Chapter 7 182 for individual patients but also for the overall health system. Dementia and cognitive impairment are leading causes of dependency and disability, respectively. It currently affects approximately 10 million people in Europe, and its prevalence is expected to double by 2030. Dementia occupies (in 2019) the seventh place among causes of death and disability globally (WHO mortality-and-global-health-estimates). 2 There must be a generally accepted method of treatment for the disease. If we consider the treatment of cognitive impairment from a wider perspective, there are multiple levels where one could expect the effect of a treatment. Treatment is not only to treat the disease, but also the condition that comes with it. The treatment should not only be focused on the patient but also on its environment, including their informal caregiver. Special attention should be paid to dealing with patient needs, including behavioural psychological symptoms of dementia (BPSD). In addition, the guidance and monitoring of needs at home are part of the treatment. The MoCA can be part of this monitoring. Another view on treatment could be to obtain the correct (diagnostic) route. Here, the MoCA can be of added value in this process, as explained in this dissertation. It is not only now validated for old age psychiatry, but we showed it can add substantially to improve referrals. Furthermore, the WHO, among other advocacy groups, states that early diagnosis of dementia is necessary (WHO Global Action Plan on the Public Health Response to Dementia 2017–2025; Prince, Bryce and Ferri, 2011). It is hoped that early diagnosis can be of use in either finding a cure or using this treatment in the near future. As for now, early diagnoses can help prepare patients for things to come. He or she can still be in control of decision making, which is inevitable. As shown in this dissertation the MoCA could have a role in this process. 3 There must be adequate facilities for diagnosis and treatment. This is a major concern at present but will be even more so in the near future because already, 50–90% of cases of dementia remain undiagnosed in high- to low-income countries, respectively, and there are already shortages of ‘adequate facilities’ (Alzheimer’s disease International, 2016). The MoCA, as shown in this dissertation in Chapters 3, 4, and 5, can contribute significantly to this through not only screening and early detection, but also by reducing false-positive referrals by triaging, thereby relieving the diagnostic pathways. As for the MoCA itself, the studies presented in this dissertation contribute to the criteria for adequate facilities, as the MoCA is now validated for these facilities.
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