The objective of the study was to differentiate normal findings (NF i.e., neurocognitive results were within normal limits) from patients with mild and major NCD (labeled Mild+Major NCD in the following). In the present study, we aim to address these limitations and therefore estimate the diagnostic accuracy of the original MoCA cut-off in a sample of consecutively referred Memory Clinic outpatients (MC sample). Heterogeneous samples reflect the clinical reality more accurately as healthcare professionals face the challenge to identify truly impaired patients from a pool of individuals with a suspected neurocognitive disorder (NCD), irrespective of the underlying cause. In addition, excluding patients who are difficult to diagnose induces several forms of bias and may lead to an overestimation of diagnostic accuracy. Furthermore, in most validation studies, a rather homogenous patient sample was recruited (e.g., only patients with probable Alzheimer’s disease (AD) according to McKhann criteria, exclusion of patients with medical comorbidities), which does not reflect the clinical reality, where patient populations are typically heterogeneous, and medical comorbidities are frequent. Optimal cut-offs are likely to be sample-dependent and specific to the individual study and should therefore be validated in independent samples. Moreover, most previous authors defined “optimal cut-offs,” which aim at finding the best balance between sensitivity and specificity, as opposed to conventional cut-offs that are based on clinical standards (e.g., test performance 1–2 SD below the normative mean ). However, the psychometric properties of any screening test are not fixed characteristics, but depend on the clinical context, limiting the transferability of these cut-offs to other settings. Consequently, new cut-offs have been proposed for various patient populations and languages (see for an overview). However, while the initially proposed cut-off (25/26 points) has shown good sensitivity for mild cognitive impairment (MCI) (i.e., ≥ 83%), this cut-off was found to have a specificity of 66% or less in various different studies, implying a potentially unacceptably high number of false-positive classifications. It correlates well with extensive neuropsychological test batteries and covers most of the cognitive domains outlined in the Diagnostic and Statistical Manual, 5th Edition (DSM-5). The Montreal Cognitive Assessment (MoCA) has gained popularity for cognitive screening. In the context of clinical research, accurate cognitive assessment tools are needed for an adequate selection of participants, since erroneous inclusion or exclusion of individuals may bias study findings. Early detection of dementia is crucial for an implementation of therapeutic strategies in the earliest disease stages, and reliable cognitive screening tools play an important role in this process of identifying individuals with cognitive impairment. Using two separate cut-offs for the MoCA combined with scores in an indecisive area enhances the accuracy of cognitive screening.Ī steep increase in the prevalence of dementia is expected, associated with social, economic, and societal challenges. Scores between these two cut-offs require further examinations. Introducing two separate cut-offs increased diagnostic accuracies with 92% specificity (23/24 points) and 91% sensitivity (26/27 points). Compared to the original MoCA cut-off, the cut-off of 23/24 points had higher specificity (92% vs 63%), but lower sensitivity (65% vs 86%). ResultsĪ cut-off of 23/24 on the MoCA had better correct classification rates than the MMSE and the original MoCA cut-off. Cut-offs were identified based on (a) Youden’s index and (b) the 10th percentile of the control group. Methodsĭata were analyzed from 496 Memory Clinic outpatients (447 individuals with a neurocognitive disorder 49 with cognitive normal findings) and from 283 normal controls. We aim to revise the cut-off on the German MoCA for its use in clinical routine. The Montreal Cognitive Assessment (MoCA) has good sensitivity for mild cognitive impairment, but specificity is low when the original cut-off (25/26) is used.
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On November 19, 2022, Misha Collins announced that he was officially putting GISH events on hold for the time being, saying he needed to focus his energy elsewhere. The contest broke two additional world records in 2013: the longest safety pin chain, measuring 1,901.8 metres (6,239.5 ft), and the largest online photo album of hugs, totaling 108,121 images. In 2012, it broke its own record with 14,580 participants, representing 69 different countries. The inaugural event, categorized by Guinness World Records as a "media scavenger hunt", broke the record for the largest scavenger hunt of its kind. He hoped to use GISHWHES to encourage participants "to do good in the world". According to Collins, the primary reason for developing the competition was that he "loved the idea of thousands of people from all over the world connecting to create incredible things". He established the event's website and gave it its name, the Greatest International Scavenger Hunt the World Has Ever Seen, calling its acronym, GISHWHES, "the ugliest acronym the world has ever seen". Ĭollins enjoyed this exercise so much that he decided to create an official scavenger hunt in 2011. One successful prompt, for example, challenged fans to photograph a group of firemen wearing nothing but kale. Soon, participants began to respond to Collins's "absurd" requests. When Supernatural won the competition, Collins, partially inspired by his time at the University of Chicago as an undergraduate during which he participated in the school's annual scavenger hunt, asked his followers to send him self-addressed stamped envelopes into which he put scavenger hunt prompts written on the backs of jigsaw puzzle pieces from a puzzle depicting a rhino. Collins posted a message on Twitter, declaring that if the show won, Ollis had promised him a rhinoceros which he would share with everyone who helped by voting for the show. The competition began informally in 2010 when Holly Ollis, a publicist for Warner Bros., asked Collins to engage his audience to help Supernatural move from second place to first in the People's Choice Awards voting. The hunt also raised funds in support of several charities each year, and was affiliated with the Random Acts 501c3.Īctor Misha Collins, known for playing the angel Castiel on the American television series Supernatural, is the founder of GISHWHES. The competition held a world record for being the largest media scavenger hunt ever to take place, and several additional world records. Actor Misha Collins officially founded GISHWHES in 2011 after a publicity stunt to help the television series Supernatural (in which Collins appeared) win a People's Choice Award. Teams of five to 15 (previously nine to 15 before 2022) competitors earned points for submitting photos and videos of themselves completing prompts from a list they received at the beginning of the week. The Greatest International Scavenger Hunt the World Has Ever Seen ( GISHWHES, pronounced gish-wes) (now shortened to just "GISH") was an annual week-long competitive media scavenger hunt originally held each October or November, but more recently each August. NOTICE FOR PUBLISHERS REGARDING ONLINE PAYMENT OF PENALTY NOTICE FOR PUBLISHERS REGARDING ONLINE PAYMENT OF PENALTY (Hindi) Standard Operating Procedure (SOP) to be followed by all PIB officers with regard to Circulation Verification-reg.Įmpanelment of CA/CA firms for Circulation Audit by PIB offices-reg. Circulation Verificationįormat for Regularity Certificate for PublicationsĬircular for Circulation Verification in Delhi-NCR region Notice regarding issuance of 'Under Process Certificate' w.r.t. 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