Summary and general discussion 7 169 the clinical view (made without knowledge of the MoCA score) of the psychiatric patients with or without MCI. However, what is very prominent is the wide range of scores per (certain) psychiatric disease; there is a tendency of concluding that you either have or do not have cognitive problems that come with that disease. Personality disorders and ‘mixed diagnoses’ of non-affective and non-psychotic disorders do not have this tendency. Personality disorders with the highest MoCA score seem to confirm the clinical experience. This seems to correspond with the findings in the literature, where there is heterogeneity among patients with affective and psychotic disorders in the severity of cognitive impairment. Again, some patients can be seriously affected, and others cannot be distinguished fromnormal controls (Van Rheenen et al., 2020). However, when patients are diagnosed with MCI and depression, they score worse in multiple domains than MCI patients without depression (Ma, 2020). In general, the literature states that unipolar depression seems to affect cognition less than bipolar depression, and the bipolar profile resembles that of schizophrenic patients, although less severe (Van Rheenen et al., 2017). Our study seems to confirm that objective cognitive problems can often be categorised as MCI. Why some patients with depression andMoCA scores that are normally deemed to have MCI but are not diagnosed with MCI has not been studied. We can only speculate regarding the same. This can find its origin in the MoCA (e.g. depressed patients scores lower) or in the diagnostic route of cognitive impairment (e.g. taking depression into consideration). The lack of motivation, which is part of depression, will influence cognitive functioning. If we look at the MCI-neurodegenerative group, the figure 2b of Chapter 4, shows a wide variation in total MoCA scores. Even though the patient has a lowMoCA score, as it appears later, the clinician diagnosed these patients as not having dementia. Although we do not know the exact motivation of the clinician in these individual cases, we can speculate that one of the main criteria for dementia, some interference with independency in (I)ADL, were not being met. Again, clinical expertise seems to ‘overrule’ (or not be in line with) the MoCA score. This is also how it should be. Needless to say, all these observations underline that a study result seems to give a fixed and rigid result for the study group, especially with validating a test, but in clinical reality, many demographic and clinical characteristics should be considered as they affect the patient. The fact that many individual factors are actually considered in a clinical assessment can also be seen by the distribution of the two control groups in our study, that is, the screened versus the triaged controls. The MoCA range is smaller if the clinician’s estimation of whether there is possible cognitive impairment is included in the inclusion criteria: 12–30
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