MACE for the Diagnosis of Dementia and MCI: 3-Year Pragmatic Diagnostic Test Accuracy Study

Background/Aims: The Mini-Addenbrooke’s Cognitive Examination (MACE) is a relatively new short cognitive screening instrument for the detection of patients with dementia and mild cognitive impairment (MCI). Few studies of the MACE have been reported hitherto. The aim of this study was to undertake a pragmatic diagnostic test accuracy study of MACE in a large cohort of patients seen in a dedicated cognitive disorders clinic. Methods: MACE was administered to consecutive patients referred to a neurology-led Cognitive Function Clinic over the course of 3 years to assess its performance for the diagnosis of dementia and MCI using various test metrics. Results: In a cohort of 599 patients, the prevalence of dementia and MCI by criterion diagnosis was 0.17 and 0.29, respectively. MACE had a high sensitivity (> 0.9) and negative predictive values (> 0.8) with large effect sizes (Cohen’s d > 1) for the diagnosis of both dementia and MCI but a low specificity (< 0.5) and positive predictive values (≤0.5). Conclusion: MACE is an acceptable test for the assessment of cognitive complaints in a secondary care setting with good metrics for identifying cases of both dementia and MCI.

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MACE versus MoCA: equivalence or superiority? Pragmatic diagnostic test accuracy study

International Psychogeriatrics ◽

10.1017/s1041610216002210 ◽

2017 ◽

Vol 29 (6) ◽

pp. 931-937 ◽

Cited By ~ 18

Author(s):

A.J. Larner

Keyword(s):

Secondary Care ◽

Characteristic Curve ◽

High Sensitivity ◽

Screening Instrument ◽

Test Accuracy ◽

Cognitive Screening ◽

Net Benefit ◽

Dementia Diagnosis ◽

Predictive Values ◽

Accuracy Study

ABSTRACTBackground:The Mini-Addenbrooke's Cognitive Examination (MACE) is a new brief cognitive screening instrument for dementia and mild cognitive impairment (MCI). Historical data suggest that MACE may be comparable to the Montreal Cognitive Assessment (MoCA), a well-established cognitive screening instrument, in secondary care settings, but no head-to-head study has been reported hitherto.Methods:A pragmatic diagnostic accuracy study of MACE and MoCA was undertaken in consecutive patients referred over the course of one year to a neurology-led Cognitive Function Clinic, comparing their performance for the diagnosis of dementia and MCI using various test metrics.Results:In a cohort of 260 patients with dementia and MCI prevalence of 17% and 29%, respectively, both MACE and MoCA were quick and easy to use and acceptable to patients. Both tests had high sensitivity (>0.9) and large effect sizes (Cohen's d) for diagnosis of both dementia and MCI but low specificity and positive predictive values. Area under the receiver operating characteristic curve was excellent for dementia diagnosis (both >0.9) but less good for MCI (MoCA good and MACE fair). In contrast, weighted comparison suggested test equivalence for dementia diagnosis but with a slight net benefit for MACE for MCI diagnosis.Conclusions:MACE is an acceptable and accurate test for the assessment of cognitive problems, with performance comparable to MoCA. MACE appears to be a viable alternative to MoCA for testing patients with cognitive complaints in a secondary care setting.

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Clinical judgement of GPs for the diagnosis of dementia: a diagnostic test accuracy study

BJGP Open ◽

10.3399/bjgpo.2021.0058 ◽

2021 ◽

pp. BJGPO.2021.0058

Author(s):

Samuel Thomas Creavin ◽

Judy Haworth ◽

Mark Fish ◽

Sarah Cullum ◽

Anthony Bayer ◽

...

Keyword(s):

Diagnostic Test ◽

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Diagnostic Test Accuracy ◽

Clinical Judgement ◽

Test Accuracy ◽

Index Test ◽

Duration Of Symptoms ◽

Diagnosis Of Dementia ◽

Accuracy Study

BackgroundGPs often report using clinical judgement to diagnose dementia.AimInvestigate the accuracy of GPs’ clinical judgement for the diagnosis of dementia.Design & settingDiagnostic test accuracy study, recruiting from 21 practices around Bristol.MethodThe clinical judgement of the treating GP (index test) was based on the information immediately available at their initial consultation with a person aged over 70 years who had cognitive symptoms. The reference standard was an assessment by a specialist clinician, based on a standardised clinical examination and made according to ICD-10 criteria for dementia.Results240 people were recruited, with a median age of 80 years (IQR 75–84 years), of whom 126 (53%) were men and 132 (55%) had dementia. The median duration of symptoms was 24 months (IQR 12–36 months) and the median ACE-III score was 75 (IQR 65–87). GP clinical judgement had sensitivity 56% (95% CI 47% to 65%) and specificity 89% (95% CI 81% to 94%). Positive likelihood ratio was higher in people aged 70–79 years (6.5, 95% CI 2.9–15) compared to people aged ≥80 years (3.6, 95% CI 1.7–7.6), and in women (10.4, 95% CI 3.4–31.7) compared to men (3.2, 95% CI 1.7–6.2), whereas the negative likelihood ratio was similar in all groups.ConclusionA GP clinical judgement of dementia is specific, but confirmatory testing is needed to exclude dementia in symptomatic people who GPs judge as not having dementia.

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Free-Cog: Pragmatic Test Accuracy Study and Comparison with Mini-Addenbrooke’s Cognitive Examination

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000500069 ◽

2019 ◽

Vol 47 (4-6) ◽

pp. 254-263 ◽

Cited By ~ 7

Author(s):

Andrew J. Larner

Keyword(s):

Cognitive Abilities ◽

Cognitive Disorders ◽

High Sensitivity ◽

Test Accuracy ◽

Net Benefit ◽

Dementia Screening ◽

Diagnosis Of Dementia ◽

Accuracy Study ◽

And Function ◽

Addenbrooke’S Cognitive Examination

Background/Aims: Canonical definitions of the dementia construct encompass deficits in both cognition and function, but most screening instruments for possible dementia address only cognitive abilities. Free-Cog is a recently described brief screening instrument for dementia designed to address not only cognitive but also functional abilities. Methods: A pragmatic test accuracy study of Free-Cog was undertaken in consecutive patients seen over 1 year in a secondary care setting. The performance of Free-Cog for diagnosis of dementia and mild cognitive impairment (MCI) was compared to that of Mini-Addenbrooke’s Cognitive Examination (MACE). Results: In a cohort of 141 patients (prevalence of dementia and MCI 11 and 32%, respectively) both Free-Cog and MACE were quick and easy to use and acceptable to patients. Both tests had high sensitivity (1.00) and large effect sizes (Cohen’s d) for diagnosis of dementia, but Free-Cog was more specific. For diagnosis of MCI, Free-Cog lacked sensitivity (0.58) but was specific (0.81), whereas MACE was sensitive (0.91) but not specific (0.35). Weighted comparison suggested equivalence for dementia diagnosis but a net benefit for MACE regarding MCI diagnosis. Conclusion: Free-Cog is an acceptable and accurate test for dementia screening in a dedicated cognitive disorders clinic, but it appears less sensitive than MACE for the identification of MCI.

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