A Comparison of the Greek ACE-III, M-ACE, ACE-R, MMSE, and ECAS in the Assessment and Identification of Alzheimer’s Disease

Abstract

Objective: This study aimed to adapt the Addenbrooke’s Cognitive Examination-III (ACE-III) and Mini-Addenbrooke’s Cognitive Examination (M-ACE) into Greek and then to examine the convergent validity against their predecessors Addenbrooke’s Cognitive Examination-Revised (ACE-R) and Mini-Mental State Examination (MMSE) in a Greek population. Moreover, a primary aim was to appraise the utility of each screen by conducting a comparison of the psychometric properties of ACE-III, M-ACE, ACE-R, MMSE, and the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis (ALS) Screen (ECAS) in detecting Alzheimer’s disease (AD). Methods: Forty patients with AD were recruited and matched with 38 controls. Bayesian Pearson’s correlation analysis was conducted to examine the convergent validity. Receiver operating characteristic curve analysis was implemented to appraise the sensitivity and specificity of the tests in detecting AD. Results: The ACE-III, M-ACE, and the ECAS scores robustly correlated with ACE-R and MMSE. The ACE-III and the ECAS-ALS Non-Specific score were the most sensitive and specific tools in detecting AD, closely followed by ECAS Total score and M-ACE. Only ECAS Total score correlated with the duration of disease. The ECAS scores were more resilient to ceiling effects than the other screens. M-ACE produced fewer ceiling effects than MMSE. Conclusion: The Greek ACE-III and M-ACE were successfully adapted and showed good convergent validity against their predecessors. They showed very good psychometric properties in detecting AD and may be considered in hectic clinical settings. ECAS Total score and ECAS-ALS Non-Specific showed comparable psychometric properties in the detection of AD and may be considered in polypathological clinics where motor impairments are common.

Validation of The Edinburgh cognitive and behavioural ALS screen (ECAS) in behavioural variant frontotemporal dementia and Alzheimer’s disease

“…Furthermore, the AD group from this previous study 6 were older than the current study (mean age of 67.19 vs. 61.18 years old respectively), and it is possible that early onset AD (<65 years of age) may have a slightly different cognitive profile from late onset. 45,46 Nevertheless, a further study which compared the Greek version of the ECAS with the ACE-III 22 found similar results to those reported here; in which both composite scores were sensitive to AD, with the posterior composite score being the most sensitive measure. Strengths of this study were its thorough investigation of the clinical validity of the ECAS with these dementia groups and the inclusion of well characterised patients (diagnoses supported by imaging, CSF, and/or genetic analysis).…”

“…In the early stages of both bvFTD and AD, deterioration typically follows a region-specific pattern with frontal lobe dysfunction beginning in the orbitofrontal cortex in bvFTD 19 ; and medial temporal and occipitoparietal regions in AD. 20,21 Recent studies have revealed that the ECAS composite score, compromising memory and visuospatial performance, was as sensitive to AD as the ACE-III 22 and was effective at differentiating ALS from AD in a Greek population. 6 This study aimed to validate the ECAS and further determine its clinical utility in detecting the cognitive and behavioural impairments in bvFTD in comparison with AD.…”

Adaptation and Validation of the Mini-Addenbrooke’s Cognitive Examination in Dementia in Arabic Speakers in Egypt

“…In addition, although our sample size was not large, it was comparable to other validation studies of the mini-ACE in dementia such as the Brazilian version (dementia = 23 and controls = 25) [20], the Thai version (dementia = 48 and controls = 60) [22] and the Greek version (dementia = 40 and controls = 38) [23]. In addition, our sample size was adequate to provide high sensitivity (92%), high specificity (95%), and high accuracy (94%) for the cutoff score calculated that was comparable to other studies.…”

“…Our optimal cutoff point was 18 out of 30, which was lower than the upper cutoff score provided by the English language version of the m-ACE (which was 25) but comparable with the lower cutoff score (which was 21) [4]. Other language versions’ cutoff scores ranged from 16 to 23 out of 30, so our cutoff score of 18 can be considered midrange: 16/30 for the Spanish version (86.7% sensitivity and 87% specificity) [19]; 20/30 for the Brazilian version (95.7% sensitivity and 90.2% specificity) [20]; 21–22/30 for the Chinese version (96% sensitivity and 87% specificity) [21]; 16–17/30 for the Thai version (95.8% sensitivity and 85% specificity) [22]; and 23/30 for the Greek version (97.4% sensitivity and 94.7% specificity) [23].…”

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

“…The M-ACE is also proven to be more sensitive and have less ceiling effect than MMSE. Studies from Japan and Greece showed that their linguistic versions of M-ACE were superior to MoCA in detecting MCI and dementia [ 59 , 68 ], but studies using the English or Chinese versions of M-ACE did not reach the same conclusion [ 39 , 69 ]. In addition, the Chinese version of M-ACE also shows comparable accuracy to the Chinese version of ACE-III (AUC 0.892 vs. 0.901) [ 39 ].…”