Diagnostic accuracy of brief cognitive screening tools to diagnose vascular cognitive impairment in Peru

Abstract

Introduction: To evaluate the diagnostic accuracy of three brief cognitive screening (BCS) tools, Peruvian version of Addenbrooke's Cognitive Examination (ACE-Pe), of INECO Frontal Screening (IFS-Pe) and of the Mini-Mental State Examination (MMSE-Pe), for the diagnosis of vascular cognitive impairment (VCI) and its nondementia stages (VCI-ND) and vascular dementia (VD) in patients with cerebral stroke in Lima-Peru. Materials and methods:A cohort analysis to evaluate the diagnostic accuracy of three BCS for VCI.Results: Two hundred and four patients were evaluated: 61% Non-VCI, 30% VCI-ND and 9% VD. To discriminate patients with VCI from controls, the area under the curve (AUC) of ACE-Pe, IFS-Pe and MMs-Pe were 0.99 (95% confidence interval [CI] 0.98-0.99), 0.99 (95%CI 0.98-0.99) and 0.87 (95%CI 0.82-0.92), respectively. Of the three BCS, the IFS-Pe presented a larger AUC to discriminate VCI-ND from VD (AUC = 0.98 [95%CI 0.95-1]) compared to ACE-Pe (AUC = 0.84 [95%CI 0.74-0.95]) and ). The IFS-Pe presented a higher sensitivity (S), specificity (Sp), and positive (+LR) and negative likelihood ratios (−LR) (S = 96.72%, Sp = 89.47%, +LR = 9.1 and −LR = 0.03) than ACE-Pe (S = 96.72%, Sp = 63.16%, +LR = 2.62 and −LR = 0.05) and MMSE-Pe (S = 90.16%, Sp = 78.95%, +LR = 4.28 and −LR = 0.12). In the multiple regression analysis, the IFS-Pe was not affected by age, sex or years of schooling. Conclusion:The IFS-Pe has the best diagnostic accuracy for detecting VCI and discriminating between pre-dementia (VCI-ND) and dementia (VD) stages.

Thyroid Dysfunction, Vitamin B12, and Folic Acid Deficiencies Are Not Associated With Cognitive Impairment in Older Adults in Lima, Peru

“…Thus, all participants included were assigned to one of three groups based on the above evaluations and clinical consensus: SCD, MCI or dementia group. For those who had dementia, we further characterized them by sub-type of dementia including: (1) vascular dementia [defined as a cognitive syndrome caused by vascular cognitive impairment due to cerebrovascular disease with manifestations of cognitive impairment exceeding those observed in normal aging; vascular dementia is the final stage of vascular cognitive impairment ( 39 )]; (2) frontotemporal dementia ( 40 ); (3) mixed dementia [requires the existence of a typical AD and dementia related to cerebrovascular disease, as previously described ( 41 , 42 )]; (4) Dementia with Lewy bodies ( 43 ); or (5) AD (utilizing criteria published by McKhann et al ( 44 ), by evidence of progressive cognitive decline on serial evaluations based on information from informants and cognitive testing by either formal neuropsychological evaluation ( 34 ).…”