However, many of these studies were designed with a case–control set-up using healthy, community-based individuals as controls (Davis et al., Citation2015), which can result in spectrum-bias (Dautzenberg et al., Citation2020 Davis et al., Citation2015 Noel-Storr et al., Citation2014), overestimating specificity. The MoCA is a widely used short screening tool for mild cognitive impairment (MCI) and mild dementia (MD) (Alzheimer’s disease International, Citation2016 Davis et al., Citation2013 Nasreddine et al., Citation2005), validated in multiple settings and languages ( CitationMocatest.Org). Using an objective test (the MoCA) only for suspected patients concurs with the above need for triaging possible impaired patients and is especially welcome in old age psychiatry, as the (subjective) cognitive complaints are numerous due to age (60+), psychiatric comorbidity (including psychotropic medication) causing CI next to CI as a primary reason for referral. Screening older patients with the MoCA is often recommended as subjective cognitive complaints agree poorly with objective cognitive deficit (Pendlebury et al., Citation2015) but results in too many false positives in old age psychiatry (Dautzenberg et al., Citation2020). General practitioners in the Netherlands are advised to use the Montreal Cognitive Assessment (MoCA) especially for patients with “possible CI” but less so for “not likely” or “likely” CI patients (Janssen et al., Citation2017). Especially as doctors without an objective test rather refer too early than too late to avoid a missed diagnose and this raises the false positive referrals.Īccording to the Cochrane review, “the MoCA may help identify people requiring specialist assessment and treatment for dementia” (Davis et al., Citation2015, p. This could help to relieve the pressure on diagnostic pathways (Alzheimer’s disease International, Citation2016 Davis et al., Citation2015), which are costly and scarce in most countries (Alzheimer’s Disease International, Citation2018). A validated short tool to assess patients that are suspected of CI to objectify the complaints, before further referral, is necessary to triage who is indeed in need of an elaborate diagnostic investigation for dementia. More referrals to memory clinics and old age psychiatry should be expected due to demographic reasons and more awareness of CI (Alzheimer’s disease International, Citation2016) alongside the trend of earlier assessment with less pronounced symptoms (Grimmer et al., Citation2015). Here, patients with a wide variety of etiologies of possible cognitive impairment (CI) are presented-including major depressive, schizophrenic- and bipolar-disorders. The MoCA can reduce referrals substantially (50%) by selecting who don’t need further work up in a memory clinic, even if they were suspected of CI after initial assessment.ĭiagnosing, as well as the guidance and treatment of dementia, including Behavioural and Psychological Symptoms of Dementia (BPSD), is often done in old age psychiatry which, at least in the Netherlands, make up to 25% of all memory clinics (Verhey et al., Citation2010). The AUC of MD against non-demented (MCI + NoCI) was 0.83(95%CI: 0.78–0.88) resulting in 90% sensitivity, 65% specificity, 50%PPV and 94%NPV at a “best” cutoff of <21 according the Youden index and respectively 0.77(95%CI: 0.69–0.85), 56%, 73%, 90%, 28% for CI (MD + MCI) against NoCI at <21.Ĭonclusion: 90% of individuals with a MoCA of <21 will have CI (MD + MCI), while 94% with a MoCA of ≥21 will not have dementia. Results: The mean MoCA scores differ significantly between the groups: 24(SE. The reference standard was the consensus-based diagnoses for MD and MCI, adhering to the international criteria and using suspected patients, but without CI as comparisons (NoCI). Method: The MoCA is validated for identifying MD and mild cognitive impairment (MCI) in a cohort of patients suspected of cognitive impairment (CI) after initial assessment in old age psychiatry. A validated instrument that can triage patients when they are suspected of mild dementia (MD) is necessary to optimise referrals. Objectives: Diagnostic pathways are limited.
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