J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2011-301804
  • PostScript
  • Letter

Head turning sign: pragmatic utility in clinical diagnosis of cognitive impairment

  1. A J Larner
  1. Correspondence to Dr A J Larner, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Lower Lane, Liverpool L9 7LJ, UK; a.larner{at}
  1. Contributors AJL devised the study, collected and analysed the data, wrote the paper, and revised it in the light of the reviewers' helpful comments.

  • Received 8 November 2011
  • Accepted 26 January 2012
  • Published Online First 15 February 2012

While taking the history from a patient with possible cognitive impairment, ‘the physician may observe that the patient exhibits the head turning sign (looking at his care-giver when asked a question), which is a common sign in A[lzheimer's] D[isease]’.1 NHS Evidence Clinical Knowledge Summary advises that the diagnosis of dementia be suspected ‘if, when you ask the person a simple question, they immediately turn to their partner — the so-called head-turning sign’.2 But how common is the head turning sign (HTS), and how useful is it in diagnosis? A prospective observational study of day-to-day clinical practice in a memory disorders clinic was undertaken to examine these questions.

HTS was operationalised thus: following introductions and initial pleasantries, HTS was adjudged to be present (HTS+) if the patient turned her/his head away from the interlocutor and towards the accompanying person(s) when first invited to describe symptoms (eg, ‘Tell me about the problems you are having with your memory’) or when specifically asked about them (eg, ‘What …

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