Clinical value of the Montreal Cognitive Assessment (MoCA) in patients suspected of cognitive impairment in old age psychiatry. Using the MoCA for triaging to a memory clinic.

Diagnostic pathways are limited. A validated instrument that can triage patients when they are suspected of mild dementia (MD) is necessary to optimise referrals. The MoCA is validated for identifying MD and mild cognitive impairment (MCI) in a cohort of patients suspected of cognitive impairment (CI) after initial assessment in old age psychiatry. The reference standard was the consensus-based diagnoses for MD and MCI, adhering to the international criteria and using suspected patients, but without CI as comparisons (NoCI). The mean MoCA scores differ significantly between the groups: 24(SE: .59) in NoCI, 21(SE: .31) in MCI and 16,7(SE: .45) in MD (< .05). The AUC of MD against non-demented (MCI + NoCI) was 0.83(95%CI: 0.78-0.88) resulting in 90% sensitivity, 65% specificity, 50%PPV and 94%NPV at a "best" cutoff of <21 according the Youden index and respectively 0.77(95%CI: 0.69-0.85), 56%, 73%, 90%, 28% for CI (MD + MCI) against NoCI at <21. 90% of individuals with a MoCA of <21 will have CI (MD + MCI), while 94% with a MoCA of ≥21 will not have dementia. The MoCA can reduce referrals substantially (50%) by selecting who don't need further work up in a memory clinic, even if they were suspected of CI after initial assessment.