Carolien Zeetsen

22 This gap between knowledge – exactly knowing what needs to be done to plan well indicated treatment – and clinical reality – realizing an NPA for each individual is impossible – may be closed by administering a brief cognitive screener, which can give a quick indication of the current cognitive status. An ideal screening instrument should meet certain criteria (Shulman, 2000). For instance, it should have a short administration time and have an easy to interpret score, it should be relatively independent of education, language or culture, have good psychometric properties such as test–retest and inter–rater reliability, and good concurrent and predictive validity with high levels of sensitivity and specificity. Above all, it must be easy to score and be acceptable in administration for both the clinician and the patient. Ideally, a cognitive screener should have parallel versions that enable longitudinal assessment in individual patients while minimizing material–specific practice–effects. There are many different cognitive screening instruments available, not all meeting the abovementioned criteria. Probably the best known and most widely used is the Mini Mental State Examination (MMSE; Folstein et al., 1975). A limitation of the MMSE is its low sensitivity in detecting mild NCD. Other well–known cognitive screening instruments are the Mini–Cog (Borson et al., 2000) and Addenbrooke’s Cognitive Examination Revised (ACE–R; Mioshi et al., 2006). These instruments have, however, been developed for the assessment of severe cognitive disorders (such as dementia) and not for use in addiction health care, and they may not be universally available. Montreal Cognitive Assessment A potentially promising cognitive screening instrument for detecting substance–induced neurocognitive disorders is the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005; see www.mocatest.org) . The MoCA was initially developed to detect mild NCD due to Alzheimer’s Disease and contains 12 items in seven cognitive domains. It is a brief test with a scoring range from 0 to 30. Administration of the instrument takes about ten to fifteen minutes and there are three alternate versions available, making it possible to retest over time. The MoCA has been used as a cognitive screener in many populations, such as, but not limited to, cerebrovascular disorders, Parkinson’s disease, HIV, head trauma, sleep behaviour disorders, brain tumours, depression, heart failure, and also substance use disorders. It is freely available in about 60 languages in 40 countries. In 2010, the Dutch version of the MoCA (version 7.1, see Figure 1.1) was made available and validated in a memory clinic population (Thissen et al., 2010). For the purpose of the current PhD project authorized translations of versions 7.2 and 7.3 were made (Wester & Kessels, 2012).