimaging. Subtype of dementia was also established. Patients had minimum follow-up of 6 months | All patients referred are sent a letter asking them to bring a relative, friend, or carer from whom additional information may be obtained. 95% CIs and Wilson methods of specificity and sensitivity used to calculate attending alone as a ‘diagnostic test’ for dementia | Quantitative: 54.8 |
| Larner, 200939 | Observation | Observational, audit of consecutive referrals | Dementia was diagnosed by DSM-IV-TR criteria based on clinical interview, informant interview where possible, neuropsychological testing, and structural brain imaging (CT ± MRI), as in previous cohorts reported from this clinic | The attending alone sign was considered as a test for dementia. The STARD checklist for reporting diagnostic accuracy studies was observed and basic principles of evidence-based diagnosis were applied to calculate test sensitivity, specificity, positive and negative predictive values (PPV, NPV), diagnostic odds ratio (DOR), and positive and negative likelihood ratios (LR+, LR-) with 95% CI. Comparison made with previous cohorts from same clinic | Quantitative: 71.4 |
| Larner, 201240 | Observation | Observational, audit of consecutive referrals | The presence of cognitive impairment (either dementia or mild cognitive impairment (MCI)) was defined according to clinical diagnostic criteria (respectively DSM-IV-TR and modified Petersen) | HTS during history taking as a sign of cognitive impairment. HTS judged to be present if patient turned their head away from interlocutor and towards accompanying person when first invited to describe symptoms (for example, ‘Tell me about the problems you’re having with your memory’). HTS later in consultation (that is, during cognitive testing) was not considered | Quantitative: 66.7 |
| Larner, 201441 | Observation | Observational, audit of consecutive referrals | Assessment by semi-structured clinical interview, cognitive screening instruments, and structural neuroimaging, supplemented as necessary by additional investigations (for example, formal neuropsychological assessment, EEG, and neurogenetic testing). Standard diagnostic criteria for dementia (DSM-IV), dementia subtypes, and MCI were used | Analysis of attending alone (AA) sign used standard principles of evidence-based diagnosis and observed the STARD checklist for reporting diagnostic accuracy studies | Quantitative: 73.8 |
| Rosseaux et al, 201042 | Video and audio | Case-control study, observational | All patients were assessed with a comprehensive clinical examination by senior staff neurologist, psychiatrist, neuropsychologist, speech therapist, and nurse and imaging with CT or MRI. A consensual diagnosis was given for each patient according to existing diagnostic criteria | Lille Communication Test (LCT) comparison of controls and subtypes of dementia. LCT addresses three domains: participation in communication, verbal communication, and non-verbal communication | Quantitative: 73.8 |
| Saunders, 199843 | Audio | Observational, naturalistic, cohort | Memory clinic consists of MDT including geriatrician, psychologist, neurologist, and neuropsychologist. Actual diagnostic process not described but history taking and neuropsychological testing formed part of assessment | Neuropsychological assessment, qualitative, quantitative, and discourse analysis with particular focus on humour exchanges | Mixed: 77.1 |
| Saunders, 199844 | Audio | Observational, naturalistic, cohort | Memory clinic consists of MDT including geriatrician, psychologist, neurologist, and neuropsychologist. Actual diagnostic process not but history taking and neuropsychological testing formed part of assessment | Neuropsychological assessment, qualitative, quantitative, and sociolinguistic analysis with focus on accounts and ways people with dementia justify or explain their memory problems | Mixed: 90.5 |
| Saunders et al, 201145 | Audio | Observational, naturalistic, cohort | Patients with cognitive impairment were those diagnosed by the neurologist or referring doctor with possible Alzheimer’s disease, probable Alzheimer’s disease, or mild cognitive impairment | Neuropsychological assessment with qualitative and quantitative analysis of health, memory accounts and humour and comparison of these in CI and non-CI groups | Mixed: 78.6 |
ACE III = Addenbrooke’s Cognitive Exam III. ACE R = Addenbrooke’s Cognitive Examination Revised. AD = alzheimer’s dementia. aMCI = amnestic mild cognitive impairment. DLB = dementia with Lewy bodies. DSM-IV = Diagnostic and Statistical Manual of Mental Disorders. DSM-IV-TR = Diagnostic and Statistical Manual of Mental Disorders (Text Revision). EEG = electroencephalogram. FMD = functional memory disorder. HTS = head turning sign. MCI = mild cognitive impairment. MDT = multidisciplinary team. MMSE = Mini-Mental State Examination. MRI = magnetic resonance imaging. NINCDS-ADRDA Criteria = National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association Criteria. NINDS-AIREN = National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences (AIREN). QA = quality assessment. STARD = Standards for Reporting of Diagnostic Accuracy Studies. VaD = vascular dementia.