Chapter 3 68 MoCA (Mitchell, 2009). According to the Cochrane review, “the MoCA may help identify people requiring specialist assessment and treatment for dementia” (Davis et al., 2015). We aim to validate the MoCA in this clinical setting following the standards for reporting diagnostic accuracy, STARD 2015 (Bossuyt et al., 2015), recommendations by using a cross-sectional study design. The purpose of the present study is to test the criterion validity (i.e. can the MoCA predict a diagnose correctly) of the MoCA to detect MCI and early stage/mild dementia (MD) in an old age psychiatry cohort including referred but not cognitive impaired patients as primary comparisons. The reference standard consists of a multidisciplinary, consensus-based diagnosis in accordance with international criteria. The above cross-sectional design avoids the spectrum-bias of most case-control studies where the extremes of the spectrumof cognitive function were included (Davis et al., 2013, 2015). To illustrate this effect, we present as a secondary outcome the MoCA results in a case-control design, using community-based healthy controls (HC) with normal cognitive aging as secondary comparisons. 3.2 Methods 3.2.1 Sample This study was performed in an old age (60years +) psychiatry outpatient clinic in a large Dutch city (Utrecht) which offers services to the North-West side of the city and its rural surroundings (57.000 inhabitants of 60+ in the North-West). Between 2008 and 2018 all newly referred patients were eligible for this study. The inclusion criterion was the ability to give written informed consent. Therefore patients referred with severe dementia (Global Deterioration Scale (GDS) ≥6) (Reisberg et al., 1982), Behavioral and Psychological Symptoms of Dementia (BPSD), or compulsory referrals were not included. Participants were assessed by a multidisciplinary team, on all occasions including an old age psychiatrist and a trained psychiatric nurse practitioner. After referral, patients with an obvious cause of their cognitive complaints were excluded to resemble a clinical screening population: those with a diagnosis of severe mid-stage dementia (GDS ≥5), a recent history of substance abuse (<2 years), recent delirium (<6 months), or an acquired brain injury including CVA or TIA. In addition, patients with insufficient command of the Dutch language were excluded. The secondary study compares the test properties of theMoCAwith an unrealistic situation: a group of community-based HC, age 60+. They were recruited from acquaintances of patients or research assistants. Inclusion criteria were: no cognitive complaints and no risk
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