Validating the MoCA for screening 3 71 Referred patients without suspicion of CI during initial assessment were followed up for a minimum of 2 years to compensate for not having a neuropsychological assessment. Patients who did not meet the aforementioned criteria for a diagnosis of dementia or MCI during follow-up were classified as No-Cognitive Impairment (NoCI). Patients who did meet the aforementioned criteria after the initial three months during follow-up were classified as inconclusive, to be cautious (n=3). 3.2.5 Statistical analyses Results were compared within the referred patients with MD, MCI or NoCI, and between the groups Total Referred Patients (MD+MCI+NoCI) and HC, using the Statistical Package for the Social Sciences (SPSS, version 22; SPSS Inc., Chicago, IL); Chi2 test to compare Sex and education. ANOVA to compare age, GAF, GDS15, and MoCA scores followed with a Least Significant Difference (LSD) (and a Bonferroni not shown) post Hoc test. An ANCOVA with age as a covariate was run additionally. Using Receiver Operating Characteristic (ROC) analysis, the Area Under the Curve (AUC) was calculated as a measure for the diagnostic accuracy of the MoCA. As the MoCA can be used to detect dementia in a clinical setting as well as to rule out cognitive impairment in a clinical setting, we calculated different ROC curves: 1. to detect dementia in a clinical setting. 2. to detect cognitive impairment (MD+MCI) in a clinical setting. 3. to detect MCI in in a subgroup of patients (MD excluded). To compare these analyses with previous casecontrol studies and to see the effect of bias, all analyses were repeated with HC. Positive and negative predicting value (PPV,NPV) were calculated for the “optimal” cut-off scores as calculated by the Youden’s J index. Cronbach’s alpha was calculated for internal consistency of the MoCA. 3.3 Results 3.3.1 Study groups Out of 2204 referrals, 1337were not eligible for this study. 867 referred patientswere assessed withaMoCA for this study (meandelay 21.5days, 65%within3weeks of referral). After applying the exclusion criteria (figure 1), a group of 710 participants remained: 81 MD, 153 MCI, 459 referred patients with no MCI or dementia (NoCI), and 17 inconclusive. Mean time needed for diagnosing was 40.5 days for the NoCI and 60.8 for the CI. For the secondary outcome, 84 HC were included of a group of 96 potential healthy volunteers (flowchart figure 1). Two of them had an IQcode between 3.25-3.5 indicatingminor decline over the past 10 years (Ehrensperger et al., 2010). All others were in-between 3.0-3.25 indicating (almost) no decline.
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