Summary and general discussion 7 153 7.1 Summary of the aims and the main findings 7.1.1 Background and aim of this dissertation In clinical practice two seemingly distinct disorder clusters are referred to the old age psychiatry; psychiatric disorders that often manifest themselves by disturbances in ‘behaviour, mood or thoughts’ and neurodegenerative disorders that often present with decline in ‘cognition’. However, there is an increase in the comorbidity of cognitive disorders with age (Ferri et al., 2005) in addition to impaired cognitions related to affective and psychotic disorders (Schouws et al., 2012; American Psychiatric Association, 2013; Baune and Renger, 2014; Bora and Pantelis, 2015). Affective and psychotic symptoms are also common in different dementias (Lyketsos et al., 2002; American Psychiatric Association, 2013; Nederlandse Vereniging voor Klinische Geriatrie, 2014; Eikelboom et al., 2021). Often, prodromal symptoms present with the ‘opposite’ cluster of symptoms, for example, cognitive problems amongst schizophrenic patients or depression preceding neurodegenerative diseases. This further complicates the diagnosis because of overlapping symptom presentation. It is estimated that the number of people (24 million in 2018) with dementia worldwide will double every 20 years, reaching 115 million by 2050 (Alzheimer’s Disease International, 2018). For the group with mild cognitive symptoms, these numbers were several times higher. In addition, today’s patient goes to a physician to request exclusion or confirmation of an underlying substrate as an explanation with increasingly milder cognitive complaints than was previously the case (Grimmer et al., 2015). This, besides the above mentioned co-existing of the symptoms, makes determining an aetiology more difficult (Mitchell, 2009) as both psychiatric and neurodegenerative causes can start with (mild) cognitive deficits. An elaborate neuropsychological assessment is part of the gold standard for identifying the cause. The patient populations to be examined will grow substantially, and the pressure on waiting lists for comprehensive cognitive assessment will further increase (Alzheimer’s Disease International, 2018). Besides as it is expensive, scarce, time-consuming, and burdensome for the patient to do this in specialised outpatient clinics by means of an extensive cognitive examination, a triaging test before a referral is made is desirable. This bedside short test that can help differentiate and objectify whether the patient in question has age-appropriate symptoms, or whether the symptoms fit a (nonneurodegenerative) psychiatric diagnosis, which can be accompanied by subjective or minor cognitive impairment, or that more research may need to be conducted in relation
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