Géraud Dautzenberg

Chapter 1

so, most patients with dementia will stay undiagnosed, 50% in developed countries and up to 90% in poor countries (Alzheimer’s disease International, 2016). A part of the public campaigns by advocacy groups or policymakers is to stimulatepatients aswell as healthcare professionals for more (early) diagnoses. This will result not only in more referrals but also in more referrals with less well-described cognitive impairments, and it will be harder to differentiate aetiologies (Mitchell, 2009). A detailed neurocognitive assessment, which is costly, time-consuming, and not widely available, is advised by advocate groups in the case of cognitive complaints. However, doing so for all patients with cognitive complaints will be an assault on available resources. The cognitive diagnostic tracks in memory clinics or old age psychiatry clinics are already being challenged and will be further challenged due to the increase in the older population (Alzheimer’s Disease International, 2018). Moreover, many subjective or even objective (mild) cognitive complaints (up to 40%) will subside or decrease over time (Alexopoulos et al. , 2006). Selecting patients who are in need of this elaborate neurocognitive assessment would help reduce the burden on resources. We have to find patients who benefit from an elaborate neurocognitive assessment better, or in other words, triaging those who are in need of a specialised neurocognitive assessment and who are not (yet) in need of such assessment. 1.4 Who A way to achieve early detection and to find those in need of an elaborate assessment is through screening. Advocacy groups for dementia encourage this, but the debate on whether screening is a solution or wise is still debatable (Borson et al. , 2013; Davis et al. , 2015; Burn et al. , 2018). Many factors must be considered, such as spending resources and efficiency. One of the main issues is which population to screen, for what purpose, and what instrument to use (Janssen et al. , 2017). As screening for cognitive impairment in a general practitioner’s office will result in different findings than at a memory clinic or in old age psychiatry, more people are likely to have cognitive impairment. Screening with a fast and cheap instrument will result in different findings than screening with a more time-consuming and multi-factor full assessment. The first example yields a high quantity with low quality, but the latter example, on the contrary, yields high quality and low quantity. Additionally, the purpose of screening should be considered. In a test, specificity and sensitivity always compete with precedence. Which one should prioritise depends on the purpose of the test. Screening for HIV can serve as an example of this. At the doctor’s office, you want to establish a definite diagnosis. You do not want to Unfortunately, this leads to more questions: ‘ who ’ is in need and ‘ how ’ do we find them?

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