Géraud Dautzenberg

Summary and general discussion

of data and its applicability to individual patients. For the study, where everyone was assessed with a MoCA one week after the initial interview, handling a short time frame was important. This is in an attempt to interpret these data with current clinical practice, whereby patients are routinely given a MoCA after the initial interview. For this group, a 3-month timeframe is nearly inappropriate as an inclusion criterion, but for the ‘suspected cognitive impairment’ group, one can argue that it is not. Barring exceptions, this is especially true for neurodegenerative disorders. In the literature, we often find a limit of 3 months, which, evidently, is not a decisive argument. If we closely consider the timing of the MoCA’s assessment relative to the other parameters (determined during the initial interview), we see that the majority had been collected within three weeks in our cohort. The discussion above argues that the study group should resemble the group for which the test is going to be used. In an idealistic case, this translates to a perfectly matching study subject for each patient. In practice, the best control data are the patient’s own baseline data for self-comparison in a study context. Thus, obtaining baseline values for individual patients is important. These data are lacking in our study. A longitudinal study design could provide even more certainty regarding the course of MoCA, with respect to the development of cognitive impairment as well as the influence of comorbidities, such as depression, onMoCA. Comorbidity is a challenging issue in many studies. By excluding them from your research group, you can create an increasingly uniform group where the results can largely be attributed to the remaining parameters. However, the less diverse or more selected the research group becomes, the less it will resemble the real world. In our cohort, some comorbidities (alcohol, Cerebrovascular accident, and obvious dementia) were excluded, whereas some (psychiatry) were explicitly not excluded. Although we have made a reasoned choice for this, there is also a danger in that it does not approach the clinical reality in which alcohol use, hidden or otherwise, is present. The fact remains that in clinical practice, the examiner (hopefully) assesses not only the MoCA total score but also how it was obtained, incorporating the patient’s clinical and demographic data.

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7.3 Considerations 7.3.1 Considerations of Section A: Unseen needs

The Camberwell Assessment of Need for the Elderly (CANE) is adapted from the Camberwell Assessment of Need (CAN, which has 22 topics) to suit the specific needs of older adults. It assesses four different domains: environmental, physical, psychological, and social needs, with 24 topics and 2 extra for the carer-giver. The adaptation of the CANE can be found

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