We conducted this study in the outpatient clinic of the Päijät-Häme Central Hospital in Finland between March 17, 2009, and March 26, 2010. The regional ethics committee approved the study and all the patients gave written informed consent prior to enrollment. 11 - 13 The purpose of this study was to compare the MoCA in the context of prehospital screening with other cognitive tests. The results of validation studies are consistent with those of the original study. The MoCA has been translated and validated in several languages ( but not in Finnish. 11, 12 The low specificity of MoCA may result in a high rate of false positives. 10 The specificity of MoCA in dementia and MCI is 43.5% to 50% which is significantly lower than 100% of the MMSE. In the group with mild Alzheimer disease, sensitivity of 100% was reached by MoCA, whereas the MMSE detected 78%. It has a sensitivity of 90% for detection of MCI, whereas MMSE has a sensitivity of 18%. The Montreal Cognitive Assessment (MoCA) is a cognitive screening test developed by Nasreddine et al. 9 However, patients with mild cognitive impairment (MCI) often have MMSE scores within the normal range. Mini-Mental State Examination (MMSE) is fast and easy to use and remains the most commonly used cognitive screening test. Up to now, there is no single ideal screening test for cognitive impairment used in Finland. An assessment of cognitive functioning is often lacking in nursing and medical records. 7 In addition, the recovery process may be complicated if the patient is unable to remember the care instructions. 5, 6 Cognitive impairment itself is a risk factor for poorer functional outcomes following surgery. 2 - 4 Delirium, in turn, increases the risk for postoperative complications and mortality. Third, there is increased risk for postoperative delirium in patients with cognitive impairment. 1 Second, depending on the level of the cognitive impairment, the patient may have difficulty in understanding the consequences of their operation. First, cognitive impairment exposes a person to accidents. Surgery and cognitive impairment are linked in many ways.
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