General introduction 17 1 diagnose someone falsely. This translates into no ‘false positives’, that is, high specificity. However, at the blood bank, you want to rule out the disease with certainty. This, in turn, translates into no ‘false negatives’, you do not want to miss a case (high sensitivity). In old age psychiatry, regarding cognitive complaints, we can organise the population by cognitive complaints, cognitive functioning, and whether they have psychiatric complaints or not. Creating groups using these three parameters results in: not suspected of cognitive impairment (but with psychiatric symptoms), suspected of but not objectified (with or without psychiatric symptoms), and objectified cognitive impairment (with or without psychiatric symptoms). Figure 1. Levels of certainty of cognitive impairment in old age psychiatry and who to screen. This results in different levels of selection for screening: screening all referred patients to old age psychiatry, or only those considered at high risk. Screening all referred patients during an initial interview brings benefits in the form of knowing patients’ cognitive status, besides avoiding doctor delays or patient delays. These benefits go beyond just (early) detection of cognitive impairment present at the time of the initial history interview that would otherwise be unnoticed. They can also help with issues in the near future such as foreseeable cognitive problems due to prevalence, psychotropic medication, or psychiatric episodes, among others. Of course, screening patients without complaints and at lower risk is not without a downside. The most prominent are the financial cost, psychological burden, and false positives, but all Wilson and Jungner’s criteria apply. On the ethical side is the unexpected discovery of cognitive impairment with major social consequences for patients. The more the population that is screened is preselected
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