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Oyarzún-González X, Abner EL, Toro P, Ferreccio C. Prevalence and Factors Associated with Subjective Memory Complaint in a Semi-Rural Community in Chile. J Alzheimers Dis 2023; 95:1221-1231. [PMID: 37661887 PMCID: PMC10964110 DOI: 10.3233/jad-230541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND Subjective memory complaints (SMC) are commonly studied in older adults and have been identified as potentially prodromal to dementia and Alzheimer's disease. Studies among younger adults from South America are lacking. OBJECTIVE To estimate the prevalence of SMC and the factors associated with it among Maule Cohort (MAUCO) participants. METHODS We performed a cross-sectional analysis to estimate the prevalence of SMC and investigated its associated factors from MAUCO baseline data (N = 6,687). Within groups defined by age (38-59, 60-74) and global cognition (Mini-Mental State Examination: ≥26, 25-22, ≤21), multinomial logistic regression models evaluated risk factors for SMC (Yes, Sometimes, No). RESULTS Overall, SMC prevalence was 16.4%; 15.9% (95% CI 14.9-16.9%) among younger and 17.6% (15.8-19.4%) among older participants. Female sex, comorbidities, and bad/fair self-reported health status (SRHS) were generally associated with higher odds of SMC. CONCLUSION Overall prevalence of SMC was 16%. Different factors were associated with the odds of SMC depending on age and global cognitive status. Future SMC studies should include sex-specific assessments, evaluate SRHS as a moderator of SMC reporting, and the influence of the SARS-CoV-2 pandemic on SMC reporting.
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Affiliation(s)
- Ximena Oyarzún-González
- Dr. Donneyong’s Laboratory, Division of Outcomes and Translational Sciences, College of Pharmacy, The Ohio State University
- Advanced Center for Chronic Diseases, ACCDiS
| | - Erin L. Abner
- Sanders-Brown Center on Aging and Alzheimer’s Disease Center, University of Kentucky, Lexington, KY, USA
- Department of Epidemiology and Environmental Health, College of Public Health, University of Kentucky, Lexington, KY, USA
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Pablo Toro
- Advanced Center for Chronic Diseases, ACCDiS
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases, ACCDiS
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Prats‐Sedano MA, Savulich G, Surendranathan A, Donaghy PC, Thomas AJ, Rowe JB, Su L, O'Brien JT. The revised Addenbrooke's Cognitive Examination can facilitate differentiation of dementia with Lewy bodies from Alzheimer's disease. Int J Geriatr Psychiatry 2021; 36:831-838. [PMID: 33275793 PMCID: PMC8247047 DOI: 10.1002/gps.5483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/20/2020] [Accepted: 11/29/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Dementia with Lewy bodies (DLB) is a major cause of degenerative dementia, yet the diagnosis is often missed or mistaken for Alzheimer's disease (AD). We assessed whether the revised Addenbrooke's Cognitive Examination (ACE-R), a brief test for dementia, differentiates DLB from AD. METHODS We first compared baseline ACE-R performance in 76 individuals with DLB, 40 individuals with AD and 66 healthy controls. We then investigated the diagnostic accuracy of a simple standardised 'memory/visuospatial' ratio calculated from the ACE-R subscores. Finally, as a comparison a logistic regression machine learning algorithm was trained to classify between DLB and AD. RESULTS Individuals with AD had poorer memory (p = 0.001) and individuals with DLB had poorer visuospatial function (p = 0.005). Receiver operating characteristics curves confirmed that the ACE-R total score could differentiate dementia from non-dementia cases with 98% accuracy, but could not discriminate between dementia types (50%, or chance-level accuracy). However, a 'memory/visuospatial' ratio ≥1.1 differentiated DLB from AD with 82% sensitivity, 68% specificity and 77% mean accuracy. The machine learning classifier did not improve the overall diagnostic accuracy (74%) of the simple ACE-R subscores ratio. CONCLUSIONS The ACE-R-based 'memory/visuospatial' ratio, but not total score, demonstrates good clinical utility for the differential diagnosis of DLB from AD.
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Affiliation(s)
| | - George Savulich
- Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | | | - Paul C. Donaghy
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Alan J. Thomas
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - James B. Rowe
- Department of Clinical NeurosciencesSchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Li Su
- Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - John T. O'Brien
- Department of PsychiatrySchool of Clinical MedicineUniversity of CambridgeCambridgeUK
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Creavin ST, Wisniewski S, Noel‐Storr AH, Trevelyan CM, Hampton T, Rayment D, Thom VM, Nash KJE, Elhamoui H, Milligan R, Patel AS, Tsivos DV, Wing T, Phillips E, Kellman SM, Shackleton HL, Singleton GF, Neale BE, Watton ME, Cullum S. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev 2016; 2016:CD011145. [PMID: 26760674 PMCID: PMC8812342 DOI: 10.1002/14651858.cd011145.pub2] [Citation(s) in RCA: 320] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Mini Mental State Examination (MMSE) is a cognitive test that is commonly used as part of the evaluation for possible dementia. OBJECTIVES To determine the diagnostic accuracy of the Mini-Mental State Examination (MMSE) at various cut points for dementia in people aged 65 years and over in community and primary care settings who had not undergone prior testing for dementia. SEARCH METHODS We searched the specialised register of the Cochrane Dementia and Cognitive Improvement Group, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), LILACS (BIREME), ALOIS, BIOSIS previews (Thomson Reuters Web of Science), and Web of Science Core Collection, including the Science Citation Index and the Conference Proceedings Citation Index (Thomson Reuters Web of Science). We also searched specialised sources of diagnostic test accuracy studies and reviews: MEDION (Universities of Maastricht and Leuven, www.mediondatabase.nl), DARE (Database of Abstracts of Reviews of Effects, via the Cochrane Library), HTA Database (Health Technology Assessment Database, via the Cochrane Library), and ARIF (University of Birmingham, UK, www.arif.bham.ac.uk). We attempted to locate possibly relevant but unpublished data by contacting researchers in this field. We first performed the searches in November 2012 and then fully updated them in May 2014. We did not apply any language or date restrictions to the electronic searches, and we did not use any methodological filters as a method to restrict the search overall. SELECTION CRITERIA We included studies that compared the 11-item (maximum score 30) MMSE test (at any cut point) in people who had not undergone prior testing versus a commonly accepted clinical reference standard for all-cause dementia and subtypes (Alzheimer disease dementia, Lewy body dementia, vascular dementia, frontotemporal dementia). Clinical diagnosis included all-cause (unspecified) dementia, as defined by any version of the Diagnostic and Statistical Manual of Mental Disorders (DSM); International Classification of Diseases (ICD) and the Clinical Dementia Rating. DATA COLLECTION AND ANALYSIS At least three authors screened all citations.Two authors handled data extraction and quality assessment. We performed meta-analysis using the hierarchical summary receiver-operator curves (HSROC) method and the bivariate method. MAIN RESULTS We retrieved 24,310 citations after removal of duplicates. We reviewed the full text of 317 full-text articles and finally included 70 records, referring to 48 studies, in our synthesis. We were able to perform meta-analysis on 28 studies in the community setting (44 articles) and on 6 studies in primary care (8 articles), but we could not extract usable 2 x 2 data for the remaining 14 community studies, which we did not include in the meta-analysis. All of the studies in the community were in asymptomatic people, whereas two of the six studies in primary care were conducted in people who had symptoms of possible dementia. We judged two studies to be at high risk of bias in the patient selection domain, three studies to be at high risk of bias in the index test domain and nine studies to be at high risk of bias regarding flow and timing. We assessed most studies as being applicable to the review question though we had concerns about selection of participants in six studies and target condition in one study.The accuracy of the MMSE for diagnosing dementia was reported at 18 cut points in the community (MMSE score 10, 14-30 inclusive) and 10 cut points in primary care (MMSE score 17-26 inclusive). The total number of participants in studies included in the meta-analyses ranged from 37 to 2727, median 314 (interquartile range (IQR) 160 to 647). In the community, the pooled accuracy at a cut point of 24 (15 studies) was sensitivity 0.85 (95% confidence interval (CI) 0.74 to 0.92), specificity 0.90 (95% CI 0.82 to 0.95); at a cut point of 25 (10 studies), sensitivity 0.87 (95% CI 0.78 to 0.93), specificity 0.82 (95% CI 0.65 to 0.92); and in seven studies that adjusted accuracy estimates for level of education, sensitivity 0.97 (95% CI 0.83 to 1.00), specificity 0.70 (95% CI 0.50 to 0.85). There was insufficient data to evaluate the accuracy of the MMSE for diagnosing dementia subtypes.We could not estimate summary diagnostic accuracy in primary care due to insufficient data. AUTHORS' CONCLUSIONS The MMSE contributes to a diagnosis of dementia in low prevalence settings, but should not be used in isolation to confirm or exclude disease. We recommend that future work evaluates the diagnostic accuracy of tests in the context of the diagnostic pathway experienced by the patient and that investigators report how undergoing the MMSE changes patient-relevant outcomes.
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Affiliation(s)
- Sam T Creavin
- University of BristolSchool of Social and Community MedicineCarynge Hall39 Whatley RoadBristolUKBS8 2PS
| | - Susanna Wisniewski
- Cochrane Dementia and Cognitive Improvement Group, Oxford UniversityOxfordUK
| | - Anna H Noel‐Storr
- University of OxfordRadcliffe Department of MedicineRoom 4401c (4th Floor)John Radcliffe Hospital, HeadingtonOxfordUKOX3 9DU
| | - Clare M Trevelyan
- Avon and Wiltshire Mental Health Partnership NHS TrustMedical EducationWoodland View, Brentry LaneBristolUKBS10 6NB
| | - Thomas Hampton
- Frimley Health NHS Foundation TrustENTFrimley Park HospitalPortsmouth RoadFrimley, CamberleySurreyUKGU16 7UJ
| | - Dane Rayment
- Avon and Wiltshire Partnership NHS TrustOlder Adult PsychiatryJenner House, Langley ParkChippenhamWiltshireUKSN15 1GG
| | - Victoria M Thom
- Avon & Wiltshire Mental Health Partnership NHS TrustForensic PsychiatryFromeside, Blackberry Hill HospitalBristolUKBS16 1EG
| | | | - Hosam Elhamoui
- Somerset Partnership NHS TrustPsychiatry91 Comeytrowe LaneTauntonSomersetUKTA1 5QG
| | - Rowena Milligan
- Mansion House SurgeryGeneral PracticeAbbey StreetStoneStaffordshireUKST15 0WA
| | - Anish S Patel
- Avon and Wiltshire Mental Health Partnership NHS TrustNBT Acute Mental Health Liaison TeamDonal Early HouseSouthmead HospitalBristolUKBS10 5NB
| | - Demitra V Tsivos
- North Bristol NHS TrustNeuropsychologySouthmead HospitalBristolUKBS10 5NB
| | - Tracey Wing
- Taunton and Somerset NHS trustCare of Elderly/ITU/A+EBristolUKBS1 3DH
| | - Emma Phillips
- 2gether NHS Foundation TrustCharlton Lane HospitalCheltenhamGloucestershireUKGL53 9DZ
| | - Sophie M Kellman
- Avon and Wiltshire Mental Health Partnership NHS TrustJenner House, Langley ParkChippenhamWiltshireUKSN15 1GG
| | - Hannah L Shackleton
- NHS ScotlandNHS Forth ValleyFalkirk Community Hospital, Majors LoanFalkirkUK
| | | | - Bethany E Neale
- RCGP Severn FacultyGeneral PracticeDeanery HouseBristolUKBA16 1GW
| | | | - Sarah Cullum
- University of BristolSchool of Social and Community MedicineCarynge Hall39 Whatley RoadBristolUKBS8 2PS
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Siciliano M, Raimo S, Tufano D, Basile G, Grossi D, Santangelo F, Trojano L, Santangelo G. The Addenbrooke's Cognitive Examination Revised (ACE-R) and its sub-scores: normative values in an Italian population sample. Neurol Sci 2015; 37:385-92. [PMID: 26563847 DOI: 10.1007/s10072-015-2410-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022]
Abstract
The Addenbrooke's Cognitive Examination Revised (ACE-R) is a rapid screening battery, including five sub-scales to explore different cognitive domains: attention/orientation, memory, fluency, language and visuospatial. ACE-R is considered useful in discriminating cognitively normal subjects from patients with mild dementia. The aim of present study was to provide normative values for ACE-R total score and sub-scale scores in a large sample of Italian healthy subjects. Five hundred twenty-six Italian healthy subjects (282 women and 246 men) of different ages (age range 20-93 years) and educational level (from primary school to university) underwent ACE-R and Montreal Cognitive Assessment (MoCA). Multiple linear regression analysis revealed that age and education significantly influenced performance on ACE-R total score and sub-scale scores. A significant effect of gender was found only in sub-scale attention/orientation. From the derived linear equation, a correction grid for raw scores was built. Inferential cut-offs score were estimated using a non-parametric technique and equivalent scores (ES) were computed. Correlation analysis showed a good significant correlation between ACE-R adjusted scores with MoCA adjusted scores (r = 0.612, p < 0.001). The present study provided normative data for the ACE-R in an Italian population useful for both clinical and research purposes.
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Affiliation(s)
- Mattia Siciliano
- Department of Psychology, Second University of Naples, Caserta, Italy
| | - Simona Raimo
- Department of Psychology, Second University of Naples, Caserta, Italy
| | - Dario Tufano
- Department of Psychology, Second University of Naples, Caserta, Italy
| | - Giuseppe Basile
- Department of Psychology, Second University of Naples, Caserta, Italy
| | - Dario Grossi
- Department of Psychology, Second University of Naples, Caserta, Italy
| | - Franco Santangelo
- Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University "Federico II", Naples, Italy
| | - Luigi Trojano
- Department of Psychology, Second University of Naples, Caserta, Italy. .,Salvatore Maugeri Foundation, Scientific Institute of Telese, Telese Terme, BN, Italy.
| | - Gabriella Santangelo
- Department of Psychology, Second University of Naples, Caserta, Italy. .,IDC-Hermitage-Capodimonte, Naples, Italy.
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The use of the Addenbrooke's Cognitive Examination in a community memory clinic. Int Psychogeriatr 2015; 27:167-8. [PMID: 25062535 DOI: 10.1017/s1041610214001525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Early diagnosis of dementia enables early intervention and gives people the opportunity to make choices and plan for their future. Such an early diagnosis requires accurate assessment. A clinical assessment in people with suspected dementia in a memory clinic setting should include a clinical interview of the patient and their next of kin, a physical and neurological examination, cognitive assessment with appropriate cognitive tests, blood investigations, ECG (electrocardiography), and brain imaging.
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Rocha MSG, Bassetti EM, Oliveira MO, Kuark RGB, Estevam NM, Brucki SMD. Addenbrooke's Cognitive Examination-Revised is accurate for detecting dementia in Parkinson's disease patients with low educational level. Dement Neuropsychol 2014; 8:20-25. [PMID: 29213875 PMCID: PMC5619444 DOI: 10.1590/s1980-57642014dn81000004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 01/06/2014] [Indexed: 11/21/2022] Open
Abstract
Diagnosis of Parkinson's disease dementia is a challenge in clinical settings. A comprehensive neuropsychological evaluation is time-consuming and expensive; brief instruments for cognitive evaluation must be easier to administer and provide a reliable classification. OBJECTIVE To study the validity of the Brazilian version of Addenbrooke's Cognitive Examination-Revised (ACE-R) for the cognitive assessment of Parkinson's disease (PD) patients with heterogeneous educational level. METHODS Patients were evaluated according to the diagnostic procedures recommended by the Movement Disorder Society (MDS) as the gold standard for the diagnosis of dementia in PD. RESULTS We studied 70 idiopathic PD patients, with a mean (SD) age of 64.1 (9.3) years and mean disease duration of 7.7 (5.3) years and educational level of 5.9 years, matched for education and age to controls. Twenty-seven patients fulfilled MDS clinical criteria for PD dementia. Mean scores on the ACE-R were 54.7 (12.8) points for patients with PD dementia, 76 (9.9) for PD patients without dementia and 79.7 (1.8) points for healthy controls. The area under the receiver operating curve, taking the MDS diagnostic procedures as a reference, was 0.93 [95% CI, 0.87-0.98; p<0.001] for ACE-R. The optimal cut-off value for ACE-R was ≤72 points [sensitivity 90%; specificity 85%; Kappa concordance (K) 0.79]. CONCLUSION ACE-R appears to be a valid tool for dementia evaluation in PD patients with heterogeneous educational level, displaying good correlation with clinical criteria and diagnostic procedures of the MDS.
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Raimondi C, Gleichgerrcht E, Richly P, Torralva T, Roca M, Camino J, Manes F. The Spanish version of the Addenbrooke's Cognitive Examination — Revised (ACE-R) in subcortical ischemic vascular dementia. J Neurol Sci 2012; 322:228-31. [DOI: 10.1016/j.jns.2012.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 08/01/2012] [Indexed: 10/27/2022]
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Komadina NC, Terpening Z, Huang Y, Halliday GM, Naismith SL, Lewis SJG. Utility and limitations of Addenbrooke's Cognitive Examination-Revised for detecting mild cognitive impairment in Parkinson's disease. Dement Geriatr Cogn Disord 2011; 31:349-57. [PMID: 21613789 DOI: 10.1159/000328165] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To evaluate the utility of the Addenbrooke's Cognitive Examination-Revised (ACE-R) as a screening tool for mild cognitive impairment in Parkinson's disease (PD-MCI). METHODS PD patients underwent comprehensive neuropsychological and neurological evaluations and ACE-R assessment. RESULTS The ACE-R was superior to the Mini-Mental State Exam (MMSE) in detecting PD-MCI, with a cutoff score of ≤93 offering a sensitivity of 61% and a specificity of 64%. The utility of the ACE-R in detecting PD-MCI is largely influenced by the fluency sub-domain score, and has optimal discriminability when utilized in patients with lower levels of education (≤12 years of formal schooling). CONCLUSION The ACE-R must be used cautiously as a screening tool for PD-MCI, with results being most influenced by its fluency sub-domain score and patient education levels.
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Affiliation(s)
- Natalie C Komadina
- University of New South Wales and Neuroscience Research Australia, Sydney, N.S.W
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9
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Konstantinopoulou E, Kosmidis MH, Ioannidis P, Kiosseoglou G, Karacostas D, Taskos N. Adaptation of Addenbrooke’s Cognitive Examination-Revised for the Greek population. Eur J Neurol 2011; 18:442-7. [DOI: 10.1111/j.1468-1331.2010.03173.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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10
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Appels BA, Scherder E. The diagnostic accuracy of dementia-screening instruments with an administration time of 10 to 45 minutes for use in secondary care: a systematic review. Am J Alzheimers Dis Other Demen 2010; 25:301-16. [PMID: 20539025 PMCID: PMC10845578 DOI: 10.1177/1533317510367485] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Early screening for dementia is crucial for identifying reversible causes as well as managing, counseling, and other therapeutic interventions. Many reviews have compared the suitability of very brief screening instruments for use in primary care, but reviews on more extensive instruments in secondary care are scarce. In addition, results on diagnostic accuracy are often biased due to methodological shortcomings, differences in the spectrum of patients or reporting. This systematic review reports the diagnostic accuracy of dementia-screening instruments with an administration time of 10 to 45 minutes, validated in secondary care, restricted to mild dementia and validation studies of ''high quality.'' Characteristics such as cognitive domains and reliability figures are also highlighted.
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Affiliation(s)
- Bregje A Appels
- Department of Medical Psychology, Slotervaart Hospital, Amsterdam, Netherlands.
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Reyes MA, Perez-Lloret S, Lloret SP, Roldan Gerschcovich E, Gerscovich ER, Martin ME, Leiguarda R, Merello M. Addenbrooke's Cognitive Examination validation in Parkinson's disease. Eur J Neurol 2008; 16:142-7. [PMID: 19049504 DOI: 10.1111/j.1468-1331.2008.02384.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a clear need for brief, sensitive and specific cognitive screening instruments in Parkinson's disease (PD). OBJECTIVES To study Addenbrooke's Cognitive Examination (ACE) validity for cognitive assessment of PD patient's using the Mattis Dementia Rating Scale (MDRS) as reference method. A specific scale for cognitive evaluation in PD, in this instance the Scales for Outcomes of Parkinson's disease-Cognition (SCOPA-COG), as well as a general use scale the Mini-mental state examination (MMSE) were also studied for further correlation. METHODS Forty-four PD patients were studied, of these 27 were males (61%), with a mean (SD) age of 69.5 (11.8) years, mean (SD) disease duration of 7.6 (6.4) years (range 1-25), mean (SD) total Unified Parkinson's Disease Rating Scale (UPDRS) score 37 (24) points, UPDRS III 16.5 (11.3) points. MDRS, ACE and SCOPA-COG scales were administered in random order. All patients remained in on-state during the study. RESULTS Addenbrooke's Cognitive Examination correlated with SCOPA-COG (r = 0.93, P < 0.0001), and MDRS (r = 0.91 P < 0.0001) and also with MMSE (r = 0.84, P < 0.001). Area under the receiver-operating curve, taking MDRS as the reference test, was 0.97 [95% confidence interval (CI): 0.92-1.00] for ACE, 0.92 (95% CI: 0.83-1.00) for SCOPA-COG and 0.91 (95% CI: 0.83-1.00) for MMSE. Best cut-off value for ACE was 83 points [Sensitivity (Se) = 92%; Specificity (Sp) = 91%; Kappa concordance (K) = 0.79], 20 points for the SCOPA-COG (Se = 92%; Sp = 87%; K = 0.74) and 26 points for MMSE (Se = 61%; Sp = 100%; K = 0.69). CONCLUSION Addenbrooke's Cognitive Examination appears to be a valid tool for dementia evaluation in PD, with a cut-off point which should probably be set at 83 points, displaying good correlation with both the scale specifically designed for cognitive deficits in PD namely SCOPA-COG, as well as with less specific tests such as MMSE.
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Affiliation(s)
- M A Reyes
- Movement Disorders Section, Neuroscience Department and Cognitive Department, Institute for Neurological Research Raul Carrea FLENI, Buenos Aires, Argentina
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Davies RR, Dawson K, Mioshi E, Erzinçlioğlu S, Hodges JR. Differentiation of semantic dementia and Alzheimer's disease using the Addenbrooke's Cognitive Examination (ACE). Int J Geriatr Psychiatry 2008; 23:370-5. [PMID: 17768772 DOI: 10.1002/gps.1887] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Addenbrooke's Cognitive Examination (ACE) is a simple diagnostic tool bridging the gap between the very brief Mini Mental State Exam (MMSE) and much longer test batteries used by neuropsychologists which has proven extremely popular internationally. OBJECTIVE We aimed to assess the ability of the ACE to differentiate semantic dementia (SD) from Alzheimer's disease (AD). METHODS The ACE was administered to three groups: SD patients (n = 40) and two separate groups of AD patients (n = 40 in each), matched for overall ACE or MMSE score. RESULTS Significant differences were found between SD and both AD groups for the ACE sub-scores of naming, reading and orientation in time. Discriminant analysis (SD versus AD) led to the formulation of a 'semantic index' (naming plus reading minus scores for serial-7s, orientation in time and drawing). Application of the semantic index to the patient data found values of less than zero to be predictive of SD rather than AD with 88% sensitivity and 90% specificity. Validation analysis in an independent sample of 24 SD and AD patients proved even more favourable. CONCLUSIONS The overall ACE score is known to be a sensitive, and specific, indicator of early neurodegenerative dementia; this study shows that the ACE can also be used to detect SD through application of the semantic index.
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Affiliation(s)
- R Rhys Davies
- University of Cambridge, Dept. of Clinical Neurosciences, Addenbrooke's Hospital, Cambridge, UK
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Larner A. Addenbrooke's Cognitive Examination (ACE) for the diagnosis and differential diagnosis of dementia. Clin Neurol Neurosurg 2007; 109:491-4. [DOI: 10.1016/j.clineuro.2007.04.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 04/04/2007] [Accepted: 04/04/2007] [Indexed: 10/23/2022]
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Larner AJ. DemTect: 1-year experience of a neuropsychological screening test for dementia. Age Ageing 2007; 36:326-7. [PMID: 17296602 DOI: 10.1093/ageing/afl183] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Fazakerley, Liverpool, UK.
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Hancock P, Larner AJ. The diagnosis of dementia: diagnostic accuracy of an instrument measuring activities of daily living in a clinic-based population. Dement Geriatr Cogn Disord 2007; 23:133-9. [PMID: 17170525 DOI: 10.1159/000097994] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Since widely accepted definitions of dementia encompass impairments in social and occupational, as well as cognitive, function, we investigated the diagnostic accuracy of Lawton and Brody's Instrumental Activities of Daily Living (IADL) Scale as an independent test for the diagnosis of dementia. METHODS The IADL Scale was administered to consecutive referrals to 2 memory clinics over a 2-year period, independent of other tests (interview, neuropsychology, imaging) which were used to establish diagnoses according to standard diagnostic criteria, and the results were compared. RESULTS In a cohort of 296 patients, 52% adjudged to have dementia, IADL Scale scores and subscores showed low sensitivity, specificity, and positive and negative predictive values for the diagnosis of dementia. The likelihood ratios, a measure of diagnostic gain, were generally small to unimportant, and diagnostic accuracy as measured by area under the receiver operating characteristic curve was no better than 0.75. CONCLUSION IADL Scale scores are not very helpful in making a diagnosis of dementia. More sensitive scales may be required to detect dementia-related functional decline, although it is also possible that dementia syndromes may be present in the absence of functional decline, challenging accepted definitions of dementia.
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Affiliation(s)
- P Hancock
- Memory Clinic, 5 Borough Partnership NHS Trust, Brooker Centre, Halton Hospital, Runcorn, UK
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Abstract
Cases of transient global amnesia (TGA) seen by one consultant neurologist over a 4-year period (2002-2005 inclusive) were identified. Of 10 possible cases, eight fulfilled suggested diagnostic criteria. Five cases were seen as ward consultations, three in outpatient clinics; seven were seen in district general hospitals. Six of the eight cases had already been seen by hospital physicians, whose working diagnoses included stroke/TIA and epilepsy. In some cases, this had resulted in inappropriate investigation, treatment and advice. Although rare, TGA is a diagnosis both hospital physicians and general practitioners need to be aware of in order to avoid potential pitfalls. The critical importance of collateral history in reaching the diagnosis is emphasised.
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Affiliation(s)
- A J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ, UK.
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17
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Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 2006; 21:1078-85. [PMID: 16977673 DOI: 10.1002/gps.1610] [Citation(s) in RCA: 1246] [Impact Index Per Article: 69.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
UNLABELLED There is a clear need for brief, but sensitive and specific, cognitive screening instruments as evidenced by the popularity of the Addenbrooke's Cognitive Examination (ACE). OBJECTIVES We aimed to validate an improved revision (the ACE-R) which incorporates five sub-domain scores (orientation/attention, memory, verbal fluency, language and visuo-spatial). METHODS Standard tests for evaluating dementia screening tests were applied. A total of 241 subjects participated in this study (Alzheimer's disease=67, frontotemporal dementia=55, dementia of Lewy Bodies=20; mild cognitive impairment-MCI=36; controls=63). RESULTS Reliability of the ACE-R was very good (alpha coefficient=0.8). Correlation with the Clinical Dementia Scale was significant (r=-0.321, p<0.001). Two cut-offs were defined (88: sensitivity=0.94, specificity=0.89; 82: sensitivity=0.84, specificity=1.0). Likelihood ratios of dementia were generated for scores between 88 and 82: at a cut-off of 82 the likelihood of dementia is 100:1. A comparison of individual age and education matched groups of MCI, AD and controls placed the MCI group performance between controls and AD and revealed MCI patients to be impaired in areas other than memory (attention/orientation, verbal fluency and language). CONCLUSIONS The ACE-R accomplishes standards of a valid dementia screening test, sensitive to early cognitive dysfunction.
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Affiliation(s)
- Eneida Mioshi
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Department of Clinical Neurosciences, Addenbrooke's Hospital, UK
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18
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Larner AJ. Audit of the Addenbrooke's Cognitive Examination (ACE) in clinical practice: 2. longitudinal change. Int J Geriatr Psychiatry 2006; 21:698-9. [PMID: 16821254 DOI: 10.1002/gps.1543] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Larner AJ. "Frontal variant Alzheimer's disease": a reappraisal. Clin Neurol Neurosurg 2005; 108:705-8. [PMID: 16102893 DOI: 10.1016/j.clineuro.2005.07.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 06/17/2005] [Accepted: 07/07/2005] [Indexed: 11/27/2022]
Abstract
Two cases of clinically diagnosed sporadic Alzheimer's disease with early and prominent behavioural features (social disinhibition, emotional blunting, stereotyped verbal utterances) sufficient to prompt an initial diagnosis of frontotemporal dementia are presented. It is suggested that the term "frontal variant AD" be used for this clinically defined phenotype, which has also been described in cases of inherited AD associated with certain presenilin-1 gene mutations. This differs from previous usage of the term "frontal variant AD" to describe AD with predominant frontal lobe neuropathological change (although the clinical phenotype may reflect regional distribution of pathology), but parallels the clinical definition of visual agnosic, aphasic and apraxic presentations of AD. The proposed usage would also emphasise differential diagnosis.
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Affiliation(s)
- Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK.
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