Addenbrooke's Cognitive Examination-Revised is accurate for detecting dementia in Parkinson's disease patients with low educational level

Rocha, Maria Sheila Guimarães; Bassetti, Elida Maria; Oliveira, Maira Okada; Estevam, Nathercia Marinho; Brucki, Sonia Maria Dozzi

doi:10.1590/S1980-57642014DN81000004

ABSTRACT

Diagnosis of Parkinson's disease dementia is a challenge in clinical settings. A comprehensive neuropsychological evaluation is time-consuming and expensive; brief instruments for cognitive evaluation must be easier to administer and provide a reliable classification. Objective: To study the validity of the Brazilian version of Addenbrooke's Cognitive Examination-Revised (ACE-R) for the cognitive assessment of Parkinson's disease (PD) patients with heterogeneous educational level. Methods: Patients were evaluated according to the diagnostic procedures recommended by the Movement Disorder Society (MDS) as the gold standard for the diagnosis of dementia in PD. Results: We studied 70 idiopathic PD patients, with a mean (SD) age of 64.1 (9.3) years and mean disease duration of 7.7 (5.3) years and educational level of 5.9 years, matched for education and age to controls. Twenty-seven patients fulfilled MDS clinical criteria for PD dementia. Mean scores on the ACE-R were 54.7 (12.8) points for patients with PD dementia, 76 (9.9) for PD patients without dementia and 79.7 (1.8) points for healthy controls. The area under the receiver operating curve, taking the MDS diagnostic procedures as a reference, was 0.93 [95% CI, 0.87-0.98; p<0.001] for ACE-R. The optimal cut-off value for ACE-R was ≤72 points [sensitivity 90%; specificity 85%; Kappa concordance (K) 0.79]. Conclusion: ACE-R appears to be a valid tool for dementia evaluation in PD patients with heterogeneous educational level, displaying good correlation with clinical criteria and diagnostic procedures of the MDS.

Key words:
Parkinson's disease; dementia; screening tests; neuropsychology; cognitive evaluation

RESUMO

O diagnóstico da demência na doença de Pakinson é desafiador na prática clínica. A avaliação neuropsicológica ampla é cara e demorada; instrumentos breves para avaliação cognitiva devem ser fáceis de realizar e fornecer uma classificação confiável. Objetivo: Estudar a validade da versão Brasileira do Addenbrooke's Cognitive Examination-Revised (ACE-R) para a avaliação em pacientes com doença de Parkinson (DP) com nível de escolaridade heterogêneo. Métodos: Os pacientes foram avaliados segundo os procedimentos diagnósticos recomendados pela Movement Disorder Society (MDS) como padrão ouro para diagnóstico de demência da DP (DDP). Resultados: Nós estudamos 70 pacientes com DP idiopática, pareados por idade e escolaridade a controles, com média de idade de 64,1 (9,3) anos, tempo médio de doença de 7,7 (5,3) anos e nível educacional de 5,9 anos. Vinte e sete pacientes preencheram critério da MDS para DDP. Os escores médios na ACE-R foram de 54,7 (12,8) pontos para DDP, 76 (9,9) para DP sem demência e 79,7 (1,8) pontos para os controles saudáveis. A área sob a curva tomando-se os procedimentos diagnósticos da MDS como referência foi 0,93 [95% CI, 0,87-0,98; p<0,001] para ACE-R. O melhor escore de corte foi de ≤72 pontos (sensibilidade de 90% e especificidade de 85%; Kappa concordance (K) 0.79). Conclusão: A ACE-R parece ser um instrumento válido para avaliação de demência em pacientes com DP de níveis educacionais heterogêneos, mostrando boa correlação com o critério clínico e procedimentos diagnósticos da MDS.

Palavras-chave:
doença de Parkinson; demência; neuropsicologia; testes de rastreio; avaliação cognitiva

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REFERENCES

¹
Lees AJ, Hardy J, Revesz T. Parkinson's disease: Lancet 2009;373: 2055-2066.
²
Chaudhuri KR, Schapira AH. Non-motor symptoms of Parkinson's disease: dopaminergic pathophysiology and treatment. Lancet Neurol 2009;8:464-474.
³
Janvin C, Aarsland D, Larsen JP, Hugdahl K. Neuropsychological profile of patients with Parkinson's disease without dementia. Dement Geriatr Cogn Disord 2003;15:126-131.
⁴
Tison F, Dartigues JF, Auriacombe S, Letenneur L, Boller F, Alpéro vitch A. Dementia in Parkinson's disease: a population-based study in ambulatory and institutionalized individuals. Neurology 1995;45: 705-708.
⁵
Marder K, Tang MX, Cote L, Stern Y, Mayeux R. The frequency and as sociated risk factors for dementia in patients with Parkinson's disease. Arch Neurol 1995;52:695-701.
⁶
Baldivia B, Brucki SM, Batistela S, Esper JC, Augusto CD, Rocha MS. Dementia in Parkinson's disease: a Brazilian sample. Arq Neuropsiquiatr 2011;69:733-738
⁷
Hobson P, Meara J. The detection of dementia and cognitive impair ment in a community population of elderly people with Parkinson's disease by use of the CAMCOG neuropsychological test. Age Ageing 1999;28:39-43.
⁸
Hughes TA, Ross HF, Musa S, et al. A 10-year study of the incidence of and factors predicting dementia in Parkinson's disease. Neurology 2000;54:1596-1602.
⁹
Dubois B, Burn D, Goetz C, et al. Diagnostic procedures for Parkinson's disease dementia: recommendations from the movement disorder soci ety task force. Mov Disord 2007;22:2314-2324.
¹⁰
Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:181-184.
¹¹
Hughes TA, Ross HF, Musa S, et al. A 10-year study of the incidence of and factors predicting dementia in Parkinson's disease. Neurology2000;54:1596-1602.
¹²
Feher EP, Mahurin RK, Doody RS, et al. Establishing the limits of the Mini-Mental State. Examination of subtests. Arch Neurol1992;49:87-92.
¹³
Verbaan D, Marinus J, Visser M, et al. Cognitive impairment in Par kinson's disease. J Neurol Neurosurg Psychiatry2007;78:1182-1187.
¹⁴
Marinus J, Visser M, Verwey NA, et al. Assessment of cognition in Par kinson's disease. Neurology2003;61:1222-1228.
¹⁵
Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 2006;21:1078-1085.
¹⁶
Larner AJ. An audit of the Addenbrooke's Cognitive Examination (ACE) in clinical practice. Int J Geriatr Psychiatry2005;20:593-594.
¹⁷
Galton CJ, Erzinclioglu S, Sahakian BJ, Antoun N, Hodges JR. A com parison of the Addenbrooke's Cognitive Examination (ACE), conven tional neuropsychological assessment, and simple MRI-based medial temporal lobe evaluation in the early diagnosis of Alzheimer's disease. Cogn Behav Neurol 2005;18:144-150.
¹⁸
Dudas RB, Berrios GE, Hodges JR. The Addenbrooke's cognitive ex amination (ACE) in the differential diagnosis of early dementias versus affective disorder. Am J Geriatr Psychiatry 2005;13:218-226.
¹⁹
Bak TH, Rogers TT, Crawford LM, Hearn VC, Mathuranath PS, Hodges JR. Cognitive bedside assessment in atypical parkinsonian syndromes. J Neurol Neurosurg Psychiatry2005;76:420-422.
²⁰
Reyes MA, Perez-Lloret S, Lloret SP, et al. Addenbrooke's Cognitive Exam ination validation in Parkinson's disease. Eur J Neurol 2009;16:142-147.
²¹
Komadina NC, Terpening Z, Huang Y, Halliday GM, Naismith SL, Lewis SJ. Utility and limitations of Addenbrooke's Cognitive Examination-Re vised for detecting mild cognitive impairment in Parkinson's disease. Dement Geriatr Cogn Disord2011;31:349-357.
²²
Robben SH, Sleegers MJ, Dautzenberg PL, van Bergen FS, ter Brug gen JP, Rikkert MG. Pilot study of a three-step diagnostic pathway for young and old patients with Parkinson's disease dementia: screen, test and then diagnose. Int J Geriatr Psychiatry2010;25:258-265.
²³
Tumas V, Rodrigues GG, Farias TL, Crippa JA. Parkinson's disease: a comparative study among the UPDRS, the geriatric depression scale and the Beck depression inventory. Arq Neuropsiquiatr2008;66:152-156.
²⁴
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-571.
²⁵
Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Sugges tions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr2003;61:777-781.
²⁶
Fahn S, Elton RL, and members of the UPDRS Development Com mittee. Unified Parkinson's disease rating scale. In: Fahn S, Marsden CD, Goldstein M, Calne DB (eds): Recent Development in Parkinson's Disease. New Jersey, Raven Press; 1987:153-163.
²⁷
Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology1967;17:427-442.
²⁸
Schwab RS, England AC, Peterson C. Akinesia in Parkinson's disease. Neurology1959;9:65-72.
²⁹
Jankovic J, McDermott M, Carter J, et al. Variable expression of Parkin son's disease: a base-line analysis of the DATATOP cohort. The Parkin son Study Group. Neurology1990;40:1529-1534.
³⁰
Wechsler D. Wechsler Memory Scale-Revised Manual. San Antonio, TX, The Psychological Corporation/Harcourt Brace Jovanovich, 1987.
³¹
Diniz LFM, Lasmar VAP, Gazinelli LSR, Fuentes D, Salgado JV. Teste de aprendizagem auditivo verbal de Rey: aplicabilidade na população idosa brasileira. Rev Bras Psiquiatr 2007;29:324-329.
³²
Nascimento E. WAIS-III: Escala de Inteligência Wechsler para Adultos: Manual David Wechsler; Adaptação e padronização de uma amostra brasileira (1ª ed., M. C. de V. M. Silva, trad). São Paulo, Casa do Psicólogo, 2004.
³³
Spreen O, Strauss E. A Compendium of Neuropsychological Tests. Ad ministration, Norms, and Commentary, ed 3. Oxford, Oxford University Press; 1998.
³⁴
Machado TH, Charchat Fichman H, Santos EL, et al. Normative data for healthy elderly on the phonemic verbal fluency task - FAS. Dement Neuropsychol 2009;3:55-60.
³⁵
Beato RG, Nitrini R, Formigoni AP, Caramelli P. Brazilian version of the Frontal Assessment Battery (FAB) - Preliminary data on administration to healthy elderly. Dement Neuropsychol2007;1:59-65.
³⁶
Carvalho VA, Caramelli P. Brazilian adaptation of the Addenbrooke's cognitive examination-revised (ACE-R). Dement Neuropsychol2007;2: 212-216.
³⁷
Larner AJ. Addenbrooke's Cognitive Examination-Revised (ACE-R) in day-to-day clinical practice. Age Ageing2007;36:685-686.

Publication Dates

Publication in this collection
Jan-Mar 2014

History

Received
20 Sept 2013
Accepted
06 Jan 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Lees AJ, Hardy J, Revesz T. Parkinson's disease: Lancet 2009;373: 2055-2066.

[2] ²
Chaudhuri KR, Schapira AH. Non-motor symptoms of Parkinson's disease: dopaminergic pathophysiology and treatment. Lancet Neurol 2009;8:464-474.

[3] ³
Janvin C, Aarsland D, Larsen JP, Hugdahl K. Neuropsychological profile of patients with Parkinson's disease without dementia. Dement Geriatr Cogn Disord 2003;15:126-131.

[4] ⁴
Tison F, Dartigues JF, Auriacombe S, Letenneur L, Boller F, Alpéro vitch A. Dementia in Parkinson's disease: a population-based study in ambulatory and institutionalized individuals. Neurology 1995;45: 705-708.

[5] ⁵
Marder K, Tang MX, Cote L, Stern Y, Mayeux R. The frequency and as sociated risk factors for dementia in patients with Parkinson's disease. Arch Neurol 1995;52:695-701.

[6] ⁶
Baldivia B, Brucki SM, Batistela S, Esper JC, Augusto CD, Rocha MS. Dementia in Parkinson's disease: a Brazilian sample. Arq Neuropsiquiatr 2011;69:733-738

[7] ⁷
Hobson P, Meara J. The detection of dementia and cognitive impair ment in a community population of elderly people with Parkinson's disease by use of the CAMCOG neuropsychological test. Age Ageing 1999;28:39-43.

[8] ⁸
Hughes TA, Ross HF, Musa S, et al. A 10-year study of the incidence of and factors predicting dementia in Parkinson's disease. Neurology 2000;54:1596-1602.

[9] ⁹
Dubois B, Burn D, Goetz C, et al. Diagnostic procedures for Parkinson's disease dementia: recommendations from the movement disorder soci ety task force. Mov Disord 2007;22:2314-2324.

[10] ¹⁰
Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry 1992;55:181-184.

[11] ¹¹
Hughes TA, Ross HF, Musa S, et al. A 10-year study of the incidence of and factors predicting dementia in Parkinson's disease. Neurology2000;54:1596-1602.

[12] ¹²
Feher EP, Mahurin RK, Doody RS, et al. Establishing the limits of the Mini-Mental State. Examination of subtests. Arch Neurol1992;49:87-92.

[13] ¹³
Verbaan D, Marinus J, Visser M, et al. Cognitive impairment in Par kinson's disease. J Neurol Neurosurg Psychiatry2007;78:1182-1187.

[14] ¹⁴
Marinus J, Visser M, Verwey NA, et al. Assessment of cognition in Par kinson's disease. Neurology2003;61:1222-1228.

[15] ¹⁵
Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 2006;21:1078-1085.

[16] ¹⁶
Larner AJ. An audit of the Addenbrooke's Cognitive Examination (ACE) in clinical practice. Int J Geriatr Psychiatry2005;20:593-594.

[17] ¹⁷
Galton CJ, Erzinclioglu S, Sahakian BJ, Antoun N, Hodges JR. A com parison of the Addenbrooke's Cognitive Examination (ACE), conven tional neuropsychological assessment, and simple MRI-based medial temporal lobe evaluation in the early diagnosis of Alzheimer's disease. Cogn Behav Neurol 2005;18:144-150.

[18] ¹⁸
Dudas RB, Berrios GE, Hodges JR. The Addenbrooke's cognitive ex amination (ACE) in the differential diagnosis of early dementias versus affective disorder. Am J Geriatr Psychiatry 2005;13:218-226.

[19] ¹⁹
Bak TH, Rogers TT, Crawford LM, Hearn VC, Mathuranath PS, Hodges JR. Cognitive bedside assessment in atypical parkinsonian syndromes. J Neurol Neurosurg Psychiatry2005;76:420-422.

[20] ²⁰
Reyes MA, Perez-Lloret S, Lloret SP, et al. Addenbrooke's Cognitive Exam ination validation in Parkinson's disease. Eur J Neurol 2009;16:142-147.

[21] ²¹
Komadina NC, Terpening Z, Huang Y, Halliday GM, Naismith SL, Lewis SJ. Utility and limitations of Addenbrooke's Cognitive Examination-Re vised for detecting mild cognitive impairment in Parkinson's disease. Dement Geriatr Cogn Disord2011;31:349-357.

[22] ²²
Robben SH, Sleegers MJ, Dautzenberg PL, van Bergen FS, ter Brug gen JP, Rikkert MG. Pilot study of a three-step diagnostic pathway for young and old patients with Parkinson's disease dementia: screen, test and then diagnose. Int J Geriatr Psychiatry2010;25:258-265.

[23] ²³
Tumas V, Rodrigues GG, Farias TL, Crippa JA. Parkinson's disease: a comparative study among the UPDRS, the geriatric depression scale and the Beck depression inventory. Arq Neuropsiquiatr2008;66:152-156.

[24] ²⁴
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-571.

[25] ²⁵
Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Sugges tions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr2003;61:777-781.

[26] ²⁶
Fahn S, Elton RL, and members of the UPDRS Development Com mittee. Unified Parkinson's disease rating scale. In: Fahn S, Marsden CD, Goldstein M, Calne DB (eds): Recent Development in Parkinson's Disease. New Jersey, Raven Press; 1987:153-163.

[27] ²⁷
Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology1967;17:427-442.

[28] ²⁸
Schwab RS, England AC, Peterson C. Akinesia in Parkinson's disease. Neurology1959;9:65-72.

[29] ²⁹
Jankovic J, McDermott M, Carter J, et al. Variable expression of Parkin son's disease: a base-line analysis of the DATATOP cohort. The Parkin son Study Group. Neurology1990;40:1529-1534.

[30] ³⁰
Wechsler D. Wechsler Memory Scale-Revised Manual. San Antonio, TX, The Psychological Corporation/Harcourt Brace Jovanovich, 1987.

[31] ³¹
Diniz LFM, Lasmar VAP, Gazinelli LSR, Fuentes D, Salgado JV. Teste de aprendizagem auditivo verbal de Rey: aplicabilidade na população idosa brasileira. Rev Bras Psiquiatr 2007;29:324-329.

[32] ³²
Nascimento E. WAIS-III: Escala de Inteligência Wechsler para Adultos: Manual David Wechsler; Adaptação e padronização de uma amostra brasileira (1ª ed., M. C. de V. M. Silva, trad). São Paulo, Casa do Psicólogo, 2004.

[33] ³³
Spreen O, Strauss E. A Compendium of Neuropsychological Tests. Ad ministration, Norms, and Commentary, ed 3. Oxford, Oxford University Press; 1998.

[34] ³⁴
Machado TH, Charchat Fichman H, Santos EL, et al. Normative data for healthy elderly on the phonemic verbal fluency task - FAS. Dement Neuropsychol 2009;3:55-60.

[35] ³⁵
Beato RG, Nitrini R, Formigoni AP, Caramelli P. Brazilian version of the Frontal Assessment Battery (FAB) - Preliminary data on administration to healthy elderly. Dement Neuropsychol2007;1:59-65.

[36] ³⁶
Carvalho VA, Caramelli P. Brazilian adaptation of the Addenbrooke's cognitive examination-revised (ACE-R). Dement Neuropsychol2007;2: 212-216.

[37] ³⁷
Larner AJ. Addenbrooke's Cognitive Examination-Revised (ACE-R) in day-to-day clinical practice. Age Ageing2007;36:685-686.

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