General introduction 35 1 memory clinic in an old age psychiatric setting, which is more the clinical setting for daily practice. Therefore, this study aims to validate the MoCA for patients suspected of having cognitive impairment in geriatric psychiatry. We will investigate whether the MoCA has sufficient discriminatory power for (the different underlying diagnoses with) MCI and more severe cognitive problems, and use patients suspected of but without objective cognitive problems as comparison group. Criteria 4 and 10 ‘There must be a recognizable latent or early symptomatic stage of the disease’ and ‘The process of detection must be a continuous process and not a one-time project’. The problemwith criterion 4 is who is to be considered to have early symptomatic signs of mild dementia as MCI is on a functional continuum and dementia is a calcification or a definition from a nosological point. They are defined from a different perspective. This creates a subthreshold state in which not all individuals will convert to dementia. Taking into account the other criteria of Wilson, we present in this chapter an additional approach for screening with the MoCA using a double threshold. These criteria were examined for the probability of mild dementia and those at risk (MCI) in chapter five, The MoCA with a double threshold: improving the MoCA for triaging patients in need of a neuropsychological assessment. Regarding Criteria 2 (There must be a generally accepted method of treatment for the disease) and 8 (There must be agreement as to who should be treated), ‘treatment’ is translated to ‘who is in need of an elaborate neurocognitive assessment’. With this in mind these criteria are examined in chapter five in particular and to a minor degree in the chapters 3 and 4 as well. Treatment should not only focus on the disease itself, but also on the problems or needs that arise from this disease. The needs that are unmet should attempted to be met, and this should also be considered a treatment. The previous chapters elaborate more on theoretical starting points. Chapter six is an illustration of the added practical value of having performed a screening for cognitive impairment. This case study shows how an initial standard screening that seems to have no added value during the time of screening suddenly appears to contribute to saving someone’s life. Wilson and Jungner’s Criteria 2, 3, and 7: ‘There must be a generally accepted method of treatment for the disease’, ‘There must be adequate facilities for diagnosis and treatment’ and ‘The natural course of the disease to be detected must be known’ should be seen in a wider perspective and beyond the primary disease but include the needs caused by this disease. These issues are more generally debated in chapters three, four, and five and in more detail in the Discussion section (chapter seven).
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