Validating the MoCA for screening 3 67 3.1 Introduction The Montreal Cognitive Assessment (MoCA) (Nasreddine et al., 2005) was developed as a brief screening test for Mild Cognitive Impairment (MCI). It is widely used across the world in a variety of settings (mocatest.org, no date). The MoCA is recommended by the Alzheimer’s Society to objectively assess cognitive complaints in a clinical setting (Ballard et al., 2015). Even thoughmore andmore advocacy groups or policy makers favor screening for dementia there is still a debate if screening in various populations is wise(Borson et al., 2013; Brunet et al., 2013; Lin et al., 2013; Prince and Comas-Herrera, 2016; Chambers, Sivananthan and Brayne, 2017; Burn et al., 2018). However, the setting of old age psychiatry is different to our opinion. By knowing a patient’s cognitive functioning at referral, besides timely detecting dementia also to monitor all causes of MCI in old age psychiatry, one can adapt their (psychiatric) treatment; e.g. pharmacotherapy (including compliance) or psychotherapy. Especially as this population is at greater risk of changing cognitive functioning not only by age but also by (psychotropic) medication or because of the referral reasons (Dautzenberg et al., 2018; Volksgezondheidenzorg.info, 2019). In the Netherlands, referrals to old age psychiatry consist of a mix of neurodegenerative and other psychiatric disorders, such as depression, bipolar disorders, schizophrenia, and severe anxiety disorders, all of which can be accompanied by poor cognitive functioning (American Psychiatric Association, 2000; Bierman et al., 2005; Schouws et al., 2012; Baune and Renger, 2014; Bora and Pantelis, 2015). We introduced in our clinic a short cognitive assessment using the MoCA for all referred patients to lower doctors delay by adding an objective aid to triage those in need for specialized diagnostic route besides having baseline cognitive data. Therefore we need to know its diagnostic test accuracy in this setting. The MoCA shows good validity in multiple languages (mocatest.org), although moderately so inDutch inageriatricmemoryclinic setting (Thissen et al., 2010). It is important tovalidate the MoCA in specific settings, as the selection of subjects with different characteristics may influence the test characteristics of a scale such as the MoCA (Rossetti et al., 2011; Davis et al., 2013, 2015). This is especially relevant in case-control study designs using community-based healthy controls, as this is not representative of the clinical reality (Davis et al., 2013, 2015). The MoCA has not yet been validated in old age psychiatry settings, where patients are referred to with multidimensional causes for MCI (Ferri et al., 2005) and to our knowledge our study is the first to do so. Differentiation between cognitive impairment as a consequence of a psychiatric disease and/or as a consequence of early stage dementia is complicated and may affect the test-characteristics of the
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