Use Of The Addenbrooke´S Cognitive Examination III (ACE-III) For The Diagnosis Of Cognitive Impairment In Lima, Peru
Nilton Custodio Capunay1, Marco Malaga1, Rosa Montesinos1, Diego Chambergo-Michilot1, Fiorella Baca-Seminario1, Juan Carlos Carbajal1, José Carlos Huilca1, David Lira1, Eder Herrera-Perez2, Monica M. Diaz3, Serggio Lanata4
1Instituto Peruano De Neurociencias, 2Universidad San Ignacio de Loyola, 3Neurology, University of North Carolina at Chapel Hill, Chapel Hill, 4Memory and Aging Center, UCSF Weill Institute for Neurosciences
Objective:

Determine the performance of the ACE-III brief cognitive test (BCT) on the diagnosis of mild cognitive impairment (MCI) and dementia in Lima, Peru.

Background:

The peruvian adaptation of the ACE-III has been previously validated as a culturally sensitive tool for dementia screening. However, the diagnostic performance of this tool was not assessed in an independent cohort. Thus, we aimed to determine the diagnostic performance of ACE-III in diagnosis of MCI and dementia in Lima, Peru

Design/Methods:

We recruited a cohort of randomly selected individuals from Lima, Peru, recruited as part of an international Latin-American project for multiple BCT validation.  Patients were evaluated sequentially: screened through the MMSE, diagnosed with the Hachinski scale, PFAQ2 and Beck Depression inventory, and finally classified with CDR and DSM-V criteria. The ACE-III was applied during the second stage and was not used for patient selection. We compared average total scores and between using ANOVA. We correlated each domain to the CDR scores using a Spearman correlation coefficient. For diagnostic performance, we used a Receiver Operating Curve (ROC). 

Results:

We included 246 patients: 96 controls, 57 with MCI and 93 with dementia. Average ACE-III scores was79.9 ± 3.16, 68.6 ± 3.30 and 58.0 ± 3.14, respectively. Differences were statistically significant between groups for all domains and total score (p<0.001). Total ACE-III score was correlated to IFS by 0.79 (0.74 – 0.84, p<0.001) and to CDR by -0.9 (-0.92 - -0.87, p<0.001).  The total ACE-III score had an AUC of 98.7% (IC95 97-99%) for MCI and 100% for dementia. 

Conclusions:

We found that ACE-III had an excellent diagnostic performance for MCI and AD in a Latin-American population. This highlights the importance of cultural and linguistic adaptations of BCTs to improve diagnostic performance.

10.1212/WNL.0000000000204167