Addenbrooke’s Cognitive Examination III (ACE-III) and mini-ACE for the detection of dementia and mild cognitive impairment

Beishon, Lucy; Batterham, Angus P; Quinn, Terry; Nelson, Christopher P.; Panerai, Ronney B.; Robinson, Thompson G.; Haunton, Victoria J.

doi:10.1002/14651858.cd013282.pub2

Cited by 39 publications

(30 citation statements)

References 59 publications

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“…People whom GPs judged as having dementia had a total ACE-III score IQR of 60–74, and those whom they judged as having MCI had a total ACE-III IQR 71–89. This compares with published ACE-III thresholds of <82 for dementia 37 and <88 for MCI, 37 and suggests that in this study, GPs are not being overly restrictive in their judgment for dementia, or liberal in their judgment for CIND.…”

Section: Discussionsupporting

confidence: 75%

Clinical judgment of GPs for the diagnosis of dementia: a diagnostic test accuracy study

et al. 2021

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BackgroundGPs often report using clinical judgement to diagnose dementia.AimInvestigate the accuracy of GPs’ clinical judgement for the diagnosis of dementia.Design & settingDiagnostic test accuracy study, recruiting from 21 practices around Bristol.MethodThe clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia.Results240 people were recruited, with a median age of 80 years (IQR 75–84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12–36 months) and the median ACE-III score was 75 (IQR 65–87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70–79 years (6.5, 95% CI 2.9–15) compared to people aged ≥80 years (3.6, 95% CI 1.7–7.6), and in women (10.4, 95% CI 3.4–31.7) compared to men (3.2, 95% CI 1.7–6.2), whereas the negative likelihood ratio was similar in all groups.ConclusionA GP clinical judgement of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people who GPs judge as not having dementia.

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Section: Discussionsupporting

confidence: 75%

Clinical judgment of GPs for the diagnosis of dementia: a diagnostic test accuracy study

et al. 2021

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“…People that GPs judged as having dementia had a total ACE-III score IQR of 60 to 74, and those that they judged as having MCI had a total ACE-III IQR 71 to 89. This compares to published ACE-III thresholds of <82 for dementia (30) and < 88 for MCI (30) and suggests that in this study GPs are not being overly restrictive in their judgement for dementia, or liberal in their judgment for CIND.…”

Section: Discussionsupporting

confidence: 51%

Clinical judgement of General Practitioners for the diagnosis of dementia: a diagnostic test accuracy study

Creavin

Haworth

Fish

et al. 2020

Preprint

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Background: The accuracy of General Practitioners' (GPs') clinical judgement for diagnosing dementia is uncertain. Aim: Investigate the accuracy of GPs' clinical judgement for the diagnosis of dementia. Design and Setting: Diagnostic test accuracy study, recruiting from 21 practices around Bristol. Method: The clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had symptoms of possible dementia. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia. Results: 240 people were recruited, with a median age of 80 years (IQR 75 to 84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12 to 36 months) and the median ACE-III score was 75 (IQR 65 to 87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70-79 years (6.5, 95% CI 2.9 to 15) compared to people aged ≥ 80 years (3.6, 95% CI 1.7 to 7.6), and in women (10.4, 95% CI 3.4 to 31.7) compared to men (3.2, 95% CI 1.7 to 6.2), whereas the negative likelihood ratio was similar in all groups. Conclusion: GP judgement is more likely to under identify rather than over identify dementia.

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“…The most recent review reports a limited literature on the accuracy of the newer versions of the test. 99 Where data are available, there is a pattern of sensitivity and specificity varying across studies and thresholds used to define test positive results, with sensitivity being higher and specificity lower for higher thresholds. These results are similar to those seen in our stroke accuracy synthesis.…”

Section: Additional Information Antihypertensive Withdrawalmentioning

confidence: 99%

European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

Quinn

Richard

Teuschl

et al. 2021

European Stroke Journal

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Introduction: The optimal management of post stroke cognitive impairment remains controversial. These joint European Stroke Organisation (ESO) and European Academy of Neurology (EAN) guidelines provide evidence-based recommendations to assist clinicians in decision making around prevention, diagnosis, treatment, and prognosis. Methods: These guidelines were developed according to ESO standard operating procedure and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and, where possible, meta-analyses of the literature, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. Results: There was limited randomised controlled trial evidence regarding single or multicomponent interventions to prevent post stroke cognitive decline. Interventions to improve lifestyle and treat vascular risk factors may have many health benefits but a beneficial effect on cognition is not proven. We found no evidence around routine cognitive screening following stroke but recognise the importance of targeted cognitive assessment. We described the accuracy of various cognitive screening tests but found no clearly superior approach to testing. There was insufficient evidence to make a recommendation for use of cholinesterase inhibitors, memantine or cognitive rehabilitation for post stroke dementia. We made a weak recommendation against using the nootropics actovegin and cerebrolysin, but quality of evidence was very low. There was limited evidence on the use of prediction tools for post stroke cognitive syndromes (cognitive impairment, dementia and delirium). The association between post stroke cognitive impairment and most acute structural brain imaging features was unclear. Conclusions: These guidelines have highlighted fundamental areas where robust evidence is lacking. Further randomised controlled trials are needed and we suggest priority areas for future research.

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Addenbrooke’s Cognitive Examination III (ACE-III) and mini-ACE for the detection of dementia and mild cognitive impairment

Abstract: Addenbrooke's Cognitive Examination III (ACE-III) and mini-ACE for the detection of dementia and mild cognitive impairment.

Cited by 39 publications

References 59 publications

Clinical judgment of GPs for the diagnosis of dementia: a diagnostic test accuracy study

Clinical judgment of GPs for the diagnosis of dementia: a diagnostic test accuracy study

Clinical judgement of General Practitioners for the diagnosis of dementia: a diagnostic test accuracy study

European Stroke Organisation and European Academy of Neurology joint guidelines on post-stroke cognitive impairment

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