The Utility of the Mini-Addenbrooke’s Cognitive Examination as a Screen for Cognitive Impairment in Elderly Patients with Chronic Kidney Disease and Diabetes

Abstract

Background/Aims: We tested the utility of the Mini-Addenbrooke’s Cognitive Examination (M-ACE) in a cohort of older adults with chronic kidney disease (CKD) and diabetes. Method: The M-ACE was administered to 112 CKD and diabetes patients attending a nephrology clinic. Cognitive impairment was based upon patient, informant, and case review, neuropsychological assessment, and application of criteria for mild cognitive impairment (MCI) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition for dementia. The M-ACE was also compared to the Mini-Mental State Examination (MMSE). Results: Upon assessment, 52 patients had normal cognitive function, 33 had MCI, and 27 had dementia. The area under the receiver operating curve for the M-ACE was 0.96 (95% CI 0.95–1.00). The sensitivity and specificity for a dementia diagnosis were 0.96 and 0.84 at the cut point <25 and 0.70 and 1.00 at the cut point <21. Mean M-ACE scores differed significantly between normal, demented, and MCI groups (p < 0.001), and compared to the MMSE, the M-ACE did not suffer from ceiling effects. Conclusion: The M-ACE is an easily administered test with good sensitivity and specificity to capture and assist in the diagnosis of MCI or dementia in patients with CKD and diabetes.

A Validation Study of the Chinese Version of the Mini-Addenbrooke’s Cognitive Examination for Screening Mild Cognitive Impairment and Mild Dementia

“…Two studies further verify the utilities of M-ACE in clinical settings. 17,18 Hobson et al’s study shows that the AUC of M-ACE to detect cognitive impairment is 0.96, comparable to that of MMSE (0.95); the sensitivity (0.96) was notably high at the cut point of 25/26. 18 Larner et al’s study shows similar results.…”

“…The present study was approved by the ethics committee of Sichuan Provincial People’s Hospital. Individuals who were 60 years or older, 8,18 Chinese-speaking with reasonable vision, hearing, and the ability to communicate verbally were recruited from the Department of Neurology, Sichuan Provincial People’s Hospital, Chengdu, China, for further clinical evaluation. They could be with or without memory complaints.…”

“…Previous studies have demonstrated the satisfactory diagnostic performances of M-ACE in English and Spanish. 16 -19 There have been no validation studies of the Chinese version of M-ACE yet.…”

Decision-making for people with dementia and advanced kidney disease: a secondary qualitative analysis of interviews from the Conservative Kidney Management Assessment of Practice Patterns Study

“…Screening tools such as the Montreal Cognitive Assessment and the Mini-Addenbrookes Cognitive Examination have been validated for both dialysis and CKD patients. 38 39 Identification of early cognitive impairment may prompt clinicians to initiate ACPs before loss of decision-making capability. ACPs should be regularly revisited to ensure that treatment preferences remain appropriate in the presence of changing comorbidity, cognitive function and QoL.…”

MACE for the Diagnosis of Dementia and MCI: 3-Year Pragmatic Diagnostic Test Accuracy Study

“…A Spanish translation administered to a cohort of mixed dementia patients and controls (n = 175) with a relatively low educational experience found that a cutoff between 16/30 and 17/30 had an optimal sensitivity (0.867) and specificity (0.870) for the diagnosis of dementia [5]. In a nephrology clinic cohort of patients with chronic kidney disease and diabetes (n = 112), the sensitivity and specificity for a dementia diagnosis were 0.96 and 0.84, respectively, at the cut point < 25/30 [6]. Studies in a dedicated cognitive disorders clinic have suggested superiority of the MACE to MMSE [7][8][9] and single-item cognitive screening questions [10] and equivalence to the Montreal Cognitive Assessment (MoCA) [9,11,12], and a better performance in those aged > 65 years, with a higher prevalence of cognitive impairment [13].…”