A programme of diagnostic test accuracy reviews

Five factors make this programme of systematic reviews of diagnostic test accuracy (DTA) an urgent UK research priority:

  • The National Dementia Strategy emphasises the importance of early diagnosis.
  • Tests based on identifying Alzheimer’s disease pathology are being developed
  • Many patients with Alzheimer’s pathology do not progress in their level of impairment
  • No decision rules for the use of biomarker-based tests have been evaluated
  • EU rules on direct-to-patient advertising are being relaxed

The acceptance of consensus diagnostic criteria always has an element of the political.  Nowhere is this more true than in dementia.  We are at pivotal time point where it is possible – and necessary –  to influence the intellectual framework surrounding diagnostic tests for dementia. And this program aims to do just that.

Aims

We are conducting 12 diagnostic test accuracy reviews that cover the full range of important imaging and laboratory biomarkers, and of simple clinical tests. In addition, a suite of 15 updates of published systematic reviews focuses on interventions, both pharmacological and non-pharmacological, which are currently in clinical use in the NHS.

This work will inform policy and clinical decision-making on several fronts. It will further policy makers’ understanding of the accuracy of available and emerging diagnostic tests. It will also inform their decisions regarding how to improve early diagnosis of dementia. The reviews will also provide a rigorously synthesized evidence base to NICE or other bodies involved in the appraisal of diagnostic tools and in the development of clinical guidance. These in turn will inform commissioning and development of care pathways for diagnosis and treatment of dementia.

The results will help clinicians decide which diagnostic tools to use in their practice, and how to advise patients about the value and limits of diagnostic tests. 

Methods

We are using the state of the art systematic review methodology and rigorous editorial peer-review process of the Cochrane Collaboration.

Outcomes

In addition to the planned reviews, several valuable products will be available to the scientific community as a result of this work.  These include:

  • ALOIS − A register of DTA studies in dementia (http://www.medicine.ox.ac.uk/alois/)
  • STARDem − Standards for the Reporting of Diagnostic accuracy studies in dementia
  • Two generic protocols
  • Methodology to perform meta-analysis on tests of diagnostic accuracy in dementia
  • Dementia DTA training modules

Partners

This project is a collaboration between the Public Health and Old Age themes of the CLAHRC CP and Cochrane Dementia and Cognitive Improvement Group (http://dementia.cochrane.org/) based in Oxford. It is funded by NIHR.  Two members of the Alzheimer’s Society are part of the management committee and contribute a public perspective to the project.

 

For more information contact: Dr Louise Lafortune, Cambridge Institute of Public Health, University of Cambridge, ll394@medschl.cam.ac.uk

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Useful links

Research update: A programme of diagnostic test accuracy reviews in dementia.
NIHR Progress report 2013
NIHR  Progress report 2013 – Tables