Géraud Dautzenberg

Chapter 1

and is at an increased risk of cognitive impairment, the less this downside will be an issue. However, this preselection of the screened population comes with missing the benefits of screening all, next to the chance of missing unseen cognitive impairment. In short, there are advantages and disadvantages of a screening. They depend on why, when, where , and who is being screened. And of course ‘With What ’ are we going to screen is of significance, too.

1.5. What 1.5.1 What test do we use?

Cognitive complaints are a core feature of many (unmet) problems encountered in old age psychiatry and often remain hidden, deliberately or not, but have a major impact on the treatment and quality of life. Therefore we want or even need to know the cognitive state during the initial history interview of referred patients. In 2008, I sought a substitute for the MMSE because it lacks the ability to detect MCI (Pinto et al. , 2019). As explained above, in old age psychiatry, we encounter a lot of subjective cognitive impairment due to various possible aetiologies that are not detectable by the MMSE. Therefore, this engenders the problem of not being able to objectify these complaints and follow their course. Were they too subtle to be detected or were the complaints only subjective? It is known that the MMSE cannot detect mild impairment well, as it is not designed to detect MCI. It was designed as a short and fast test for detecting major cognitive impairment. Part of the MMSE, a memory test, asks for three words to be remembered: the MoCA asks for five words. However, during an elaborate neurocognitive assessment, participants are asked to remember 15 words. The latter takes considerably more time, but no ceiling effect occurs, as the median number of words to remember is approximately six to seven. In addition, a learning effect can be observed, since the 15-word test is repeated more often. This example illustrates well the tension between trying to be fast and trying to be complete, limiting wrong conclusions. A bedside test that could objectively assess the cognitive state, including MCI, of our patients quickly, cheaply, conveniently, and sensitively enough to detect mild cognitive impairment, was needed. Among others, I considered the 2-minute test, 7-minute test, clock drawing test, ACE/ACE-R (Addenbrooke’s Cognitive Examination), and the CAMCOG (in part). Because of an educated guess, I chose the newly introduced MoCA.

18