After referral, patients with an obvious cause of their cognitive complaints were excluded to resemble a clinical screening population: Those with a diagnosis of severe mid‐stage dementia (GDS greater than or equal to 5), a recent history of substance abuse (<2 years), recent delirium (<6 months), or an acquired brain injury including cerebrovascular accident (CVA) or transient ischemic attack (TIA). Participants were assessed by a multidisciplinary team, on all occasions including an old age psychiatrist and a trained psychiatric nurse practitioner. Therefore, patients referred with severe dementia (Global Deterioration Scale greater than or equal to 6), 24 Behavioral and Psychological Symptoms of Dementia (BPSD), or compulsory referrals were not included. The inclusion criterion was the ability to give written informed consent. Between 20, all newly referred patients were eligible for this study. This study was performed in an old age (60 years +) psychiatry outpatient clinic in a large Dutch City (Utrecht), which offers services to the north‐west side of the city and its rural surroundings (57.000 inhabitants of 60+ in the north‐west). 18, 20 To illustrate this effect, we present as a secondary outcome the MoCA results in a case‐control design, using community‐based HC with normal cognitive aging as secondary comparisons. The above cross‐sectional design avoids the spectrum‐bias of most case‐control studies where the extremes of the spectrum of cognitive function were included. The reference standard consists of a multidisciplinary, consensus‐based diagnosis in accordance with international criteria. The purpose of the present study is to test the criterion validity (ie, can the MoCA predict a diagnose correctly) of the MoCA to detect MCI and early stage/mild dementia (MD) in an old age psychiatry cohort including referred but not cognitive impaired patients as primary comparisons. We aim to validate the MoCA in this clinical setting following the standards for reporting diagnostic accuracy (STARD 2015) 23 recommendations by using a cross‐sectional study design.
22Īccording to the Cochrane review, “the MoCA may help identify people requiring specialist assessment and treatment for dementia.” 18 Differentiation between cognitive impairment as a consequence of a psychiatric disease and/or as a consequence of early stage dementia is complicated and may affect the test‐characteristics of the MoCA. 18, 20 The MoCA has not yet been validated in old age psychiatry settings, where patients are referred with multidimensional causes for MCI 21 and to our knowledge our study is the first to do so. 18, 19, 20 This is especially relevant in case‐control study designs using community‐based healthy controls (HC), as this is not representative of the clinical reality. 17 It is important to validate the MoCA in specific settings, as the selection of subjects with different characteristics may influence the test characteristics of a scale such as the MoCA. The MoCA shows good validity in multiple languages, 2 although moderately so in Dutch in a geriatric memory clinic setting. Therefore, we need to know its diagnostic test accuracy in this setting. We introduced in our clinic a short cognitive assessment using the MoCA for all referred patients to lower doctors delay by adding an objective aid to triage those in need for specialized diagnostic route besides having baseline cognitive data. 10, 11 In The Netherlands, referrals to old age psychiatry consist of a mix of neurodegenerative and other psychiatric disorders, such as depression, bipolar disorders, schizophrenia, and severe anxiety disorders, all of which can be accompanied by poor cognitive functioning. By knowing patient's cognitive functioning at referral, besides timely detecting dementia also to monitor all causes of MCI in old age psychiatry, one can adapt their (psychiatric) treatment eg, pharmacotherapy (including compliance) or psychotherapy, especially as this population is at greater risk of changing cognitive functioning not only by age but also by (psychotropic) medication or because of the referral reasons. 4, 5, 6, 7, 8, 9 However, the setting of old age psychiatry is different to our opinion. 3Įven though more and more advocacy groups or policy makers favor screening for dementia, there is still a debate if screening in various populations is wise. 2 The MoCA is recommended by the Alzheimer Society to objectively assess cognitive complaints in a clinical setting. It is widely used across the world in a variety of settings. The Montreal Cognitive Assessment (MoCA) 1 was developed as a brief screening test for mild cognitive impairment (MCI).
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