The MoCA with a double threshold 5 119 5.2.2 Measurements Initial assessment The initial assessment was completed by old age psychiatrists (n=4, having at least 8 years of practical experience in 2008) and included a laboratory test, medical and functional history from a next of kin and an investigation of Instrumental Activities of Daily Living (IADL) performed by a psychiatric nurse practitioner with a home visit. The 15-item Geriatric Depression Scale (GDS15) (Yesavage and Sheikh, 1986) and the Global Assessment of Functioning (GAF) (American Psychiatric Association, 2000) were also administered during this time. Diagnostic test All of the referred participants were assessed with a MoCA as soon as possible but within 3 months of referral by a trained psychiatric nurse practitioner. This was independent of the diagnostic procedure. The MoCA consists of one page that covers the cognitive domains of executive function and visuospatial abilities, naming, short term memory, attention and working memory, language, concentration, verbal abstraction and orientation. It can be administered within 10 minutes and the maximum score is 30, which indicates that no errors were made. Correction for low education effects was done, according to the instructions, by adding one point to the total of patients with 12 years of education or less. The suggested best cut-off for the diagnosis of dementia was a score of 21 (<21) and <26 for MCI, in both old age psychiatry and memory clinic settings (Dautzenberg et al., 2020, 2021). Reference test The reference test was the diagnosis determined at multidisciplinarymeetings, including an old age psychiatrist, neuropsychologist and geriatrician. The diagnosis of MD, MCI or NoCI was supported with at least a 4-hour NPA. The NPA included multiple tests in the domains of memory, attention, executive function, fluid intelligence and language capacities (for details please see Dautzenberg et al., 2020). The diagnoses were made in consensus and in accordance with the MCI criteria as proposed by an international consortium (Winblad et al., 2004; Gauthier et al. 2006), or the Dutch guideline on dementia (CBO Geriatrie, 2014). This guideline covers the criteria of -DSM IV/5 and the international criteria for dementia. The results of the MoCA were not used to diagnose MCI or dementia. The Dutch translation of the DSM 5 was introduced in the Netherlands at the end of the study of the cohort (2017). All patients were classified according to DSM IV for the purpose of this study.
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