Chapter 4 92 language, concentration, verbal abstraction and orientation. It can be applied within 10 minutes and the maximum score is 30 which indicates no errors were made. Correction for low education effects were made, according to the instructions, by adding one point to the total of patients with 12 years of education or less. Suggested cutoff for the diagnosis of dementia was a score of 21 (<21), for MCI <26. These cutoffs gave the best Youden index for this population (Dautzenberg et al., 2020). Reference test The reference test was the diagnosis determined at multidisciplinary meetings, these meetings included an old age psychiatrist, a neuropsychologist and a geriatrician. The diagnosis of MD, MCI or SNoCI was supported with (at least) a 4 hour neuropsychological assessment. This included multiple tests in the domains of memory, attention, executive function, fluid intelligence and language capacities (table 1). The diagnoses were made in consensus and in accordance with the DSM IV (American Psychiatric Association, 2000), the MCI criteria as proposed by an international consortium (Gauthier, et al., 2006; Winblad et al., 2004), or the Dutch guideline on dementia (Nederlandse Vereniging voor Klinische Geriatrie, 2014). This guideline covers the criteria of -DSM IV for dementia, -NIAAA / NINCDS-ADRDA for Alzheimer’s disease (McKhann et al., 2011), -NINDS-AIREN / AHAASA for Vascular dementia (Gorelick et al., 2011; Román et al., 1993), -Frontotemporal dementia (FTD) according The Lund and Manchester Groups (Gorno-Tempini et al., 2011; Neary et al., 1994), and the Consensus for Dementia with Lewy Body (DLB) (McKeith et al., 2005). The results of the MoCA were not used to diagnose MCI or Dementia. 4.2.3 Statistical analyses Demographic and clinical variables were compared within patients suspected of MD, MCI or SNoCI using 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) post Hoc test. Using Receiver Operating Characteristic (ROC), analysis of the Area Under the Curve (AUC) was calculated as a measure for the diagnostic accuracy of the MoCA. We calculated three different ROC curves, as the MoCA can be used for different tasks: 1. to find dementia (MD versus MCI+SNoCI); 2. to rule out Cognitive Impairment (MD+MCI versus SNoCI); and; 3. to detect MCI (MCI versus SNoCI) (as CI is a multidimensional state, one may also want to identify who is at risk for developing dementia by focusing on MCI).
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