J Clin Neurol.  2019 Jul;15(3):313-320. 10.3988/jcn.2019.15.3.313.

Validation Study of the Chinese Version of Addenbrooke's Cognitive Examination III for Diagnosing Mild Cognitive Impairment and Mild Dementia

• Li X
• Yang L
• Yin J
• Yu N
• Ye F

• KMID: 2451114
• DOI: http://doi.org/10.3988/jcn.2019.15.3.313

Abstract

BACKGROUND AND PURPOSE
There are only a few cognitive screening tests for the Chinese-speaking population, and so this study aimed to validate the Chinese version of Addenbrooke's Cognitive Examination III (ACE-III) for detecting mild cognitive impairment (MCI) and mild dementia. Its diagnostic accuracy was compared with the Chinese versions of the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA).
METHODS
The 176 included individuals were divided into 3 groups: mild dementia group, MCI group, and normal control group. MMSE, MoCA, and ACE-III were administered to all participants by researchers who were blinded to the clinical grouping. The receiver operating characteristic (ROC) curves were analyzed.
RESULTS
ACE-III exhibited good internal consistency and convergent validity. Age and education level significantly influenced the total ACE-III scores. When screening MCI, the area under the ROC curve (AUC) was significantly larger for ACE-III than for MMSE (0.88 vs. 0.72, p<0.05) and MoCA (0.88 vs. 0.76, p<0.05). ACE-III showed higher sensitivity (0.75) and specificity (0.89) than MMSE (0.64 and 0.63, respectively) and MoCA (0.67 and 0.77) at the optimal cutoff score of 88/89. For detecting mild dementia, ACE-III yielded satisfactory sensitivity (0.94) and specificity (0.83) at the optimal cutoff score of 74/75. The AUC of ACE-III was 0.95, which was comparable to those of MMSE (0.95) and MoCA (0.91). In participants with ≥12 years of education, the AUC was significantly larger for ACE-III than for MMSE when detecting MCI (0.90 vs. 0.68, p<0.05) and mild dementia (0.97 vs. 0.90, p<0.05).
CONCLUSIONS
The present study has verified that ACE-III is a reliable and accurate tool for screening MCI and mild dementia in the Chinese-speaking population, and is significantly superior to MMSE and MoCA for detecting MCI.

Keyword

validation studies; Addenbrooke's Cognitive Examination III; Chinese; dementia; mild cognitive impairment

MeSH Terms

Area Under Curve
Asian Continental Ancestry Group*
Dementia*
Education
Humans
Mass Screening
Methylenebis(chloroaniline)
Mild Cognitive Impairment*
ROC Curve
Sensitivity and Specificity
Methylenebis(chloroaniline)

Figure

• 

  Fig. 1 ROC curves of ACE-III, the MMSE, and the MoCA for screening MCI and mild dementia (A, B). ACE-III: Addenbrooke's ognitive Examination III, MCI: mild cognitive impairment, MMSE: Mini Mental State Examination, MoCA: Montreal Cognitive Assessment, ROC: receiver operating characteristic.

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