Addenbrooke's Cognitive Examination validation in Parkinson's disease

• Published in: European journal of neurology Vol. 16; no. 1; pp. 142 - 147
• Main Authors: Reyes, M. A., Lloret, S. P., Gerscovich, E. R., Martin, M. E., Leiguarda, R., Merello, M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-01-2009
• Subjects: Aged; Aged, 80 and over; Cognition Disorders - diagnosis; Cognition Disorders - etiology; Cognition Disorders - physiopathology; cognitive evaluation; Cohort Studies; dementia; Diagnosis, Differential; Female; Humans; Lewy Body Disease - diagnosis; Lewy Body Disease - physiopathology; Male; Middle Aged; Neurologic Examination - methods; neurology; Neuropsychological Tests - standards; Parkinson 's disease; Parkinson Disease - complications; Parkinson Disease - diagnosis; validation study
• ISSN: 1351-5101; 1468-1331; 1471-0552
• DOI: 10.1111/j.1468-1331.2008.02384.x

Background:  There is a clear need for brief, sensitive and specific cognitive screening instruments in Parkinson’s disease (PD).
Objectives:  To study Addenbrooke’s Cognitive Examination (ACE) validity for cognitive assessment of PD patient’s using the Mattis Dementia Rating Scale (MDRS) as reference method. A specific scale for cognitive evaluation in PD, in this instance the Scales for Outcomes of Parkinson’s disease – Cognition (SCOPA‐COG), as well as a general use scale the Mini‐mental state examination (MMSE) were also studied for further correlation.
Methods:  Forty‐four PD patients were studied, of these 27 were males (61%), with a mean (SD) age of 69.5 (11.8) years, mean (SD) disease duration of 7.6 (6.4) years (range 1–25), mean (SD) total Unified Parkinson’s Disease Rating Scale (UPDRS) score 37 (24) points, UPDRS III 16.5 (11.3) points. MDRS, ACE and SCOPA‐COG scales were administered in random order. All patients remained in on‐state during the study. Results: Addenbrooke’s Cognitive Examination correlated with SCOPA‐COG (r = 0.93, P < 0.0001), and MDRS (r = 0.91 P < 0.0001) and also with MMSE (r = 0.84, P < 0.001). Area under the receiver‐operating curve, taking MDRS as the reference test, was 0.97 [95% confidence interval (CI): 0.92–1.00] for ACE, 0.92 (95% CI: 0.83–1.00) for SCOPA‐COG and 0.91 (95% CI: 0.83–1.00) for MMSE. Best cut‐off value for ACE was 83 points [Sensitivity (Se) = 92%; Specificity (Sp) = 91%; Kappa concordance (K) = 0.79], 20 points for the SCOPA‐COG (Se = 92%; Sp = 87%; K = 0.74) and 26 points for MMSE (Se = 61%; Sp = 100%; K = 0.69).
Conclusion:  Addenbrooke’s Cognitive Examination appears to be a valid tool for dementia evaluation in PD, with a cut‐off point which should probably be set at 83 points, displaying good correlation with both the scale specifically designed for cognitive deficits in PD namely SCOPA‐COG, as well as with less specific tests such as MMSE.