Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-23T16:34:30.611Z Has data issue: false hasContentIssue false
  • English
  • Français

A meta-analysis of the accuracy of the Addenbrooke's Cognitive Examination (ACE) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) in the detection of dementia

Published online by Cambridge University Press:  05 December 2013

Andrew J. Larner  and
Alex J. Mitchell
Andrew J. Larner*
Affiliation:
Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
Alex J. Mitchell
Affiliation:
Department of Psycho-oncology, Leicestershire Partnership NHS Trust, Leicester, UK Department of Cancer and Molecular Medicine, University of Leicester, Leicester, UK
*
Correspondence should be addressed to: Dr Larner, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK. Email: a.larner@thewaltoncentre.nhs.uk.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

The Addenbrooke's Cognitive Examination (ACE) and its Revised version (ACE-R) are relatively new screening tools for cognitive impairment that may improve upon the well-known Mini-Mental State Examination (MMSE) and other brief batteries. We systematically reviewed diagnostic accuracy studies of ACE and ACE-R.

Methods:

Published studies comparing ACE, ACE-R and MMSE were comprehensively sought and critically appraised. A meta-analysis of suitable studies was conducted.

Results:

Of 61 possible publications identified, meta-analysis of qualifying studies encompassed 5 for ACE (1,090 participants) and 5 for ACE-R (1156 participants); of these, 9 made direct comparisons with the MMSE. Sensitivity and specificity of the ACE were 96.9% (95% CI = 92.7% to 99.4%) and 77.4% (95% CI = 58.3% to 91.8%); and for the ACE-R were 95.7% (95% CI = 92.2% to 98.2%) and 87.5% (95% CI = 63.8% to 99.4%). In a modest prevalence setting, such as primary care or general hospital settings where the prevalence of dementia may be approximately 25%, overall accuracy of the ACE (0.823) was inferior to ACE-R (0.895) and MMSE (0.882). In high prevalence settings such as memory clinics where the prevalence of dementia may be 50% or higher, overall accuracy again favored ACE-R (0.916) over ACE (0.872) and MMSE (0.895).

Conclusions:

The ACE-R has somewhat superior diagnostic accuracy to the MMSE while the ACE appears to have inferior accuracy. The ACE-R is recommended in both modest and high prevalence settings. Accuracy of newer versions of the ACE remain to be determined.

Keywords

Addenbrooke's Cognitive Examinationmeta-analysisMini-Mental State Examination; sensitivity and specificity
Type
Review Article
Information
International Psychogeriatrics , Volume 26 , Issue 4 , April 2014 , pp. 555 - 563
Copyright
Copyright © International Psychogeriatric Association 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, P. et al. (2010). Validation of the German revised Addenbrooke's Cognitive Examination for detecting mild cognitive impairment, mild dementia in Alzheimer's disease and frontotemporal lobar degeneration. Dementia and Geriatric Cognitive Disorders, 29, 448–456. doi: 10.1159/000312685.Google Scholar
Crawford, S., Whitnall, L., Robertson, J. and Evans, J. J. (2012). A systematic review of the accuracy and clinical utility of the Addenbrooke's Cognitive Examination and the Addenbrooke's Cognitive Examination-Revised in the diagnosis of dementia. International Journal of Geriatric Psychiatry, 27, 659–669. doi: 10.1002/gps.2771.Google Scholar
Davies, R. R. and Larner, A. J. (2013). Addenbrooke's Cognitive Examination (ACE) and its Revision (ACE-R). In Larner, A. J. (ed.), Cognitive Screenisng Instruments. A Practical Approach (pp. 61–77). London: Springer.CrossRefGoogle Scholar
Dos Santos Kawata, K. H. et al. (2012). A validation study of the Japanese version of the Addenbrooke's Cognitive Examination-Revised. Dementia and Geriatric Cognitive Disorders Extra, 2, 29–37. doi: 10.1159/000336909.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Garcia-Caballero, A. et al. (2006). Validation of the Spanish version of the Addenbrooke's Cognitive Examination in a rural community in Spain. International Journal of Geriatric Psychiatry, 21, 239–245.CrossRefGoogle Scholar
Harbord, R. M., Egger, M. and Sterne, J. A. (2006). A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Statistics in Medicine, 25, 3443–3457.Google Scholar
Hsieh, S., Schubert, S., Hoon, C., Mioshi, E. and Hodges, J. R. (2013). Validation of the Addenbrooke's Cognitive Examination-III in frontotemporal dementia and Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 36, 242–250. doi: 10.1159/000351671.Google Scholar
Larner, A. J. (2007). Addenbrooke's Cognitive Examination (ACE) for the diagnosis and differential diagnosis of dementia. Clinical Neurology and Neurosurgery, 109, 491–494.Google Scholar
Larner, A. J. (2013a). Addenbrooke's Cognitive Examination-Revised (ACE-R): pragmatic study of cross-sectional use for assessment of cognitive complaints of unknown aetiology. International Journal of Geriatric Psychiatry, 28, 547–548. doi: 10.1002/gps.3884.Google Scholar
Larner, A. J. (2013b). Comparing diagnostic accuracy of cognitive screening instruments: a weighted comparison approach. Dementia and Geriatric Cognitive Disorders Extra, 3, 60–65. doi: 10.1159/000348623.Google Scholar
Law, E. et al. (2013). Does the Addenbrooke's Cognitive Examination-Revised add to the Mini-Mental State Examination in established Alzheimer disease? Results from a national dementia research register. International Journal of Geriatric Psychiatry, 28, 351–355. doi: 10.1002/gps.3828.CrossRefGoogle Scholar
Liberati, A. et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ, 339, b2700. doi: 10.1136/bmj.b2700.CrossRefGoogle ScholarPubMed
Mallett, S., Halligan, S., Thompson, M., Collins, G. S. and Altman, D. G. (2012). Interpreting diagnostic accuracy studies for patient care. BMJ, 344, e3999. doi: 10.1136/bmj.e3999.Google Scholar
Mathuranath, P. S., Nestor, P. J., Berrios, G. E., Rakowicz, W. and Hodges, J. R. (2000). A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia. Neurology 55, 1613–1620.CrossRefGoogle ScholarPubMed
Mioshi, E., Dawson, K., Mitchell, J., Arnold, R. and Hodges, J. R. (2006). The Addenbrooke's Cognitive Examination Revised: a brief cognitive test battery for dementia screening. International Journal of Geriatric Psychiatry, 21, 1078–1085.Google Scholar
Mitchell, A. J. (2009). A meta-analysis of the accuracy of the Mini-Mental State Examination in the detection of dementia and mild cognitive impairment. Journal of Psychiatric Research, 43, 411–431. doi:10.1016/j.jpsychires.2008.04.014.Google Scholar
Mitchell, A. J. (2013). The Mini-Mental State Examination (MMSE): an update on its diagnostic validity for cognitive disorders. In Larner, A. J. (ed.), Cognitive Screening Instruments. A Practical Approach (pp. 15–46). London: Springer.Google Scholar
Moher, D. et al. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 339, b2535. doi: 10.1136/bmj.b2535.Google Scholar
Stokholm, J., Vogel, A., Johannsen, P. and Waldemar, G. (2009). Validation of the Danish Addenbrooke's Cognitive Examination as a screening test in a memory clinic. Dementia and Geriatric Cognitive Disorders, 27, 361–365. doi: 10.1159/000209271.Google Scholar
Yoshida, H. et al. (2011). Validation of Addenbrooke's cognitive examination for detecting early dementia in a Japanese population. Psychiatry Research, 185, 211–214. doi: 10.1016/j.psychres.2009.06.012.Google Scholar
Yoshida, H. et al. (2012). Validation of the Revised Addenbrooke's Cognitive Examination (ACE-R) for detecting mild cognitive impairment and dementia in a Japanese population. International Psychogeriatrics, 24, 28–37. doi: 10.1017/S1041610211001190.Google Scholar