Géraud Dautzenberg

Summary and general discussion

7.4 Concluding remarks To screen or not to screen – that was the question.

Next to taking the Wilson and Jungner criteria into account, we are convinced that, in this dissertation, we have provided the arguments that the MoCA can play a substantial role colouring thegrey area that this question raises. Thereforeallowing (part of) this discussion to be settled for cognitive impairment. As subjective cognitive complaints do not always correspond with objective impairment, a fast and reliable bedside test is needed. This accounts especially in old age psychiatry where MCI is a frequent issue due to multiple aetiologies. What you see is not always what you get. This is also true for needs, unmet needs, and the free concentration of valproic acid. Unfortunately, the question to screen or not to screen cannot (yet) be answered on these matters. The MoCA is suitable for MCI screening in old age psychiatry, with its population at risk. However knowing its strengths and weaknesses is essential. It is better suited for detecting MCI than the MMSE, with fewer false negatives. The MMSE, with low false positives for dementia, can be used on one side of the uncertainty spectrum. An elaborated neuropsychological assessment is needed on the other side of the uncertainty spectrum to differentiate between different aetiologies of cognitive impairment. Between these two extremes the MoCA fills the gap perfectly for screening and triaging patients with an increased risk of developing or having cognitive impairment, including MCI; for example, in an old age psychiatry setting. It is faster, cheaper, and therefore easier to apply than a neuropsychological assessment; however, it will have difficulties in differentiating the aetiologies. Therefore the MoCA should not only be used on indication (triaging) but also to get an indication (screening) in old age psychiatry.

7

If your MMSE score is wrong, then something is really going on. If your MoCA score is right, then you should be alright. If your MoCA score is so so, active monitoring is the way to go. If your MoCA score is low, an elaborate assessment should follow.

We hope we have convinced the reader (for now) of the importance of knowing the strengths and weaknesses of a screening instrument in old age psychiatry.

Trust me, I am a validated test…….? Trust me I ‘m a doctor, and know how to use a validated test!

187