The Portuguese version of Addenbrooke’s Cognitive Examination–Revised (ACE-R) in the diagnosis of subcortical vascular dementia and Alzheimer’s disease

Abstract

The aim of this study was to investigate the accuracy of the Portuguese version of Addenbrooke's Cognitive Examination-Revised (ACE-R) in detecting and differentiating early stage subcortical vascular dementia (SVD) from early stage Alzheimer's disease (AD). Ninety-two subjects (18 SVD patients, 36 AD patients, and 38 healthy controls) were assessed using the ACE-R. Between-group's differences were evaluated using the Quade's rank analysis of covariance. The diagnostic accuracy and discriminatory ability of the ACE-R were examined via receiver operating characteristic (ROC) analysis. The ACE-R was able to successfully discriminate between patients and healthy subjects. The mean ACE-R total scores differed between SVD and AD patients; there were also significant differences in attention and orientation and in memory measures between the groups. An optimal cut-off of 72/73 was found for the detection of AD (sensitivity: 97%; specificity: 92%) and SVD (sensitivity: 100%; specificity: 92%).

Cognitive screening instruments to identify vascular cognitive impairment: A systematic review

“…All the studies were conducted in an outpatient setting, where subjects were recruited by convenience or consecutive sampling from those attending geriatric medicine or neurology‐based memory clinics and dedicated referral centres (eg, a National CADASIL clinic), with additional participants including controls obtained from general practice or other community settings such as volunteer groups. Most studies were conducted in Europe (seven studies), with five in Asia, two in North America, and one in South America …”

“…Among stroke centre patients with cerebrovascular disease but without evidence of cortical infarct or haemorrhage, the highest was also in China (53.4%) . The mean age of patients with VCI across all studies ranged from 51.6 years to 75.5 years . Brookes et al included younger patients with CADASIL, an established cause of early onset cerebrovascular disease, while Goncalves et al included older outpatients attending neurology clinics in Portugal .…”

“…The mean age of patients with VCI across all studies ranged from 51.6 years to 75.5 years . Brookes et al included younger patients with CADASIL, an established cause of early onset cerebrovascular disease, while Goncalves et al included older outpatients attending neurology clinics in Portugal . Among those with VCI, the gender distribution across all studies was heterogenous, with the proportion of females ranging from as low as 3.5% to as high as 62.1% …”

“…In all, eight different types of CSIs (batteries or individuals tests, excluding subtests or combinations), used alone or in combination and some multiple times (27 when all subtests, scoring versions, and variants were counted, see Appendix), were found. These included short batteries of cognitive tests such as the MMSE (n = 4 papers), the MoCA (n = 4) and its shortened version, the MoCA Short (n = 1), the BMET (n = 3) and the Executive functioning and Memory Ratio (EMR) derived from the BMET (n = 1), the ACE‐Revised (ACE‐R) (n = 1), and the Cognitive Assessment Battery (CAB) (n = 1), which includes the following subtests: Symbol Digit Modalities Test (SDMT), immediate and delayed recall, the Boston Naming Test, the Stroop Colour Word Test, and the Clock Drawing Executive Test (CLOX) combined with cube drawing; each subtest was examined separately . The most commonly studied single‐item instrument was the CDT ( n = 5) with six different scoring systems reported: the Rouleau, Cahn, Babins and the AD Cooperative Study scoring methods, and two versions of the CLOX, ie, CLOX1 (free drawing) and CLOX2 (copying); the CDT was also combined with the MMSE and the CLOX was combined with the Cube Copying Test .…”

“…Other individual instruments included the TMT (types A and B) (n = 1), tests of delayed recall (n = 3), including the Delayed Memory Index (DMI) subtest from the Repeatable Battery for the Assessment of Neuropsychological Status Update (RBANS), and four tests of verbal fluency: the F‐A‐S Phonemic (letter) Fluency (n = 1), Categorical Fluency (n = 1), the combination of the Controlled Oral Word Association Test (COWAT) and the Rey Auditory Verbal Learning Test (RAVLT) (n = 1), and the Orthographical fluency subtest from the Taiwanese version of the FAB (n = 1) . The longest administration time was for the ACE‐R at 15 minutes and CAB at 20 minutes …”