The 'attended alone' and 'attended with' signs in the assessment of cognitive impairment: a revalidation

ABSTRACT

Objectives: To examine the diagnostic utility of the ‘attended alone’ (AA) and ‘attended with’ (AW) signs for the diagnosis of major and minor neurocognitive disorder.

Methods: Consecutive unselected new outpatient referrals (N = 1209) to a dedicated cognitive disorders clinic over a 5-year period (2015–2019 inclusive) were observed for the AA and AW signs. Criterion diagnoses were by usual clinic assessment using standard (DSM-5) diagnostic criteria.

Results: AW proved to be very sensitive for the identification of major and minor neurocognitive disorder but with generally low positive predictive values. In the subgroup of patients attending with more than one informant, the AW2+ sign, positive predictive value was higher and likewise with increasing patient age where the prevalence of AW was higher. Diagnostic utility of AW and AA was independent of patient gender.

Conclusion: AW and AA are easily observed and categorized signs. AW has a high sensitivity for cognitive impairment while AA has a high positive predictive value for its absence.

KEYWORDS:

• Attended alone sign
• attended with sign
• diagnosis
• major and minor neurocognitive disorder

Declaration of Interest

The author reports no conflicts of interest.

Data Sharing

The data that support the findings of this study are available from the corresponding author, AJL, upon reasonable request.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The contents of the paper and the opinions expressed within are those of the authors, and it was the decision of the authors to submit the manuscript for publication. There was no funding received.