Chapter 4 86 ABSTRACT Objectives: Diagnostic pathways are limited. A validated instrument that can triage patients when they are suspected of mild dementia (MD) is necessary to optimize referrals. Methods: The MoCA is validated for identifying MD and mild cognitive impairment (MCI) in a cohort of patients suspected of cognitive impairment (CI) after initial assessment in old age psychiatry. The reference standard was the consensus-based diagnoses for MD and MCI, adhering to the international criteria and using suspected patients that followed the same diagnostic route, but without CI, as comparisons (SNoCI). Results: The mean MoCA scores differ significantly between the groups: 24(SE:.59) in SNoCI, 21(SE:.31) in MCI and 17(SE:.45) in MD (p<0.05). The AUC of MD against non-demented (MCI+SNoCI) was 0.83 (95%CI: 0.78-0.88) resulting in 90% sensitivity, 65% specificity, 50% PPV and 94% NPV at a ‘best’ cutoff of <21 according the Youden index and respectively 0.77 (95%CI: 0.69-0.85), 56%, 73%, 90%, 28% for CI (MD+MCI) against SNoCI at <21. Conclusion: 90%of individuals with aMoCA of <21 will have CI (MD+MCI), while 94%with aMoCA of ≥21 will not have dementia. The MoCA can reduce referrals substantially (50%) by selecting who doesn’t need further work up in a memory clinic, even if they were suspected of CI after initial assessment.
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