Abstract
ABSTRACT Objective: To determine the diagnostic accuracy of the Addenbrooke’s Cognitive Examination Revised (ACE-R) as a cognitive screening tool for older adults with low levels of schooling and healthy aging, MCI and dementia in Brazil. Methods: All participants underwent neurological and psychiatric examinations and were administered a validated version of ACE-R. Results: A total of 85 participants were evaluated; most were females (84.7%, n = 72). The post hoc analysis showed statistical differences in ACE-R total scores between older adults with mild cognitive impairment (MCI) and controls (p < 0.001) and in subitem scores including verbal fluency, language, visuospatial skills and attention (p < 0.001). The visual-spatial skills subitem was the most strongly correlated with schooling level (r = 0.509, p < 0.001), whereas late, immediate recall and recognition memory were not influenced by schooling. The ACE-R had the best diagnostic accuracy in discriminating between MCI and controls = 0.69 (<57.5; 80/66), MD and controls = 0.98 (<50; 100/96), MCI and MD = 0.86 (<49.5; 100/74). Conclusions: ACE-R and Mini-Mental State Examination (MMSE) scores for older adults with MCI and controls were significantly lower than those reported in similar studies. These preliminary findings support the need for establishing reliable cut-off scores for cognitive assessment of older Brazilian adults with low schooling at risk for dementia taking into consideration ecological and local variables.
Highlights
The increase in life expectancy in Brazil has been associated with a higher prevalence of age-related mental conditions such as Alzheimer’s disease (AD)[1,2]
The present study evaluated a total of 87 participants comprising 9 adults with mild dementia (MD) (4 from Fortaleza and 5 from São Luís), 49 with Mild cognitive impairment (MCI)
The participants with AD showed a performance below the described in the study with lower total scores in the Mini-Mental State Examination (MMSE) (21.8 vs. 17.2)[29], and lower scores for verbal fluency (6.4 vs. 2.7), language (19.9 vs. 9.7) and visuospatial skills (12.8 vs. 7.1)[30]
Summary
The increase in life expectancy in Brazil has been associated with a higher prevalence of age-related mental conditions such as Alzheimer’s disease (AD)[1,2]. Brazil is one of 10 countries with the largest population of older adults in the world (WHO-UN). By 2020, the Brazilian population of older adults aged 60 or more is projected to reach 29.8 million, and those over 80 are expected to reach 4.7 million[4], and around 3 million people (11%) will have dementia. The prevalence of MCI in people over 65 years of age is 12-18%10, and the annual rate of progression from MCI to AD is 10-15%7,11. In Brazil, the estimated incidence rate of MCI is 13.2%12. Detection of MCI in older adults using validated screening tests is of great importance since this population group could benefit from new drugs that are being investigated for the treatment of degenerative diseases such as AD. Evidence shows that, since MCI is a transitional stage between normal aging and AD, there is less brain involvement and those affected are theoretically more likely to benefit from drug therapies[9]
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