Addenbrooke's Cognitive Examination-Revised is accurate for detecting dementia in Parkinson's disease patients with low educational level

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.ObjectiveTo 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.MethodsPatients 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.ResultsWe 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].ConclusionACE-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.

Screening of cognitive impairment in patients with Parkinson's disease: diagnostic validity of the Brazilian versions of the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised

“…The cut-off scores and accuracy observed in our sample were very similar to those observed in other studies using theses scales in the general Brazilian population 15,16,18,25 . The practical importance to study alternative short global scales to evaluate cognition in patients with PD is due to the general impression that the MMSE, the most commonly used instrument worldwide to evaluate cognition in patients with PD, does not provide sufficient accuracy for the detection of dementia or MCI in these patients 2,10 .…”

“…The Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) are other brief global cognitive instruments that have been used to evaluate cognition in general population and in patients with PD 3,4 . Many studies reported that these scales can be useful and may be better than the MMSE to detect cognitive impairment in patients with PD 2,5,6,7,8,9,10,11,12,13,14,15 . In Brazil, the MoCA and ACE-R have been translated and adapted for clinical use, but their diagnostic validity in Brazilian clinical settings still remains uncertain 16,17,18,19 .…”

“…Besides, only one of them have evaluated patients with PD 15 . Therefore, we aimed in this study to assess the discriminant validity of the MoCA and ACE-R measures to detect MCI and dementia in Brazilian patients with PD in comparison to established diagnostic criteria and a gold standard neuropsychological test battery.…”

Uso da Addenbrooke&#39;s Cognitive Examination III (ACE-III) em pacientes com doença de Parkinson idiopática

“…Esta bateria apresenta uma boa sensibilidade para detecção de demência (Larner, 2007;Hsieh et al, 2008;Komadina et al, 2011;Terpening et al, 2011). Estudos usando ACE-R para detecção de demência em pacientes com DP encontraram pontuações de corte variáveis, mas apresentaram uma boa acurácia diagnóstica (Rocha et al, 2014;Berankova et al, 2015;Sobreira et al, 2015). Em geral, a acurácia foi julgada superior àquela encontrada com a aplicação do MEEM.…”

Validade de critério, estabilidade e aplicabilidade de um sistema de realidade virtual imersiva para avaliar a orientação egocêntrica de idosos com e sem comprometimento cognitivo leve

“…Addenbrooke (ACE-R)O rastreio cognitivo foi realizado por meio do Exame Cognitivo de Addenbrooke (ACE-R), validado em português, que avalia os domínios de orientação, atenção, memória, fluência verbal, linguagem e habilidade visuoespacial66 (ANEXO B).O ACE-R incorpora todos os itens do Mini Exame do Estado Mental (MEEM)70 , porém considerado quase três vezes mais eficaz na detecção e diferenciação da demência61 . O teste foi desenvolvido e revisado para fornecer um breve teste sensível aos estágios iniciais, sendo também eficaz para diferenciar subtipos de demência, como a Doença de Alzheimer71 . Este teste pode ser administrado rapidamente e é facilmente pontuado (15 a 20 minutos), onde o maior escore possível é de 100 pontos, distribuídos da seguinte forma: atenção e orientação (18), memória (26), fluência verbal (14), idioma (26) e capacidade visuoespacial (16) 72 .…”