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K Shulman, and A Feinstein. London: Martin Dunitz, 2003, £34.95, (hardback), pp 176. ISBN 1-84184-239-7
What is the most effective way to screen for cognitive impairment in a busy clinic, or at the bedside? This is a question that most clinicians might contemplate, even if momentarily, in their busy schedules. In this brief text, Shulman and Feinstein take the reader briskly through the arguments for and against some common screening instruments.
There are several good aspects to the book. Firstly, before immersing themselves in the tests, the authors ask what one might want from an ideal screening test. Importantly, they cover—albeit rapidly—the application of signal detection analysis to clinical methods in the form of receiver operating characteristic (ROC) curves, together with the concepts of sensitivity and specificity. This lays the groundwork for much of what follows. Secondly, several of the tests that are scrutinised (for example, Mini Mental State Examination) are critically assessed, with both their potential advantages and pitfalls discussed. Thirdly, I was particularly pleased to find that the authors have included a chapter specifically on assessing frontal lobe function, because many standard screening instruments are often poor at revealing such dysfunction. It was also useful to see a chapter devoted to structured means of interviewing informants—often a critical part of the cognitive assessment. Finally, for a small text, this book has a very good list of references, directing the reader well to the primary sources.
If there are any deficiencies, perhaps one might quibble about the emphasis given by the authors to clock drawing, or the relative paucity of discussion on the use of combining tests. Similarly, the neuropsychiatric interests of the authors may not quite fit those of clinical neurologists. But overall this is an interesting and useful review of the methods available for screening cognitive impairment, which can be read quickly and efficiently, even by the busiest of clinicians.
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