Summary and general discussion 7 155 and complicates diagnostics due to increasing overlapping symptom presentation. A validated short test that allows the scores to be interpreted properly can help identify or exclude (mild) cognitive impairment. The MoCA is becoming the ‘test to be used’ for short cognitive screening tests, rather than the MMSE to identify mild cognitive impairment (MCI). Internationally, the MoCA has been well validated in different settings; however, in an (old age) psychiatric setting so far no validation study has taken place’. In addition to the preceding summary of arguments for introducing an objective cognitive test, there is also the following. One must consider that patients tend not to mention all of their needs during visits. The symptoms experienced do not always have to correspond to their objective symptoms. This also applies for what close relatives report. This is true not only for cognitive impairment but also for other needs in old age psychiatry. Hence, many health problems remain unresolved. Disagreement on the needs and the needs that need to be met can result in unnecessarily lower quality of treatment (Stobbe et al., 2013) and avoidable lower compliance (Hancock et al., 2003). The ability to tailor treatment will enhance the outcome. Therefore, we must be aware of and consider that patients are not always able to properly articulate or draw attention to their request for help or, in fact, the cause of their complaints. This may be because, for example, they are ashamed of, in denial of, or do not understand the cause of their complaint (i.e. patient delay) or because, for example, they cannot articulate it well, the doctor does not understand it properly, and/or initiates the necessary or supportive examination too late (i.e. doctor delay). The CANE is designed to be used in old age psychiatry to identify a wider area of needs among the elderly, which have not yet been met. It uses not only the perspective of the doctor but also the perspective of the patient and, if available, of the next of kin. Summary of the Aims Section A: What is the patient’s (unseen and unmet) need for help in old age psychiatry according to the CANE? How do these factors relate to patient characteristics? Are they different from a setting comprising younger patients? We conducted this study specifically in a population of older patients with bipolar disorder, as older bipolar patients tend to be more complex, with more cognitive decline among other complications than their younger counterparts (Schouws et al., 2012; Dols et al., 2014).
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