Chapter 1 22 reminds most readers of the Maslow pyramid (Maslow, 1954, 1970). In our study we use the definition of – and objectively define ‘needs’ by – the Camberwell Assessment of Needs for the Elderly (CANE). The CANE incorporates the Maslow findings as well as the taxonomy proposed by Bradshaw (Bradshaw, 1972) involving normative needs (by experts), felt needs (by patients), expressed needs (or demanded), and comparative needs (with other patients) from a sociological perspective. The aforementioned contemplations or dilemmas I experienced (in the Why paragraph) is well-described by the concepts presented in the dissertation of Reynolds (Reynolds, 2003) on the CANE that are: Need: What people benefit from; Demand: What people ask for; Supply: What is provided. How these three concepts are interpreted is prone to change over time for numerous reasons, but most noticeable to knowledge (of science, e.g. doctor, as well as the patients/public) and resources (in money as well as technics). The results of these three interpretations will have an effect on doctors’ responses to the dilemma mentioned above, that is, when should a doctor (re)act even if a need is not expressed as such? This includes the question of whether screening is desirable. It is, therefore, not surprising that these three concepts (need, demand, and supply) are, to some extent, reflected in Wilson and Jungner’s criteria listed above, although the criteria in themselves did not change over time. One could say that the questions remain the same, but the answers will change. The DSM IV andDSM5 list the diagnostic criteria for different psychiatric and neurocognitive diseases (NCD). Without trying to be complete but also trying not to copy the DSM, we will summarise and capture its essence here as an introduction with an emphasis on cognitive impairments. ‘Mild cognitive impairment’: Mild cognitive impairment, often abbreviated as MCI, was (re)introduced by the Mayo clinic in 1999 and 2004 (Petersen, 2004). The definition of MCI has evolved over the years; however, the idea behind it remains the same (Table 2). The idea behind introducing MCI is that cognitive impairment is a state on a continuum ranging from normal cognition on one side to dementia on the other end of the continuum. ‘It should be considered as a description of cognitive functioning in which the underlying disorder can vary rather than as a nosological entity representing the prodromal stage of AD’ (Visser and Verhey, 2008). However, the original starting point of the concept focused on Alzheimer’s disease (AD); therefore, the theory was more towards MCI being a state before the transition towards Alzheimer’s disease. In recent decades, there has been a shift in awareness that, even though Alzheimer’s disease is the most frequent cause of
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