Chapter 1 10 even more so will have (mild) cognitive impairment (Volksgezondheidenzorg.info, 2019; ‘2020 Alzheimer’s disease facts and figures’, 2020)? Alternatively, were fear, shame, and loneliness key? Moreover, could disproving the subjective cognitive impairment through an objective test and organising transportation to the bridge club do the trick? For these questions to be answered with more certainty, one needs to judge cognitive complaints. Unfortunately, subjective cognitive complaints are poorly correlated with objective cognitive deficit (Pendlebury et al., 2015). This also accounts for next of kin reports and even more so for retrospective recall (Ryu et al., 2020). In addition, for being able to define a state, one must be able to compare it. This is often done in comparison to normative data, that is, the data of others resembling the patient in age and education. However, it would be even better to know the course and, therefore, be able to compare the patient with herself over time. In the above example, the issue would be simplified if there were a baseline at our disposal: was there already cognitive impairment, and if so, did the cognitive impairment change over time? During the depression, or was there a time correlation with recovery or after starting medication? There are many reasons why one wishes for some solid ground when assessing cognitive function in old age psychiatry. But the above all comes down to: Testing is objectifying. However, validated comprehensive tests that can help distinguish between the different aetiologies are not widely available in the short term. Therefore, not only is a short, rapid implementable test needed, but it also needs to be validated to interpret the results. Whether one needs to determine to exclude cognitive impairment or notice cognitive impairment at an earlier stage. 1.1.2 Why for Me? The Minimal Mental State Examination (MMSE) (Folstein, Folstein and McHugh, 1975) — I presume that most medical doctors are familiar with it — is a cognitive test to objectify cognitive impairment or screen for dementia or other severe cognitive impairments. It is a practical bedside test (a short questionnaire using only paper and pencil). Even though it was introduced in 1975, it still was at the beginning of my research, or even still is a sort of standard of short cognitive screeners when cognitive impairment is suspected (alzheimer-nederland.nl). However, its major shortcoming is a ceiling effect, meaning that less severe impairments would not be noticed by the MMSE or higher educated persons could pass the test even if they have impairments (Mitchell, 2017; Pinto et al., 2019). Therefore, at the beginning of my career as an old age psychiatrist, I was trying to select a cognitive test that would better fit my daily clinical use, including house visits, in correctly
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