Applicability of the ACE-III and RBANS Cognitive Tests for the Detection of Alcohol-Related Brain Damage

Abstract

Background and AimsRecent investigations have highlighted the value of neuropsychological testing for the assessment and screening of Alcohol-Related Brain Damage (ARBD). The aim of the present study was to evaluate the suitability of the Addenbrooke’s Cognitive Examination (ACE-III) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for this purpose.MethodsComparing 28 participants with ARBD (11 with Korsakoff’s Syndrome and 17 with the umbrella “ARBD” diagnosis) and 30 alcohol-dependent participants without ARBD (ALs) we calculated Area Under the Curve (AUC) statistics, sensitivity and specificity values, base-rate adjusted predictive values, and likelihood ratios for both tests.ResultsHigh levels of screening accuracy were found for the total scores of both the ACE-III (AUC = 0.823, 95% CIs [0.714, 0.932], SE = 0.056; optimal cut-off ≤86: sensitivity = 82%, specificity = 73%) and RBANS (AUC = 0.846, 95% CIs [0.746, 0.947], SE = 0.052; optimal cut-off ≤83: sensitivity = 89%, specificity = 67%) at multiple cut-off points. Removing participants with a history of polysubstance from the samples (10 ALs and 1 ARBD) improved the diagnostic capabilities of the RBANS substantially (AUC = 0.915, 95% CIs [0.831, 0.999], SE = 0.043; optimal cut-off ≤85: sensitivity = 98%, specificity = 80%), while only minor improvements to the ACE-III’s accuracy were observed (AUC = 0.854, 95% CIs [0.744, 0.963], SE = 0.056; optimal cut-off ≤88: sensitivity = 85%, specificity = 75%).ConclusionOverall, both the ACE-III and RBANS are suitable tools for ARBD screening within an alcohol-dependent population, though the RBANS is the superior of the two. Clinicians using these tools for ARBD screening should be cautious of false-positive outcomes and should therefore combine them with other assessment methods (e.g., neuroimaging, clinical observations) and more detailed neuropsychological testing before reaching diagnostic decisions.

Informing the development of diagnostic criteria for differential diagnosis of alcohol-related cognitive impairment (ARCI) among heavy drinkers: A systematic scoping review

“…Three studies [ 14 , 26 , 27 ] contributed to both scoping review objectives. Eight studies [ 9 , 14 , 26 – 31 ] included participants with alcohol-related dementia or ARCI and were included in the summary of evidence addressing our primary objective relating to new or adapted diagnostic or screening criteria for ARCI. Twelve studies [ 14 , 26 , 27 , 32 – 42 ] were included in the summary of evidence addressing our secondary objective relating to cognitive assessment tools.…”

“…Eight studies [ 9 , 14 , 26 – 31 ] included participants with alcohol-related dementia or ARCI and were included in the summary of evidence addressing our primary objective relating to new or adapted diagnostic or screening criteria for ARCI. Twelve studies [ 14 , 26 , 27 , 32 – 42 ] were included in the summary of evidence addressing our secondary objective relating to cognitive assessment tools. Seven studies [ 26 , 27 , 34 , 35 , 37 , 38 , 41 ] evaluated the accuracy, validity and/or reliability of a cognitive assessment tool; two studies [ 26 , 27 ] included patients with a diagnosis of ARCI and five studies [ 34 , 35 , 37 , 38 , 41 ] with patients with a diagnosis of AUD.…”

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

“…Since then, ACE-III has become the most widely used version, having been translated into more than 33 languages [ 26 ], and it is also considered a good scale for screening cognitive impairment. ACE-III is applied in a wider field of screening cognitive dysfunction in different diseases, including mild cognitive impairment (MCI), AD, FTD, stroke, PD, alcohol-related brain damage, schizophrenia, and so on [ 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ]. The Chinese version of ACE-III was translated in 2012 [ 36 ], and its parallel versions were developed in 2018 and 2019 ( Figure 1 ).…”

“…Similar to ACE-R, aside from detecting early stages of AD, ACE-III has been used for tracking performances of cognitive domains in various neurological disorders [ 25 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 ] ( Table 2 ). Memory, rather than other cognitive domains, is more impaired in AD [ 25 ], while fluency and language are more impaired in behavioral variant frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA), respectively [ 25 ].…”

“…Memory, rather than other cognitive domains, is more impaired in AD [ 25 ], while fluency and language are more impaired in behavioral variant frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA), respectively [ 25 ]. Three domains (attention, memory, and fluency) decline in alcohol-related brain damage, and memory and visuospatial are impaired in rheumatoid arthritis [ 28 , 32 ]. The Hungarian ACE-III is able to delineate cognitive decline in PD with all five domains affected [ 31 ].…”