Géraud Dautzenberg

Chapter 7

2017) as it is also advised to be used by the Cochrane and Alzheimer International Society (Davis et al. , 2013; Alzheimer’s Disease International, 2018).

In addition to this, there are other reasons for a good validating test:

-For the ‘diagnosis’ of MCI, the course is uncertain, 20% of recovered 40% remain stable, and 40%are diagnosedwith dementia after 3.5 years. Therefore, it is important tomonitor the patient population. The MoCA can be used for this task (Krishnan et al. , 2017). -For current drug therapies for dementia, it is important to be able to properly distinguish between MCI and dementia, because in the former, any benefits of medication, such as cholinesterase inhibitors, do not outweigh the side effects (Nederlandse Vereniging voor Klinische Geriatrie, 2014) and can even be potentially harmful. -The high expectations that treatments will eventually be found for some causes of dementia, where early diagnosis seems essential, also contribute to this. Therefore, the MoCA can be used for screening, as an add-on test for triaging or obtaining a baseline function and the MoCA can be used for active follow-up of cognitive function. The latter is important in old age psychiatry, where the prevalence of subjective as well as objective cognitive impairment is high. This includes follow-up of cognitive impairments accompanying psychiatric diseases. In all these cases, the MoCA has advantages over the MMSE as it is more sensitive to MCI. In a study by Rodrigues-Ramirez only 8% compared to 69% of patients with schizophrenia scored below cut-off on the MMSE or the MoCA respectively (Ramírez et al. , 2014). Currently, the administration of theMMSE also requires a fee to be paid. TheMoCA also has advantages over an elaborate neurocognitive assessment in the aforementioned situations because it is faster, easier to apply (less specialised staff needed), less stressful for the patient, less costly, and reduces the waiting list for NPA. So the use of the MoCA in old age psychiatry settings is substantiated by arguments, but there are still different ways to use it. Therefore creating different prevalence and because of this different accuracy. This depends on the local circumstances, whether one only wants to use it on indication from the patient (objectifying or reassuring), an indication from the clinician (triaging), or as a screener or even as a baseline tool for all referred patients to old age psychiatry settings. As our study shows, one should be aware of the influence that psychiatric diseases can have on the MoCA score, among other clinical and demographic factors, and that this can have, but often does not have, a big impact on the total score. Although our study suggests that the MoCA cannot differentiate between patients with MCI due to neurodegenerative causes or MCI due to psychiatric causes using

174