Validation of the Sinhala Version of the Addenbrooke’s Cognitive Examination-Revised for the Detection of Dementia in Sri Lanka: Comparison with the Mini-Mental Status Examination and the Montreal Cognitive Assessment

Abstract

Background: Sri Lanka is a rapidly aging country, where dementia prevalence will increase significantly in the future. Thus, inexpensive and sensitive cognitive screening tools are crucial. Objectives: To assess the reliability, validity, and diagnostic accuracy of the Sinhalese version of the Addenbrooke’s Cognitive Examination-Revised (ACE-R s). Method: The ACE-R was translated into Sinhala with cultural and linguistic adaptations and administered, together with the Sinhala version of the Montreal Cognitive Assessment (MoCA), to 99 patients with dementia and 93 gender-matched controls. Results: The ACE-R s cutoff score for dementia was 80 (sensitivity 91.9%, specificity 76.3%). The areas under the curve for the ACE-R s, Mini-Mental State Examination (MMSE) and MoCA were 0.90, 0.86, and 0.86, respectively. The ­ACE-R s had good interrater reliability (intraclass correlation = 0.94), test-retest reliability (intraclass correlation = 0.99), and internal consistency (Cronbach’s α = 0.8442). Conclusions: The ACE-R s is sensitive, specific and reliable to detect dementia in persons aged ≥50 years in a Sinhala-speaking population and its diagnostic accuracy is superior to previously validated tools (MMSE and MoCA).

Mini-ACE: Validation Study Among Older People in Long-Term Care

“…Test-retest reliability was assessed with Pearson and intraclass correlation coefficients (ICC > .75, Weir, 2005). Given that only studies with other ACE versions computed test-retests (Fang et al, 2014;Pan et al, 2022;Suriyakumara et al, 2019), their values were used as a range for comparison (.93-.99). Cohen's kappa was computed to assess inter-rater reliability between two independent scorers, with values between .93-.90 used as a reference based on previous works with other ACE versions (Fang et al, 2014;Matias-Guiu et al, 2015;Pan et al, 2022;Suriyakumara et al, 2019).…”

“…Given that only studies with other ACE versions computed test-retests (Fang et al, 2014;Pan et al, 2022;Suriyakumara et al, 2019), their values were used as a range for comparison (.93-.99). Cohen's kappa was computed to assess inter-rater reliability between two independent scorers, with values between .93-.90 used as a reference based on previous works with other ACE versions (Fang et al, 2014;Matias-Guiu et al, 2015;Pan et al, 2022;Suriyakumara et al, 2019). However, due to the nature of the Clock-drawing and the potential for some subjectivity in its scoring, we performed Cohen's kappa coefficient calculation only for this task (the scoring of the other tasks in the M-ACE is straightforward and does not require a unique scoring approach).…”

Rating scales validated for Sri Lankan populations: an update

“…It contains 5 subtests: attention/orientation (18 points), memory (26 points), fluency (14 points), language (26 points) and visuospatial (16 points) (27). The cutoff score for detecting dementia in the ACE-R validated for the Sinhala speaking population aged ≥50 years is 80, with a sensitivity of 91.9% and specificity of 76.3% (28).…”

Concordancia entre las pruebas Mini Mental State Examination, Short Portable Mental Status Questionnarie y Montreal Cognitive Assesment para el tamizaje del deterioro cognitivo en adultos mayores

“…Los hallazgos encontrados en este estudio con respecto a la muy buena concordancia hallada entre las pruebas MoCA y MMSE son similares a los encontrados con otros estudios parecidos realizados en otros países [24][25][26][27] e incluso muchas de estas revisiones han logrado crear tablas de conversión de puntaje de una prueba hacia otra 28,29 o crear otros tipos de pruebas que midan el deterioro cognitivo tomando como base las dos anteriormente mencionadas 30 . En general, ambas pruebas son capaces de determinar de manera correcta la presencia de deterioro; pero, la utilización de un cuestionario sobre el otro depende de varios factores, como la disponibilidad de tiempo para aplicar la prueba y el conocimiento del encuestador sobre la misma para facilitar su aplicación 6 .…”

“…Adicionalmente a esto, cabe resaltar que la investigación acerca del tema no se detiene, ya que día a día se proponen nuevas y mejores pruebas para determinar el deterioro cognitivo. Así mismo, se ha descrito el uso de aplicativos celulares para realizar la evolución de forma más eficiente 36 , pero, muchas de estas pruebas siguen teniendo como ideas primarias las evaluaciones que se realizan en el MMSE o MoCA 30,37 , por lo tanto, siguen siendo fundamentales en la valoración integral del paciente geriátrico.…”