Géraud Dautzenberg

Chapter 7

5 A reliable detection method must exist. What is considered reliable? Is it the same as the gold standard? Is the gold standard reliable (Coart et al. , 2015)? In this dissertation, the gold standard is considered to be the elaborate diagnostic route required by international criteria, even though they even come with uncertainties. This is well illustrated by the additions ‘possible’ and ‘probable’ (McKhann et al. , 2011) by the NIA-AA/NINCDS-ADRDA or, as stated in the DSM-5, where the criteria minor and major NCD include the amount deviations in standard deviations from the healthy mean. In this dissertation, we investigated the reliability of the MoCA, as this was not yet clear for an old age psychiatry setting. Taking the above into account, we still make the bold claim that a reliable diagnosis of ‘no cognitive problems’ can be made with the MoCA ( ≥ 26). Using a double cut-off we can add ‘possible in need of an elaborate cognitive assessment ( ≥ 21 MoCA < 26)’ and ‘probable in need of an elaborate cognitive assessment ( < 21)’. By keeping these phrases in mind, one could consider a very low MoCA score accruing with other clinical data fitting dementia, and other causes have been ruled out as an indication for possible dementia. 6 The detection method must be acceptable to the public. In clinical practice, not everyone with complaints wants to know the reason for these complaints. In particular, regarding cognitive impairment, some are afraid of the results or consequences. Some prefer to ignore or downplay their complaints or attribute them to normal ageing. Some just don’t think it is worth the effort (of getting an Neuropsychological assessment). However, this puts the clinician in a dilemma, as we know that unseen needs can lead to lower quality of life, more healthcare consumption, and lower overall health. Especially for cognitive functioning, it is often necessary to know the patients’ impairment so that the treatment can be adjusted accordingly. This is not only important for psychotherapy, or avoiding dangerous foreseeable situations, but also for pharmacotherapy, e.g., ranging from finding cognitive side effects towards to what extent patients can use their medication safely without assistance. Using the MoCA can be of help to indicate whether the clinician should consider the cognitive capacities of the patients while prescribing. In addition, the MoCA has a low burden on the patient in terms of time and cost compared to an elaborate neurocognitive assessment. The MoCA can also add to follow without too much burden on the course of cognition, especially when compared with an elaborate cognitive assessment.

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