Addenbrooke's Cognitive Examination Research Articles

Association between serum apolipoprotein E and cognitive functions in temporal lobe epilepsy

Objective The aim was to estimate serum level of apolipoprotein E (Apo E) in patients with temporal lobe epilepsy (TLE) and to investigate the association between Apo E and cognitive functions in patients with TLE. Background There is a relation between Apo E and TLE, which has led to increased attention for examination. Apo E may exacerbate epilepsy and promote memory impairment in patients with long-standing TLE. Patients and methods A total of 40 patients with TLE and 40 normal participants were included. Interictal electroencephalogram and magnetic resonance imaging were done. Brain cognitive assessment was done using minimental state examination and Addenbrooke's cognitive examination revised (ACE-R). Serum Apo E was done using enzyme-linked immunosorbent assay technique. Results Minimental state examination and ACE-R scores were significantly less in the patients with TLE compared with the controls (P Conclusion There is a cognitive impairment in patients with TLE especially for memory, verbal fluency, and visuospatial activity. Serum Apo E was associated with cognitive impairment in TLE, which may suggest its possible role in cognitive impairment in patients with TLE.

On-line memory clinic – piloting a hybrid model

AimsQuality improvement project was undertaken to reorganise memory clinic to incorporate both virtual and in-person consultation (Hybrid Virtual model), as depicted in the following model:MethodTele triage conducted to ascertain information from patient and carer. This reduced time for face to face assessment.Nurse did face to face assessment to complete cognitive test (Addenbrooke's Cognitive Examination III) & carer completed Bristol Activities of Daily Living scale. Nurse would also do BP, PR, oxygen sats & temp.Nurse discussed the assessment with the consultant (who is in the inpatient unit) on line using MS TEAMSConsultant would then see patient on line, confirm diagnosis, answer questions, give information on medication and post prescription (if required)Feedback was collected using Telehealth Satisfaction questionnaireResultHybrid remote memory clinic was started on 29/09/20. A total of 37 patients were seen in this clinic by 31/01/21.Collected feedback from 21 patients was generally positive –Information provided on video consultation prior to assessment -18 reported it as excellentHow well you privacy was respected – 21 reported it as excellent.Information you received on the treatment – 18 reported it as excellentConclusionThe hybrid remote memory clinic was more effective than telephone consultation or on line only consultation as it was –Easy to establishing rapportPhysical examination could be performedDigital literacy was no longer a limiting factorPrescribing medication was slightly more difficult but possible

Screening for Cognitive Dysfunction in Amphetamine Users in Saudi Arabia; a Case-control Investigation Using Propensity Score Matching Analysis

ABSTRACT Amphetamine users have deficits in cognitive performance; however, the effects of duration and amount of use on cognitive decline remain elusive. The aim of this study was to evaluate the correlates of cognitive functioning in amphetamine users in Saudi Arabia. This was a case-control community-based study, using an Arabic adaptation of Addenbrooke’s Cognitive Examination (ACE). The study compared users of amphetamine (n = 50) and controls (n = 50) in terms of performance on the ACE. Amphetamine users underperformed controls in the cognitive domains of attention, memory, language, fluency, and visuospatial faculties, even after controlling for psychiatric and sociodemographic variables. Heavy and prolonged use of amphetamine was associated with worse cognitive performance. Use of amphetamine at lower doses was not associated with worsening of cognitive functioning. The study adds to the evidence that amphetamine use is associated with impairment in cognitive functioning in Saudi Arabia. This has implications in terms of designing therapeutic interventions that account for potential cognitive difficulties in amphetamine abusers.

A study to assess the cognitive functions and the general health in patients with substance dependence

Introduction: Cognitive function has been addressed as a hallmark feature of substance use disorders, with alteration in “executive” domains of attention, inhibition/regulation, working memory, and decision-making. Poor cognition or cognitive dysfunction has been recognized as a fundamental impairment in addiction and a potentially important target for intervention. The present study was planned with the aim to assess the cognitive functions and general health in patients with substance dependence and also to correlate general health with the level of cognitive function. Methodology: Ninety participants were included in the study and were categorized into three groups of thirty each as patients taking alcohol, opioids, and nicotine. Consecutive sampling was adopted for the sample collection. Each participant was assessed for dependence, demographic data, and tested by the Addenbrooke's Cognitive Examination Scale-III and General Health Questionnaire-12. Descriptive statistics were applied to calculate the frequencies, percentage, mean, median, and standard deviation. Data were further analyzed for significance using the Chi-square, correlation, and Mann–Whitney test. Results: There is a statistically significant difference seen in marital status (P = 0.005), education (P = 0.001), family type (P = 0.008), and locality (P = 0.000). Furthermore, with substance use, there is a significant change in the domains of general health with P

Diagnostic accuracy of brief cognitive screening tools to diagnose vascular cognitive impairment in Peru.

To evaluate the diagnostic accuracy of three brief cognitive screening (BCS) tools, Peruvian version of Addenbrooke's Cognitive Examination (ACE-Pe), of INECO Frontal Screening (IFS-Pe) and of the Mini-Mental State Examination (MMSE-Pe), for the diagnosis of vascular cognitive impairment (VCI) and its non-dementia stages (VCI-ND) and vascular dementia (VD) in patients with cerebral stroke in Lima-Peru. A cohort analysis to evaluate the diagnostic accuracy of three BCS for VCI. Two hundred and four patients were evaluated: 61% Non-VCI, 30% VCI-ND and 9% VD. To discriminate patients with VCI from controls, the area under the curve (AUC) of ACE-Pe, IFS-Pe and MMs-Pe were 0.99 (95% confidence interval [CI] 0.98-0.99), 0.99 (95%CI 0.98-0.99) and 0.87 (95%CI 0.82-0.92), respectively. Of the three BCS, the IFS-Pe presented a larger AUC to discriminate VCI-ND from VD (AUC=0.98 [95%CI 0.95-1]) compared to ACE-Pe (AUC=0.84 [95%CI 0.74-0.95]) and MMSE-Pe (0.92 [95%CI 0.86-0.99]). The IFS-Pe presented a higher sensitivity (S), specificity (Sp), and positive (+LR) and negative likelihood ratios (-LR) (S=96.72%, Sp=89.47%, +LR=9.1 and -LR=0.03) than ACE-Pe (S=96.72%, Sp=63.16%, +LR=2.62 and -LR=0.05) and MMSE-Pe (S=90.16%, Sp=78.95%, +LR=4.28 and -LR=0.12). In the multiple regression analysis, the IFS-Pe was not affected by age, sex or years of schooling. The IFS-Pe has the best diagnostic accuracy for detecting VCI and discriminating between pre-dementia (VCI-ND) and dementia (VD) stages.

Behavioural changes predict poorer survival in amyotrophic lateral sclerosis

ObjectiveThe Motor Neuron Disease Behavioural Scale (MiND-B) is a clinically validated tool that was developed to detect behavioural dysfunction in patients with amyotrophic lateral sclerosis (ALS). The current study aimed to evaluate behavioural impairment using MiND-B, as well as cognitive dysfunction in ALS patients, and to determine their prognostic implications. MethodPatients with a clinical diagnosis of ALS were prospectively recruited from a specialised multidisciplinary ALS clinic. Patients underwent behavioural assessment with the Motor Neuron Disease Behavioural Scale (MiND-B) and cognitive evaluation using the Addenbrooke’s Cognitive Examination (ACE). Primary outcome measure was selected as survival time, defined by time from assessment to time of death or censor date. Univariate assessment of survival effect was carried out using Kaplan-Meier survival analysis followed by cox regression analysis to assess the effect of MiND-B and ACE scores on survival time. ResultsA total of 134 patients were included in the study. MiND-B testing determined that 59% were classified as having behavioural dysfunction, with deficits associated with a significantly shorter survival time (HR 2.53, p = 0.003, 95% CI 1.3–4.6). Furthermore, regression analysis demonstrated that for every 1-point reduction in the MiND-B score, risk of death increased by 3%. ACE testing established that 33% of the cohort had evidence of cognitive dysfunction. Patients with cognitive dysfunction on ACE testing had a significantly shorter survival time than patients without cognitive impairment (HR 2.0, p = 0.042, 95% CI 1.04–3.3). ConclusionThe presence of behavioural and cognitive impairments in ALS patients was associated with poor survival. The MiND-B and ACE inventories are simple and efficient clinical tools that can be administered in the multidisciplinary ALS clinic, that aid in the prognostication of this patient population.

Clinical characteristics and diagnostic accuracy of the revised Addenbrooke Cognitive Examination (ACE-R) in older adults with a low educational level

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.

Randomized crossover trial of a modified ketogenic diet in Alzheimer\u2019s disease

BackgroundBrain energy metabolism is impaired in Alzheimer’s disease (AD), which may be mitigated by a ketogenic diet. We conducted a randomized crossover trial to determine whether a 12-week modified ketogenic diet improved cognition, daily function, or quality of life in a hospital clinic of AD patients.MethodsWe randomly assigned patients with clinically confirmed diagnoses of AD to a modified ketogenic diet or usual diet supplemented with low-fat healthy-eating guidelines and enrolled them in a single-phase, assessor-blinded, two-period crossover trial (two 12-week treatment periods, separated by a 10-week washout period). Primary outcomes were mean within-individual changes in the Addenbrookes Cognitive Examination - III (ACE-III) scale, AD Cooperative Study - Activities of Daily Living (ADCS-ADL) inventory, and Quality of Life in AD (QOL-AD) questionnaire over 12 weeks. Secondary outcomes considered changes in cardiovascular risk factors and adverse effects.ResultsWe randomized 26 patients, of whom 21 (81%) completed the ketogenic diet; only one withdrawal was attributed to the ketogenic diet. While on the ketogenic diet, patients achieved sustained physiological ketosis (12-week mean beta-hydroxybutyrate level: 0.95 ± 0.34 mmol/L). Compared with usual diet, patients on the ketogenic diet increased their mean within-individual ADCS-ADL (+ 3.13 ± 5.01 points, P = 0.0067) and QOL-AD (+ 3.37 ± 6.86 points, P = 0.023) scores; the ACE-III also increased, but not significantly (+ 2.12 ± 8.70 points, P = 0.24). Changes in cardiovascular risk factors were mostly favourable, and adverse effects were mild.ConclusionsThis is the first randomized trial to investigate the impact of a ketogenic diet in patients with uniform diagnoses of AD. High rates of retention, adherence, and safety appear to be achievable in applying a 12-week modified ketogenic diet to AD patients. Compared with a usual diet supplemented with low-fat healthy-eating guidelines, patients on the ketogenic diet improved in daily function and quality of life, two factors of great importance to people living with dementia.Trial registrationThis trial is registered on the Australia New Zealand Clinical Trials Registry, number ACTRN12618001450202. The trial was registered on August 28, 2018.

Motor cortical excitability predicts cognitive phenotypes in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are well-recognised as an extended disease spectrum. This study hypothesised that cortical hyperexcitability, an early pathophysiological abnormality in ALS, would distinguish cognitive phenotypes, as a surrogate marker of pathological disease burden. 61 patients with ALS, matched for disease duration (pure motor ALS, n = 39; ALS with coexistent FTD, ALS-FTD, n = 12; ALS with cognitive/behavioural abnormalities not meeting FTD criteria, ALS-Cog, n = 10) and 30 age-matched healthy controls. Cognitive function on the Addenbrooke’s cognitive examination (ACE) scale, behavioural function on the motor neuron disease behavior scale (MiND-B) and cortical excitability using transcranial magnetic stimulation (TMS) were documented. Cortical resting motor threshold (RMT), lower threshold indicating hyperexcitability, was lower in ALS-FTD (50.2 ± 6.9) compared to controls (64.3 ± 12.6, p < 0.005), while ALS-Cog (63.3 ± 12.7) and ALS (60.8 ± 13.9, not significant) were similar to controls. Short interval intracortical inhibition (SICI) was reduced across all ALS groups compared to controls, indicating hyperexcitability. On receiver operating characteristic curve analysis, RMT differentiated ALS-FTD from ALS (area under the curve AUC = 0.745, p = 0.011). The present study has identified a distinct pattern of cortical excitability across cognitive phenotypes in ALS. As such, assessment of cortical physiology may provide more precise clinical prognostication in ALS.

I Have to Pay to Use the Montreal Cognitive Assessment: What Should I Do?

For many years, the Montreal Cognitive Assessment (MoCA) has been one of the most commonly used cognitive screening instruments in ambulatory care settings. Because the MoCA will no longer be in the free public domain by the end of 2020, it is important to consider cognitive screening tests that are comparable and free. We briefly review three cognitive screening instruments, the Saint Louis University Mental Status examination, the Short Test of Mental Status, and the Addenbrooke's cognitive examination, and compare these tests with the MoCA. The Addenbrooke's cognitive examination is a comprehensive cognitive examination that is too long for administration in primary care. The Short Test of Mental Status uses a 38-point scale, does not account for education, and is available only in English. The Saint Louis University Mental Status is an ideal candidate to replace the MoCA because similar to the MoCA, it is based on a 30-point scale and available in many languages. In addition to dementia, it has been validated for diagnosing mild cognitive impairment. While the MoCA has more tests suited for detecting dysexecutive dementias, it is possible to supplement the Saint Louis University Mental Status with comparable public domain executive function tests. In summary, we believe the Saint Louis University Mental Status to be a suitable free alternative to the MoCA.

A study of quality of sleep, quality of life, and cognition in elderly: Healthy control, depressed and with mild neurocognitive disorder

Background: Sleep plays a vital role in maintaining optimum physical and mental functioning and can be implicated in affecting the quality of life (QOL) and cognition in elderly population. This study aims to assess quality of sleep, QOL and to assess the effect of quality of sleep on QOL and cognition in elderly population Materials and Methods: A cross-sectional study was done in elderly population in which 30 were healthy control, 30 depressed, and 30 with mild neurocognitive disorder (NCD) who were assessed using Pittsburg Sleep Quality Index, World Health Organization QOL (WHOQOL)-BREF, Geriatric Depression Scale-Short form, and Addenbrooke's Cognitive Examination Scale-Revised (ACE-R). Statistical analysis was done using SPSS 20 software using descriptive methods and Pearson's correlation test. Results: Mean Pittsburgh Sleep Quality Index (PSQI) score was the lowest and mean WHOQOL-BREF score highest in healthy control compared to elderly with mild NCD and depression, the difference being statistically significant in both cases (P < 0.01). PSQI scores have negative correlation with the ACE-R scores when studied in healthy control group (P < 0.05, r = −0.136) and WHOQOL-BREF domain scores overall (P < 0.01 r = −0.485, −0.497, −0.350, −0.475). Conclusion: Quality of sleep in elderly with depression and mild NCD is lower as compared to healthy control. Sleep may affect QOL and cognition in elderly and thus it would be essential to screen and identify sleep-related issues and intervene early.

“A prospective study of assessment of neurocognitive function in illiterate patients with gliomas treated with chemoradiation”: Assessment of neurocognitive function in gliomas

ObjectiveNeurocognitive functioning (NCF) is an important component of quality of life (QoL) in glioma patients. The neurocognitive toxicity from irradiation of brain tumours may be related to damage to neural progenitor cells (NPC). The aim of our study was to assess the NCF in illiterate glioma patients. MethodsThis was a prospective study done in glioma patients admitted for adjuvant treatment. Illiterate and semiliterate post op glioma patients with ECOG PS ≤ 3 were included. Neurocognitive assessment was done using Addenbrooke's Cognitive Examination (ACE-III) questionnaire prior to the start of RT and at 6month and 12 month follow up. The scores were correlated to the doses to sub ventricular zone (SVZ) and sub granular zone (SGZ) regions. Results20 patients were recruited.16 patients were illiterate and four patients were semiliterate. Median of the mean dose to the SVZ I/L (ipsilateral) was 48.5 Gy and SGZ I/L was 39.5 Gy. In patients who received ≤49 Gy mean dose to SVZ I/L, there was statistically significant improvement in memory, fluency, language and total ACE scores at six months. In patients with SGZ I/L mean dose ≤40 Gy, there was improvement in memory, language, and total ACE score at six months. Similar trend continued at 12 months follow up. ConclusionsNCF assessment by ACE III questionnaire is a useful tool even in illiterate patients. Lower RT doses to the ipsilateral SVZ and SGZ showed significant improvement in total ACE scores at 6 months and improvement in specific domains at 6 and 12 months.

Clinical utility of cognitive screening instruments in dementia patients of neurology OPD (Memory Clinic) in Eastern Uttar Pradesh, India

Introduction: Dementia is a major public health challenge that is becoming more common with growing age. It involves progressive and often remorseless decline in cognition, functions, behavior and care needs. The Assessment of dementia greatly relies on collateral as well as patient-derived information. The use of various cognitive tests assumes great importance during the process of diagnostic investigation. In this research we attempt to assess the practical usage of various cognitive scales. Materials and Methods: In this study, we studied the data of 233 patients in the neurology OPD. The following cognitive scales like Montreal Cognitive Assessment (MoCA), Addenbrooke’s Cognitive Examination (ACE), Hachinski Ischemic Score (HIS), and Everyday Abilities Scale for India (EASI) were performed on the above selected data of patient. Results: 228 (97.85) % of patients were found to have cognitive impairment when screened with MoCA. However, 230 (98.7%) of patients screened with EASI had a disability score. The patients with a HIS score of more than 7 was (64) 27.9%. Whereas, ACE indicated all patients had score below 83 (100%). The sensitivity of MoCA, ACE, and EASI score was 72.69% and 72.29%, 71.74% respectively with a specificity of 50 and 100, 0.0% respectively for the above scores, whereas the sensitivity and specificity of HIS was 49.50% and 10.61. Conclusion: MoCA, ACE, and EASI tools have good capability to detect most patients with cognitive impairments. They are sensitive to predict probable cases of dementia, therefore can be used as an efficient diagnostic tool in quick screening of cognitive impairment. Keywords: Montreal Cognitive Assessment (MoCA), Addenbrooke’s Cognitive Examination (ACE), Hachinski Ischemic Score (HIS), Everyday Abilities Scale for India (EASI), and dementia.

Assessment of cognitive impairment by using Addenbrooke’s Cognitive Examination (ACE) and Montreal Cognitive Assessment (MoCA) amongst type 2 diabetes mellitus patients in Eastern Uttar Pradesh, India

Aim: The occurrence of diabetes mellitus (DM) is in increasing trend worldwide predominantly in South East Asian countries comprising India. Also, there is strong evidences that, DM upsurges the risk of cognitive impairment and dementia. Hence our main aim behind this study was to divulge the relationship between DM and mild cognitive impairment (MCI). Materials and Methods: A retrospective cohort study was conducted by reviewing and analyzing the medical records of DM who had been consulted at the neurology out-patient department during a period of 2015 - 2016. The cognitive impairment in DM patients were assessed by using Addenbrooke’s Cognitive Examination (ACE) and Montreal Cognitive Assessment (MoCA). Statistical Analysis: The data was analyzed using Statistical Package for Social Sciences (SPSS) version 19 software. If the p-value < 0> Results: The prevalence of cognitive impairment in DM patient is seemingly high with both scores i.e. 96.31% with MoCA and 99.85% with ACE-R. The variables like sex and age groups were not statistically significant with MoCA scores. The MoCA score & ACE-R score showed a negative association with education levels. The MoCA scores of different items i.e. visuo-excutive, naming, attention, language, abstraction and orientation were highly statistically significant at 0.01% level, between the DM patients who had cognitive impairment and DM patients with normal score, except memory which score zero in all patients. Conclusion: The prevalence of cognitive impairment in DM patients is very high. The, elder age, low education attainment, and unskilled occupation were also the potential identified risk factors for cognitive impairment. Keywords: Diabetes, Dementia, MoCA, Cognitive impairment, Low education etc.

The revised Addenbrooke's Cognitive Examination can facilitate differentiation of dementia with Lewy bodies from Alzheimer's disease.

ObjectivesDementia with Lewy bodies (DLB) is a major cause of degenerative dementia, yet the diagnosis is often missed or mistaken for Alzheimer's disease (AD). We assessed whether the revised Addenbrooke's Cognitive Examination (ACE‐R), a brief test for dementia, differentiates DLB from AD.MethodsWe first compared baseline ACE‐R performance in 76 individuals with DLB, 40 individuals with AD and 66 healthy controls. We then investigated the diagnostic accuracy of a simple standardised ‘memory/visuospatial’ ratio calculated from the ACE‐R subscores. Finally, as a comparison a logistic regression machine learning algorithm was trained to classify between DLB and AD.ResultsIndividuals with AD had poorer memory (p = 0.001) and individuals with DLB had poorer visuospatial function (p = 0.005). Receiver operating characteristics curves confirmed that the ACE‐R total score could differentiate dementia from non‐dementia cases with 98% accuracy, but could not discriminate between dementia types (50%, or chance‐level accuracy). However, a ‘memory/visuospatial’ ratio ≥1.1 differentiated DLB from AD with 82% sensitivity, 68% specificity and 77% mean accuracy. The machine learning classifier did not improve the overall diagnostic accuracy (74%) of the simple ACE‐R subscores ratio.ConclusionsThe ACE‐R‐based ‘memory/visuospatial’ ratio, but not total score, demonstrates good clinical utility for the differential diagnosis of DLB from AD.

Validation of the Hungarian Version of Addenbrooke's Cognitive Examination for Detecting Major and Mild Neurocognitive Disorders

&#x0D; Aim: The screening of cognitive decline is a mandatory step in the early diagnosis and appropriate treatment of dementia to begin. In order to achieve this, an easy-to-take, validated neurocognitive test with good specificity and sensitivity are essential in the assessment. The aim of this study was to evaluate the Hungarian version of Addenbrooke’s Cognitive Examination (version I., ACE)- by comparing it with the conventional Mini-Mental State Examination (MMSE)- as a new form of assessment in order to screen for early dementia among the elderly.&#x0D; Study Design: Descriptive cross-sectional.&#x0D; Place and Duration of Study: This study is a part of a larger research, conducted among voluntary elderly from the city of Pécs (Hungary) between January 2016 and December 2018.&#x0D; Methodology: The study refers to 66 patients with mild neurocognitive disorder (NCD), 51 patients with major NCD, and 133 healthy participants. The Diagnostic and Statistical Manual of Mental Disorders (version 5.) criteria were used for the diagnosis of dementia. Statistical analysis was performed using the receiver operator characteristics method.&#x0D; Results: The optimal cut-off score for the ACE-I for detecting mild NCD was 82, with a sensitivity of 89% and a specificity of 96%. The optimal cut-off for the ACE for identifying major NCD was 76 with sensitivity of 98% and a specificity of 98%.&#x0D; Conclusion: We concluded that the Hungarian version of the ACE is an accurate test for the detection of NCD, and could be adopted in various clinical practices.

Development and piloting of a novel 15‐minute cognitive telephone (FACT) screen to diagnose mild cognitive impairment and dementia

AbstractBackgroundIt is crucial to follow up patients with mild cognitive impairment (MCI) and dementia. For persons unable to visit hospital for follow‐up, we designed a brief telephone‐screen, the fifteen‐minute assessment of cognition over the telephone (FACT). This was piloted for its ability to diagnose and differentiate patients with MCI and Alzheimer’s disease (AD).MethodThe FACT consists of 27 items categorized under attention and orientation, memory, language, and executive functions domains. Patients with MCI (n=40), AD (n=40) and healthy age and education matched volunteers (n=23) were administered the FACT a week after presentation and neuropsychological testing at the clinic. Performance on the Addenbrookes Cognitive Examination (ACE III) was used as a gold standard.ResultFACT correlated well with ACE III, the Pearson correlation coefficient was 0.82 (p = 0.00). The subcomponents of both tests also showed moderate to high correlations. The area under the ROC curve for FACT discriminating MCI from AD was 0.92 and MCI from healthy volunteers was 0.83.ConclusionThe novel telephone interview screen (FACT) was comparable to the ACE III in diagnosing and differentiating patients with MCI from AD. A mobile telephone usage is almost universal across India including poor, illiterate and rural population. Thus the use of FACT as a screening tool may be extended to population surveys, which are crucial in tackling dementia, a major health challenge in India.

Does feature binding account for functional decline in patients with mild cognitive impairment? Evidence from the Details of Function of Everyday Life Questionnaire (DoFEL)

AbstractBackgroundAvailable functional scales used to discriminate normal and abnormal ageing are informative of basic abilities (e.g., bathing, grooming, feeding, etc.). These are complex functions and the tools used to assess them lack theories from cognitive ageing. These features have rendered them insensitivity to the early stages of dementia such as that caused by Alzheimer’s disease (AD). To overcome these limitations, we need to improve our understanding of the cognitive underpinnings of functional decline. The ability to bind information in memory (i.e., feature binding) declines from the preclinical stages of AD. It remains unknown whether such subtle cognitive deficits can underpin decline of instrumental activities of everyday life (IADL, e.g., managing finances, using technologies, shopping) found in the prodromal stages of AD. To address this need we have developed a theory‐driven scale namely Details of Function of Everyday Life Questionnaire (DoFEL). We used DoFEL to investigate if cognitive constructs such as memory binding can account for impairment of specific abilities that support instrumental functions.MethodsParticipants (N=168) completed a neuropsychological test battery, comprising of a set of novel and traditional neuropsychological tasks known to be useful in the early detection of AD. Binomial logistic regression was utilised to evaluate the predictive effect of DoFEL relative to other scales such as the Addenbrooke's cognitive examination (ACE).ResultsA stratified model incorporating the Shopping and Money, Work and Social Life and Domestic Chores domains of the DoFEL, X2(3)=48.57, p &lt; 0.001, R2 = 0.70, AUC=0.94, demonstrated comparable accuracy to that of the ACE‐R scores, X2(1)=47.61, p &lt; 0.001, R2 = 0.71, AUC=0.94. The DoFEL scores informing on conjunctive binding abilities had a moderately high accuracy and Nagelkerke's R2 results, indicating a higher predictive power to discriminate between healthy older adults and individuals with MCI.ConclusionsFunctional composite measures integrating feature binding constructs within measures of IADL impairment are plausible future indicators of early cognitive decline in prodromal AD. Further research is required to evaluate the validity of DoFEL and its sensitivity across the whole AD continuum.

A novel hybrid scale for the assessment of cognitive and executive function: The Free-Cog.

BackgroundScales measuring cognitive and executive functions are integral to the assessment and management of patients with suspected cognitive impairment. Some of the most commonly used cognitive tests are now subject to copyright restrictions. Furthermore, no existing scale assesses both executive and cognitive abilities.AimsWe aimed to develop and validate a novel hybrid scale for use in clinical practice which integrate measures of cognition and executive abilities (‘Free‐Cog’).MethodsThe instrument was devised through a national collaboration including health professionals, those with lived experience of dementia and researchers. Following ethics committee approval, the Free‐Cog was assessed in 25 real‐world clinical settings across England, Wales and Scotland. It was compared to three other cognitive tests routinely administered in clinical practice: the Mini‐Mental State Examination (MMSE), the Montreal Cognitive Assessment (MOCA), and the Addenbrooke's Cognitive Examination (ACE).ResultsThe Free‐Cog was tested in 960 patients with clinical diagnoses of dementia, Mild Cognitive Impairment (MCI), and normal controls. Similar to the MMSE, MOCA and ACE, it discriminated well between the three groups (p < 0.001). It correlated well with the other instruments. Using a receiver operating characteristic curve analysis, Free‐Cog achieved an Area Under Curve of 0.94 for dementia versus controls, 0.80 for MCI versus controls and 0.77 for dementia versus MCI. A version of the tool adapted for telephone consultation, the Tele Free‐Cog, also discriminated well between patient groups.ConclusionsFree‐Cog is a non‐proprietary, empirically derived, concise assessment. Uniquely, it combines cognitive and executive function questions in the one instrument. It could be used to inform the assessment of people presenting with cognitive impairment and is available to anyone interested in trialling it.

What is the accuracy of Addenbrooke's Cognitive Examination III (ACE III) and mini-ACE for detection of mild cognitive impairment?

What is the accuracy of Addenbrooke's Cognitive Examination III (ACE III) and mini-ACE for detection of mild cognitive impairment?