Summary and general discussion 7 181 7.3.5 Applying the criteria of Wilson and Jungner (1968) to the MoCA as a screener for cognitive impairment. As mentioned in the introduction, the interpretation of the three concepts Need, Demand, and Supply (Need: What people benefit from; Demand: What people ask for; Supply: What is, or could be, provided), viewed from the perspective of Bradshaw’s taxonomy, are prone to change over time as knowledge and resources will change even though their meaning will remain the same. These three concepts will have a major impact whether to screen or not. We hope that the results presented in this dissertation with these three concepts of Bradshaw in mind, will add to address the Wilson and Jungner criteria. However, our answers are by no means complete and are prone to change with time as knowledge (of the expert, the patient or the community by new research) and resources (budget as well as new tests or techniques) will keep changing and will influence the answers to the four questions asked by Bradshaw. What does the expert know, what does the patient feel, what does the patient express, and what do other patients do (Bradshaw, 1972)? We focus in this paragraph on the MoCA as a screener however the Wilson and Jungner criteria could or even should be applied to the other ‘screening instruments’ we used in this dissertation, i.e., the CANE and valproic acid concentration. Especially the ‘free valproic acid concentration screening’ as it is not implemented in guidelines of most countries when patients use valproic acid, in contrary to screening the ‘total valproic acid concentration’. This is exemplary of the shift of knowledge that could influence the outcome of the Wilson and Jungner criteria on whether guidelines should recommend to screen with free instead of total valproic acid concentration. As a lot of the Wilson and Jungner criteria on this topic cannot (jet) be answered sufficiently we cannot come to conclusion by these criteria. Most notably criteria 1, 3, 7, and 9 as they refer to the prevalence, adequate facilities for detecting, the course and the cost which are not jet clear in the case of an elevated free concentration during therapeutic total valproic acid concentrations. 1 The disease to be detected must be a major health problem. First, we want to note that cognitive impairment is not a disease but a state, as explained in Chapter 1 and 5. This does not mean that cognitive impairment cannot be a major health problem. Even if we look at mild cognitive impairment. The qualifier ‘mild’ only refers to something about the degree of symptoms or the state of the condition. However, the consequences can be significant. Although the definition of MCI states that the impact on IADL and ADL should be minor, the emotional consequences of awareness of change do not have to be. Another way of looking at these criteria is to consider this not only
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