The Addenbrooke’s Cognitive Examination Revised Is as Effective as the Original to Detect Dementia in a French-Speaking Population

Abstract

Introduction: This paper presents the validation of the French version of the Addenbrooke’s Cognitive Examination Revised (ACE-R). Methods: The variability of the 3 versions of the ACE-R (A, B and C), performed by the same observer, hence mainly 2 or 3 times on 119 patients showing no progression, was first calculated by Cronbach’s alpha coefficient, t test and linear regression. The alpha coefficients of the 3 versions were obtained showing that the ACE-R versions can be considered as one, and an analysis of the interobserver variability was performed by Cohen’s kappa coefficient, t test and linear regression on 12 patients. Eventually, we performed a receiver operating characteristic (ROC) analysis to compare the sensitivities and specificities to detect dementia of the ACE, the ACE-R and Mini Mental State Examination on 319 consecutive patients. Results: The ROC areas of sensitivities and specificities of the ACE and ACE-R were very similar. Two cutoffs were identified at 83/100 and 89/100 with a specificity to normality of 98.6% if the ACE-R score was ≥83 and a sensitivity to dementia of 98.4% if the ACE-R score was ≤89. Conclusion: ACE-R in French is as reliable and valid as the original version to detect dementia.

Normative Data for the Spanish Version of the Addenbrooke's Cognitive Examination III

“…However, the cutoff point was lower in a UK memory clinic with patients aged 75-85 years (81/100) [23], and even lower in our previous study in Spain (65/100) in a population with a mean age of 78 years and a mean number of years of education of 7.4 as well as different types of dementia [4]. Similar discrepancies were observed in the previous versions of the ACE [24,25,26]. In this regard, the implementation of the current norms to the sample of healthy controls and patients with mild dementia of different types used in our previous study of validation of the ACE-III [4] demonstrated an improvement of the accuracy for the discrimination between healthy and cognitively impaired individuals.…”

Cognitive Tests to Detect Dementia

“…High sensitivity corresponds to high negative predictive value and is the ideal to rule out dementia. We found considerable variation Borson et al, 34 2003 Borson et al, 35 2005 Borson et al, 36 2006 Carnero-Pardo et al, 37 2013 Fuchs et al, 38 2012 Holsinger et al, 39 2012 Kaufer et al, 40 2008 Milian et al, 41 Alexopoulos et al, 42 2010 Bastide et al, 43 2012 Carvalho et al, 44 2010 dos Santos Kawala et al, 45 2012 Fang et al, 46 2014 Konstantinopoulou et al, 47 2011 Kwak et al, 48 2010 Mioshi et al, 9 2006 Pigliautile et al, 49 2011, study 1 Pigliautile et al, 49 Dalrymple-Alford et al, 53 2010 Dong et al, 54 2012 Hu et al, 55 2013 Larner, 56 2012 Cummings-Vaughn et al, 57 2014 Luis et al, 58 2009 Martinelli et al, 59 2014 Nasreddin et al, 31 2005 Smith et al, 60 on the definitions of cutoff thresholds among the individual studies. According to our selection criteria, the most common cutoff scores for the MMSE for dementia were 23 and 24 (44.4% study cohorts), and approximately 20% of eligible cohorts used cutoff scores of 25 to 26 (range, 17-28).…”

An Investigation of the Utility of the Addenbrooke's Cognitive Examination III in the Early Detection of Dementia in Memory Clinic Patients Aged over 75 Years

“…Thus, the higher published cut-off is likely to produce higher numbers of false positives and so poorer specificity, and the optimal cut-off is likely to be lower. This may also account for the lower overall sensitivities and specificities than those reported in the index study [1]; a pattern observed in some similar ACE-R studies [8,10,11]. …”

“…Previous research [5,7,8,9,10,11,12,13,14,15,16,17,18,19] suggests that the differences in participant demographics and methodologies of this and the index study are likely to have had a significant impact. The participants' levels of education in the two studies are comparable [12.4 (2.8) vs. 12.5 (3.0) years; t = -0.205, p > 0.05] but their age in this study is significantly higher [79.7 (3.73) vs. 66.0 (6.25) years; t = -18.38, p < 0.001].…”

“…On this basis, such studies should, as others have noted [6], explore whether the published cut-offs require revision to optimise diagnostic accuracy in clinical practice. ACE-R studies that utilised such an approach have found the higher published cut-off (88) to have very poor specificity and identified lower optimal cut-offs, the latter ranging from 73 in a series of UK studies [7,8,9], to 83 in a French study [10], to 84 in an Australian study [11]. Exploration of the impact of demographic variables on ACE-III performance is also indicated.…”