• Cognition

In his provocative piece, Dr Larner suggests that the screening cognitive instruments should be abandoned in routine clinical practice. This is based on theoretical and practical considerations that I will go through in turn. I am not a screening instrument apologist, but, in my view, they clearly continue to have a useful role.

In terms of theoretical issues, he addresses issues related to the validity of subtests and the overall score.

With respect to subtests, I completely agree that these do not reflect entirely ‘pure’ constructs. But this is also an issue for the more detailed neuropsychology that Dr Larner wishes to retain. Most memory batteries, for example, will allow derivation of a delayed memory index, which any neuropsychologist will tell you is not just a measure of delayed memory, but is also impacted by attention, concentration, executive function, mood, motivation and effort. But whatever else affects delayed memory subtests in a battery, no neuropsychologist would argue that they do not reflect delayed memory.

I also agree that the power to detect deficits in particular domains is limited. In terms of the Mini-Mental State Exam (MMSE) focused …