Validación de la versión española del Mini-Addenbrooke's Cognitive Examination para el cribado de demencias

Validity and reliability of the Persian version of Mini-Addenbrooke's Cognitive Examination among Iranian highly educated older adults

BACKGROUND

Limited studies have examined psychometric properties of dementia screening tools in university-educated older adults. We aimed to examine this population's diagnostic accuracy of the Iranian version of Mini-Addenbrooke's Cognitive Examination (M-ACE).

MATERIALS & METHODS

Eighty-seven participants with over 60 years with university education were divided into three groups: Major neurocognitive disorder, mild neurocognitive disorder, and healthy control. The Iranian version of M-ACE, the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), the Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale and Diagnostic and Statistical Manual of Mental Disorders 5th edition-Text Revision (DSM-5) were used.

RESULTS

A high internal reliability of questionnaire was confirmed by Cronbach's alpha coefficient. One-way ANOVA and post hoc analysis confirmed a significant difference between study groups. The scores of M-ACE were found to have a high positive correlation with MMSE, IADL, ADL, and a moderate correlation with GDS. The optimal cutoff score of M-ACE to screen for mild and major neurocognitive disorders were 27.5 and 20.5, respectively.

CONCLUSION

The M-ACE was a concise and reliable tool used to identify neurocognitive disorders in highly educated older adults, but they should be evaluated at a higher traditional cut score in earlier stages.

Utility of Chinese Versions of Addenbrooke’s Cognitive Examination: A Narrative Review

Addenbrooke’s cognitive examination (ACE) is a cognitive screening tool that has developed through three stages: ACE, ACE-Revised (ACE-R), and ACE-Ⅲ. In addition, mini-Addenbrooke’s Cognitive Examination (M-ACE) and ACE mobile are the additional versions that is derived from ACE-III. ACE and its related versions show better performance than Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in detecting mild cognitive impairment in different neurological disorders. It has been translated into numerous languages, including Chinese. Through reviewing the history, validity, and comparison with other cognitive tests of Chinese versions of ACE, it aims to facilitate the clinical and scientific use, further development, improvement, and validation of Chinese versions of ACE in various neurological disorders and ultimately promote early identification and management of cognitive impairment in China.

Applying ACE-III, M-ACE and MMSE to Diagnostic Screening Assessment of Cognitive Functions within the Polish Population

The research aims to compare the accuracy of the mini-mental state examination (MMSE), the Addenbrooke's cognitive examination III (ACE-III) and the mini-Addenbrooke's cognitive examination (M-ACE) within the Polish population. The model comprised several stages: the features of each test were compared; the shifts in result categorisations between the norm and below the norm were analysed; a third category-mild cognitive impairment (MCI)-was included. Additionally, particular ACE-III domains that scored below domain-specific norm thresholds were analysed to establish the potential early predictors of dementia. All tests correlated to a high and very high degree-cf. MMSE and ACE-III (r = 0.817; p < 0.001), MMSE and M-ACE (r = 0.753; p < 0.001), ACE-III and M-ACE (r = 0.942; p < 0.001). The area under the ROC curve for the ACE-III diagnostic variable had a high value (AUC = 0.920 ± 0.014). A cut-off point of 81 points was suggested for ACE-III; the M-ACE diagnostic variable had an equally high value (AUC = 0.891 ± 0.017). A cut-off point of 20 points was suggested. A significant decrease in the mean score values for people who scored norm or below the norm under ACE-III, as compared to the MMSE results for norm (p < 0.0001), occurred for speech fluency (which decreased by 26.4%). The tests in question are characterised by high sensitivity and specificity. Targeted ACE-III seems best recommended for use in specialised diagnostic centres, whereas M-ACE appears to be a better suited diagnostic alternative for primary health care centres in comparison to MMSE.

Normative data of the Portuguese version of the Mini-Addenbrooke's Cognitive Examination

Introduction:

Mini-Addenbrooke's Cognitive Examination (M-ACE) is a screening neurocognitive test with diagnostic accuracy for mild cognitive impairment and dementia. The present study aims to determine the construct validity, concurrent and divergent validity and to determine the normative equation for the Portuguese version of M-ACE.

Method:

The sample is composed by 130 participants without any subjective complaint of memory loss and completely independent in daily life activities, recruited in health units, day care centers and religious and civic associations, from several districts of Portugal. The ACE-III, from which the M-ACE was extracted, and the Geriatric Depression Scale (GDS) were administered to all participants.

Results:

Reliability is considered good (α = 0.844) and the item-total correlations of the M-ACE were highly significant. M-ACE showed a positive correlation with ACE-III and a negative correlation with GDS. Schooling and age were the only variables related to M-ACE performance. The obtained model from the multiple regression was significant. A normative equation was extracted from this model.

Conclusions:

The Portuguese version of M-ACE has solid psychometric properties enabling its clinical use. The availability of M-ACE normative equation based on a healthy sample according to age and education enables the use of a brief screening tool for cognitive functioning. M-ACE does not require formal specialized training, it is a quick test which can be an advantage, for instance, in primary health care consultations.

Mini-Addenbrooke's Cognitive Examination (MACE): a Useful Cognitive Screening Instrument in Older People?

Background

The Mini-Addenbrooke’s Cognitive Examination (MACE) is a recently described brief cognitive screening instrument.

Objective

To examine the test accuracy of MACE for the identification of dementia and mild cognitive impairment (MCI) in a cohort of older patients assessed in a neurology-led dedicated cognitive disorders clinic.

Methods

Cross-sectional assessment of consecutive patients with MACE was performed independent of the reference standard diagnosis based on clinical interview of patient and, where possible, informant and structural brain imaging, and applying standard clinical diagnostic criteria for dementia and MCI. Various test accuracy metrics were examined at two MACE cut-offs ( ≤ 25/30 and ≤ 21/30), comparing the whole patient cohort with those aged ≥ 65 or ≥ 75 years, hence at different disease prevalences.

Results

Dependent upon the chosen cut-off, MACE was either very sensitive or very specific for the identification of any cognitive impairment in the older patient cohorts with increased disease prevalence. However, at both cut-offs the positive predictive values and post-test odds increased in the older patient cohorts. At the more sensitive cut-off, improvements in some new unitary test metrics were also seen.

Conclusion

MACE is a valid instrument for identification of cognitive impairment in older people. Test accuracy metrics may differ with disease prevalence.

A Validation Study of the Chinese Version of the Mini-Addenbrooke's Cognitive Examination for Screening Mild Cognitive Impairment and Mild Dementia

BACKGROUND/AIMS

There are limited cognitive screening tests for the Chinese-speaking population. This study aimed to validate the Chinese version of the Mini-Addenbrooke's Cognitive Examination (M-ACE) for detecting mild cognitive impairment (MCI) and mild dementia. Its diagnostic accuracy was compared with that of Mini-Mental State Examination (MMSE). The study also evaluated the influential factors of M-ACE scores and its convergent validity against Clinical Dementia Rating Scale (CDR) and MMSE.

METHOD

One hundred sixty-nine participants were classified into 3 groups: mild dementia, MCI, and healthy control. Mini-Mental State Examination and M-ACE were administered by researchers who were blinded to the clinical grouping. Receiver operating characteristic curves were graphed to test the diagnostic accuracy.

RESULTS

Mini-Addenbrooke's Cognitive Examination scores had good convergent validity against CDR and MMSE. Years of education ( r = 0.4, P < .001) yielded significant impacts on M-ACE scores. The optimal cutoff score of M-ACE to detect MCI was 25/26 (sensitivity = 0.88; specificity = 0.72) with an area under curve (AUC) significantly higher than MMSE (0.86 vs 0.72). The optimal cutoff score of M-ACE to screen mild dementia (21/22) yielded satisfactory sensitivity (0.96) and specificity (0.87) with a comparable AUC to MMSE (0.96 vs 0.94).

CONCLUSIONS

Mini-Addenbrooke's Cognitive Examination was a brief and reliable tool to detect MCI and mild dementia in the Chinese-speaking population significantly superior to MMSE when detecting MCI.

Diagnostic accuracy of the Thai version of the Mini-Addenbrooke's Cognitive Examination as a mild cognitive impairment and dementia screening test

AIM

To examine the diagnostic accuracy of the Thai version of the Mini-Addenbrooke's Cognitive Examination (MACE-T) for detecting mild cognitive impairment and dementia.

METHODS

Participants consisted of 60 controls, 40 people with mild cognitive impairment (MCI) and 48 people with dementia. All participants completed the Thai version of the Addenbrooke's Cognitive Examination - III (ACE-T) and the MACE-T scores were obtained from items within the ACE-T.

RESULTS

A cut-off score of 21/22 detected MCI with a sensitivity of 95% (95% confidence interval (CI): 86.1-100) and specificity of 85% (95% CI: 77.8-93.4). A cut-off score of 16/17 detected dementia with a sensitivity and specificity of 95.8% (95% CI: 88.2-100) and 85% (95% CI: 76.4-89.7), respectively. Using Bayes theorem, the MACE-T demonstrated high negative predictive values (> 94%) for diagnosing MCI and dementia, independent of their prevalence rates. Education was the only significant predictor of performance in the MACE-T.

CONCLUSION

The MACE-T is a good short cognitive screening test with high diagnostic accuracy for screening for MCI and dementia.

MACE for Diagnosis of Dementia and MCI: Examining Cut-Offs and Predictive Values

The definition of test cut-offs is a critical determinant of many paired and unitary measures of diagnostic or screening test accuracy, such as sensitivity and specificity, positive and negative predictive values, and correct classification accuracy. Revision of test cut-offs from those defined in index studies is frowned upon as a potential source of bias, seemingly accepting any biases present in the index study, for example related to sample bias. Data from a large pragmatic test accuracy study examining the Mini-Addenbrooke's Cognitive Examination (MACE) were interrogated to determine optimal test cut-offs for the diagnosis of dementia and mild cognitive impairment (MCI) using either the maximal Youden index or the maximal correct classification accuracy. Receiver operating characteristic (ROC) and precision recall (PR) curves for dementia and MCI were also plotted, and MACE predictive values across a range of disease prevalences were calculated. Optimal cut-offs were found to be a point lower than those defined in the index study. MACE had good metrics for the area under the ROC curve and for the effect size (Cohen's d) for both dementia and MCI diagnosis, but PR curves suggested the superiority for MCI diagnosis. MACE had high negative predictive value at all prevalences, suggesting that a MACE test score above either cut-off excludes dementia and MCI in any setting.

The Mini-Addenbrooke's Cognitive Examination (M-ACE) as a brief cognitive screening instrument in Mild Cognitive Impairment and mild Alzheimer's disease

The Mini-Addenbrooke's Cognitive Examination (M-ACE) is a brief cognitive screening test that evaluates four main cognitive domains (orientation, memory, language and visuospatial function) with a maximum score of 30 points and administration time of five minutes.

Objective

To assess the performance of healthy elderly, MCI patients and mild AD patients using the Brazilian version of the M-ACE.

Methods

The test was applied to a group of 36 Mild Cognitive Impairment (MCI), 23 mild Alzheimer's Disease (AD) and 25 cognitive healthy elderly. All participants were aged ≥60 years.

Results

The M-ACE displayed high internal consistency (Cronbach alpha >0.8; 95% CI 0.7-0.8) and proved effective for differentiating the AD group from MCI and control groups, providing superior accuracy than the MMSE (the cut-off point of 20 points had the highest sensitivity and specificity - 95.6% and 90.16% respectively, with a high area under the curve - AUC=0.8; 95% CI 0.7-0.9). Performance on the M-ACE was strongly correlated with that of the MMSE and Functional Activities Questionnaire (FAQ). The M-ACE was not accurate in discriminating MCI from control subjects.

Conclusion

The M-ACE is a brief screening test which provided high accuracy for diagnosing AD in this sample. The suggested cut-off point in this study was 20 points for AD.

Comparative Diagnostic Accuracy of the ACE-III, MIS, MMSE, MoCA, and RUDAS for Screening of Alzheimer Disease

BACKGROUND

Our aim was to evaluate and compare the diagnostic properties of 5 screening tests for the diagnosis of mild Alzheimer disease (AD).

METHODS

We conducted a prospective and cross-sectional study of 92 patients with mild AD and of 68 healthy controls from our Department of Neurology. The diagnostic properties of the following tests were compared: Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination III (ACE-III), Memory Impairment Screen (MIS), Montreal Cognitive Assessment (MoCA), and Rowland Universal Dementia Assessment Scale (RUDAS).

RESULTS

All tests yielded high diagnostic accuracy, with the ACE-III achieving the best diagnostic properties. The area under the curve was 0.897 for the ACE-III, 0.889 for the RUDAS, 0.874 for the MMSE, 0.866 for the MIS, and 0.856 for the MoCA. The Mini-ACE score from the ACE-III showed the highest diagnostic capacity (area under the curve 0.939). Memory scores of the ACE-III and of the RUDAS showed a better diagnostic accuracy than those of the MMSE and of the MoCA. All tests, especially the ACE-III, conveyed a higher diagnostic accuracy in patients with full primary education than in the less educated group. Implementing normative data improved the diagnostic accuracy of the ACE-III but not that of the other tests.

CONCLUSIONS

The ACE-III achieved the highest diagnostic accuracy. This better discrimination was more evident in the more educated group.

MACE versus MoCA: equivalence or superiority? Pragmatic diagnostic test accuracy study

BACKGROUND

The Mini-Addenbrooke's Cognitive Examination (MACE) is a new brief cognitive screening instrument for dementia and mild cognitive impairment (MCI). Historical data suggest that MACE may be comparable to the Montreal Cognitive Assessment (MoCA), a well-established cognitive screening instrument, in secondary care settings, but no head-to-head study has been reported hitherto.

METHODS

A pragmatic diagnostic accuracy study of MACE and MoCA was undertaken in consecutive patients referred over the course of one year to a neurology-led Cognitive Function Clinic, comparing their performance for the diagnosis of dementia and MCI using various test metrics.

RESULTS

In a cohort of 260 patients with dementia and MCI prevalence of 17% and 29%, respectively, both MACE and MoCA were quick and easy to use and acceptable to patients. Both tests had high sensitivity (>0.9) and large effect sizes (Cohen's d) for diagnosis of both dementia and MCI but low specificity and positive predictive values. Area under the receiver operating characteristic curve was excellent for dementia diagnosis (both >0.9) but less good for MCI (MoCA good and MACE fair). In contrast, weighted comparison suggested test equivalence for dementia diagnosis but with a slight net benefit for MACE for MCI diagnosis.

CONCLUSIONS

MACE is an acceptable and accurate test for the assessment of cognitive problems, with performance comparable to MoCA. MACE appears to be a viable alternative to MoCA for testing patients with cognitive complaints in a secondary care setting.