Chapter 1 32 Meta-analyses show that there are cognitive impairments across all domains but also that there is a large overlap with healthy controls on an individual basis. No specific schizophrenia profile was found. Although executive functions and memory feature prominently, working memory seems to be particularly affected: impaired digit span and especially, backward digit span (Nuechterlein et al., 2008). The category fluency task, not part of the MoCA, would also be impaired (Bortolato et al., 2015). The mentioned disorders are only found at the group level and cannot be translated to the individual test results due to the very diverse individual profiles. ‘Doctors’ delay’: This defines the time elapsed between the first visit to the doctor and the correct diagnosis. This term is often used for delays that can occur due to misdiagnosis or not (yet) finding the aetiologies. Not reporting the symptom (correctly), but only the complaints, can be due to doctors’ delay as well as patient delay. ‘Patients’ delay’: This defines the time elapsed between the onset of the first symptoms and the visit to the doctor for this symptom. There can be conscious and unconscious reasons for not mentioning the symptoms. Often encountered reasons can be divided into three stages, 1) appraisal delay: the time the patient takes to appraise a symptom as a sign of illness; 2) illness delay: the time taken from deciding one is ill until deciding to seek professional medical care; and 3) utilization delay: the time from the decision to seek care until the patient goes to the clinic and uses its services (Safer et al., 1979). This is especially true for older individuals with cognitive impairment, such as those accepting symptoms as part of ageing. Shame, denial, fear of diagnosis or consequences, fear of stigmatisation, or not wanting to complain are also noticed (Parker et al., 2020). 1.6 How- Aim and outline of the dissertation In the previous paragraphs, we have substantiated the necessity of this study. One needs to be aware of the ‘needs’ and especially the ‘unmet needs’ during treatment. Multiple factors cause doctors and patients to delay these ‘needs’. Cognitive impairment can lead to a major ‘need’, especially in old age psychiatry. An elaborate neurocognitive assessment to weigh or estimate this need is not feasible for all patients. A bedside test that is fast, such as the MMSE, is often not sensitive enough to detect mild impairment.
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