With now over 50 million people worldwide with dementia (Prince et al., Reference Prince, Bryce, Albanese, Wimo, Ribeiro and Ferri2013), there are almost certainly well over 100 million people with cognitive concerns and many of these will attend their health professional keen to know what is going on. We need those without intensive training in this field to be more confident and correct in their diagnosis when such a concerned person turns up. Many simple diagnostic tests have been proposed and some assessed – these include the walk and talk (divided attention) test (those who stop when asked a question while walking may be cognitively impaired) (Lamoth et al., Reference Lamoth, van Deudekom, van Campen, Appels, de Vries and Pijnappels2011), the clock drawing test (Brodaty and Moore, Reference Brodaty and Moore1997), the “handbag” sign (those clutching their personal possessions are more likely to be cognitively impaired) and the “hippopotamus sign” (calling the rhinoceros, in those tests that include this, a hippopotamus). Simple screening tests have been extensively validated and are important to the clinician in formulating a diagnosis (Lorentz et al., Reference Lorentz, Scanlan and Borson2002). The “head-turning” and the “attended with/alone” signs are frequently observed, and many clinicians assessing such individuals would be well aware of them and probably even unknowingly factor them into their diagnosis. In this issue, Pinar Soysal and colleagues (Soysal et al., Reference Soysal, Usarel, Ispirli and Isik2017) have evaluated these signs and, in those older people attending with cognitive concerns, found they had quite good diagnostic value. They were not very specific but showed good sensitivity and negative predictive value. Indeed, at the recent Alzheimer's Association International Conference in London there were several posters evaluating “soft but simple” signs although not all performed as expected – one group found gait actually sped up in those with cognitive impairment that were asked a question.

But are these simple signs going to improve screening and diagnostic accuracy? It is likely that they increase the diagnostic confidence of the clinician who has already started to suspect something is awry, but it is unlikely they reverse a clinician's lack of concern about cognition in the patient in front of them. They may speed up the diagnostic ship, but would rarely turn it around. It is more important that the clinician takes memory concerns, expressed by the patient or their family/friends, seriously and has a structured approach to assessment. Whether through clinical acumen, a thorough approach or being further alerted by a simple sign such as head turning, the next step should be a recognized screening tool–e.g., the MMSE, Mini-Cog, GPCOG, or the MoCA- and referral to an appropriate specialist, where available. It certainly turns the heads of we specialists when the patient finally comes to us for assessment after complaining of memory problems to their primary care physician for years. That is one head-turning sign we best avoid.