Those with active depression ( n = 23), aged <45 years ( n = 22), declining consent ( n = 3), with an unclear diagnosis ( n = 21), unable to communicate in English ( n = 2), or with resolving delirium in patients recently discharged from hospital ( n = 2), were excluded. Normal controls were recruited by convenience sampling from healthy participants, usually caregivers, without cognitive problems accompanying the patients. SMC was defined as subjective non-progressive memory complaints in patients without objective cognitive deficits or functional decline, scoring ‘poor’ or ‘fair’ on a five-point Likert scale in response to the question “how is your memory?”. Parkinson’s disease dementia (PDD) and MCI were defined by the Movement Disorder Society Guidelines, Lewy body dementia (LBD) and MCI using the third report of the LBD Consortium. FTD MCI was diagnosed clinically with reference to proposed criteria. Frontotemporal dementia (FTD) was diagnosed clinically referencing the Lund-Manchester Criteria. MCI was diagnosed using Petersen’s criteria according to the National Institute on Aging-Alzheimer’s Association workgroup diagnostic guidelines. Mild dementia was defined if assistance in complicated instrumental activities such as handling medications and finances etc. Early dementia was defined clinically as noticeable deficits with demanding organizational tasks, e.g., decreased job function (as opposed to ‘prodromal Alzheimer’s disease’, which is synonymous with ‘MCI due to Alzheimer’s disease’ and defined by biomarkers). Severity was correlated with the Reisberg FAST scale. Alzheimer’s disease and vascular type dementia were classified using the Diagnostic and Statistical Manual of Mental Disorders (4th-edition). Patients referred for investigation of memory loss were recruited from a university hospital memory clinic in Cork City, Ireland, between March 2012 and December 2014. Given this, we chose to compare the Q mci and MoCA, two “MCI specific” screening instruments, in a geriatric memory clinic population. Furthermore, little is known about the optimal cut-off scores for either instrument in patients referred to a clinic. Neither the MoCA nor the Q mci are usually compared to short screens designed specifically to detect MCI as well as dementia. It correlates with the standardized Alzheimer‘s Disease Assessment Scale-cognitive section, Clinical Dementia Rating scale and the Lawton-Brody activities of daily living scale. The Quick Mild Cognitive Impairment screen (Q mci), presented in Supplementary Material 1, is a short screening test for CI that was developed as a rapid, valid, and reliable instrument for the early detection and differential diagnosis of MCI and dementia. Recently, it has been suggested that lowering its cut-off will improve its specificity without adversely affecting its sensitivity. Its specificity at its recommended cut-off (<26) is low, between 35% and 50%, lower than that reported in the original validation cohort. It is long, taking at least 10 minutes to complete, and its subtest scores are criticized for having low accuracy when predicting impairment in their respective cognitive domains. Although the MoCA is increasingly considered the short cognitive instrument of choice, its use as a screen presents some challenges. The MoCA overcomes the high ceiling effects and educational bias associated with the MMSE, has fewer practice effects and is available in multiple formats. Normative population data are also available. The Montreal Cognitive Assessment (MoCA) is a well-established cognitive screen, highly sensitive at differentiating MCI from normal cognition and dementia and is widely validated against the most commonly used instrument, the Mini-Mental State Examination (MMSE), in multiple settings, disorders and languages. Thus, sensitive and specific instruments are required to screen for CI, particularly in busy clinical settings. Different treatment approaches are recommended depending on where patients fall on the spectrum. MCI represents a heterogeneous group of disorders of memory impairment, characterized by objective and subjective memory loss but preserved function, with variable progression to dementia. SMC are common, increase with age, and are associated with cognitive decline. Memory loss is a spectrum from subjective memory complaints (SMC), which is characterised by normal cognition on neuropsychological testing, to mild cognitive impairment (MCI) and dementia. As society ages, the prevalence of cognitive impairment (CI) is expected to rise, resulting in increased numbers of older people presenting with memory complaints.
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