Simple diagnostic signs in those with cognitive impairment–anything to improve detection of cognitive disorders

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With now over 50 million people worldwide with dementia (Prince et al., 2013), there are almost certainly well over 100 million people with cognitive concerns and many of these will attend their health professional keen to know what is going on. We need those without intensive training in this field to be more confident and correct in their diagnosis when such a concerned person turns up. Many simple diagnostic tests have been proposed and some assessed – these include the walk and talk (divided attention) test (those who stop when asked a question while walking may be cognitively impaired) (Lamoth et al., 2011), the clock drawing test (Brodaty and Moore, 1997), the “handbag” sign (those clutching their personal possessions are more likely to be cognitively impaired) and the “hippopotamus sign” (calling the rhinoceros, in those tests that include this, a hippopotamus). Simple screening tests have been extensively validated and are important to the clinician in formulating a diagnosis (Lorentz et al., 2002). The “head-turning” and the “attended with/alone” signs are frequently observed, and many clinicians assessing such individuals would be well aware of them and probably even unknowingly factor them into their diagnosis. In this issue, Pinar Soysal and colleagues (Soysal et al., 2017) have evaluated these signs and, in those older people attending with cognitive concerns, found they had quite good diagnostic value. They were not very specific but showed good sensitivity and negative predictive value. Indeed, at the recent Alzheimer's Association International Conference in London there were several posters evaluating “soft but simple” signs although not all performed as expected – one group found gait actually sped up in those with cognitive impairment that were asked a question.