Chapter 3 80 weaknesses of our study – unrealistic scattering and seemingly missed CI diagnoses – would in practice be interpreted as part of a larger clinical picture; incongruous results would be reconsidered if these MoCAs are clinically relevant or correct, or considered as CI. This would increase the specificity of the MoCA. Further research should focus on the suspected CI referrals only and investigate if a MoCA reassessment after recovery from serious psychiatric episodes can lower the false positive rate. Another limitation is that we did not gave all the comparisons the same full diagnostic assessment due to practicality and resource constraints. Because adding the HC was mainly to underscore the spectrum-bias effect, this is to our opinion acceptable. The NoCI that were not suspected of CI, hence didn’t got a full diagnostic work-up, were followed for at least 2 years to compensate for this limitation. The NoCI that were suspected of CI did get the same full diagnostic assessment. Excluding the GDS ≥5 and BPSD could be seen as selection-bias and a limitation. To our opinion avoiding the extremes of the spectrum is a strength of our study. The clinical reality is that the obvious demented will not be screened whether they need a specialized diagnostic route. But including their low MoCA scores in the study would bias the results. 3.5 Conclusion This study shows that validating the MoCA in a biased setting, i.e against healthy controls, overestimates specificity. Our findings are in line with the literature, where lower cut-off scores are repeatedly suggested (Lee et al., 2008; Rossetti et al., 2011; Waldron-Perrine and Axelrod, 2012; Davis et al., 2015; Gil et al., 2015; O’Caoimh, Timmons and Molloy, 2016; Carson, Leach and Murphy, 2018; Pugh et al., 2018) to tackle this problem. Taking the above results into account, one can conclude that the MoCA can be useful in an old age psychiatric setting to confirm normal cognitive functioning and to identify those who are in need for a specialized diagnostic pathway. However, further research is necessary to minimize the number of false positives in the latter group.
RkJQdWJsaXNoZXIy MTk4NDMw