Addenbrooke's Cognitive Examination validation in Parkinson's disease.
BACKGROUND
There is a clear need for brief, sensitive and specific cognitive screening instruments in Parkinson's disease (PD).


OBJECTIVE
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).


CONCLUSIONS
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.
Reyes
M A
MA
Movement Disorders Section, Neuroscience Department and Cognitive Department, Institute for Neurological Research Raul Carrea FLENI, Buenos Aires, Argentina.
Perez-Lloret
S
S
Lloret
S P
SP
Roldan Gerschcovich
E
E
Gerscovich
E R
ER
Martin
M E
ME
Leiguarda
R
R
Merello
M
M
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D020961:Lewy Body Disease / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods*; D009483:Neuropsychological Tests / Q000592:standards*; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis*