Chapter 7 154 to (mild) cognitive impairment (Davis et al., 2013; Prince and Comas-Herrera, 2016). This test should then meet the requirements of a short acquisition time, test multiple cognitive domains, and have good sensitivity and specificity for not only dementia but also Mild Cognitive Impairment (MCI) in particular, due to the above-mentioned reasons, among others. The Mini-Mental State Examination (MMSE) is the most commonly used test to quickly detect cognitive impairment (Folstein, Folstein and McHugh, 1975). However, the problem withMMSE is that it easily scores false negatives inmild tomoderate cognitive impairment (Nasreddine et al., 2005; Davis et al., 2013). If someone experiences symptoms but makes the MMSE adequate, it does not exclude (mild to moderate) cognitive disorders. Thus, the MMSE seems inappropriate as a precise screening instrument for mild-to-moderate cognitive complaints or patients with complaints who have a background of a higher level of education (Nasreddine et al., 2005). A fast test with discriminatory power in this group of patients with a non-uniform presentation is of great value. The Montreal Cognitive Assessment (MoCA) is a short screening test (10 minutes long) for cognitive complaints and is designed for this purpose (Nasreddine et al., 2005). In doing so, the MoCA seems more appropriate for finding mild to moderate cognitive impairment, which the MMSE does not adequately detect (Nasreddine et al., 2005; Davis et al., 2013). The test has already been validated in over 27 languages (mocatest.org), with good sensitivity and specificity of 90% and 87% for English and French, respectively. However, the results of the Dutch version in patients with cognitive symptoms in a geriatrics department deviated from this for unknown reasons, with a sensitivity and specificity of 72% and 73% for MCI, respectively, compared with healthy controls (Thissen et al., 2010). Validation has also been performed in several specific populations, including those with vascular dementia (Ihara et al., 2013) and frontotemporal dementia (Freitas et al., 2012). It is clear that the test should be validated in specific populations to maintain high reliability (Rossetti et al., 2011). Depending on the population in which the test is administered, reliability changes. The positive predictive value (PPV) decreases and the negative predictive value (NPV) increases when there are fewer cognitive impairment patients in the studied population. For example, for the MMSE in a memory clinic, the PPV is 86% and NPV is 73%, and in general practice, PPV is 54% and NPV is 96% (Mitchell, 2009). The above underpins the fact that an increasing number of people have dementia; they are examined earlier in the process, and this interferes with regular (psychiatric) treatments
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