Creavin Sam T, Cullum Sarah J, Haworth Judy, Wye Lesley, Bayer Antony, Fish Mark, Purdy Sarah, Ben-Shlomo Yoav
School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
North Bristol NHS Trust Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol, BS10 5NB, UK.
BMC Fam Pract. 2016 Jul 19;17:79. doi: 10.1186/s12875-016-0475-2.
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.
认知有问题的人及其家人在接受痴呆症评估时会感到痛苦和不确定，并且认为二级医疗保健中的传统诊断评估对患者的关注不够。詹姆斯·林德联盟已将研究重点放在调查初级保健在支持更有效的诊断途径中的作用上，该主题也受到卫生专员的关注。然而，很少有研究调查初级保健中痴呆症诊断测试的准确性。
我们将进行一项前瞻性诊断测试准确性研究，以评估一系列简单测试对70岁以上有症状且已咨询过全科医生（GP）的人群进行全因性痴呆诊断的准确性。我们将邀请符合条件的人参加研究诊所，在那里他们将接受一系列全科医生可在诊所进行的指标测试，并在同一次就诊时由记忆障碍专家进行评估。参与研究的全科医生将要求进行神经影像学和血液检查，并按照其通常的临床实践对患者进行管理。参考标准将是三位专家（神经科医生、精神科医生和老年科医生）基于专家评估、全科医生记录和检查得出的共识判断，但不包括指标测试组中的项目。目标疾病将是全因性痴呆，但我们也将尽可能调查亚型的诊断准确性。我们将对患者进行定性访谈，并与临床医生进行焦点小组讨论，以帮助我们了解使用我们正在研究的测试在初级保健中诊断痴呆症的可接受性和可行性。
我们的结果将帮助临床医生决定对疑似痴呆症患者应进行哪些测试，并为诊断途径的委托提供信息。
