Aims

I will investigate whether an evaluation in general practice can have comparable test accuracy to a specialist opinion for diagnosing dementia in symptomatic elderly people. Objective 1: I will systematically review the test accuracy of general practitioners gestalt clinical judgment for the diagnosis of dementia in symptomatic primary care patients and, if indicated, perform a meta-analysis. My hypothesis is that the utility of the gestalt clinical judgment of general practitioners in diagn osing dementia is better than chance but inferior to specialist assessment. Objective 2: I will conduct an empirical, prospective, diagnostic test accuracy (DTA) study comparing GP gut feeling , blood tests, neuroimaging, index collection of cognitive tests suitable for GPs and specialist assessment to a reference consensus expert panel diagnosis. I will identify the most useful components of a diagnostic evaluation in general practice. My hypothesis is that a combination of brief cognitive tests adds diagnostic value to a GP’s gestalt judgment. Objective 3: I will conduct exploratory qualitative research to evaluate the feasibility and acceptability of GP diagnosis of dementia for patients and clinicians, based on the set of tests that I identify as most useful.