INVESTIGADORES
PEREZ LLORET Santiago
congresos y reuniones científicas
Título:
Addenbrooke’s cognitive examination (ACE) validation in Parkinson’s Disease.
Autor/es:
MARCO AURELIO REYES; SANTIAGO PEREZ LLORET; ELIANA ROLDÁN GERSCOVICH; MARÍA EUGENIA MARTÍN; RAMÓN LEIGUARDA; RAMÓN LEIGUARDA
Lugar:
Chicago
Reunión:
Congreso; Congreso Internacional de Movimientos Anormales; 2008
Resumen:
Background: There is a clear need for brief, but sensitive and specific, cognitive screening instruments in Parkinson’s Disease (PD). Objectives: to study the validity of Addenbrooke’s Cognitive Examination (ACE) for the cognitive assessment in PD taking Mattis Dementia Rating Scale (MDRS) as the reference method. A specific scale for cognitive evaluation in Parkinson’s Disease – such as the SCOPA-COG and a general scale such as the MMSE were also studied for further correlation. Methods: 44 consecutive PD patients fulfilling UKPDSBB criteria were recruited. 27 of them (61%) were females, mean (SD) age was 69.5 (11.8), mean (SD) of disease duration 7.6 (6.4) and range was 1-25, mean (SD) UPDRS total score 37 (24), UPDRS III 16.5 (11.3) were studied. MDRS, ACE and SCOPA-COG were administered in random order. All patients remained in on-state during the study. Correlations were assessed by pearson coeficient. Sensitivity and specificity and their 95% interval coefficient  (95%CI) were calculated. Area under the receiver-operating characteristic (ROC) curve was calculated. Optimal cut-points where defined by finding the value that maximized sensitivity (Se), specificity (sp) and agreement as measured by kappa coefficient (k). Results: ACE correlated with SCOPA-COG (r=0.93, p<0.0001) and MDRS (r=0.91 p<0.0001), which also correlated with SCOPA (r=0.87, p<0.0001) and MMSE (r=0.84, p<0.001). Area under the ROC curve, taking MDRS as the reference test, was 0.97 (95%IC–: 0.92 – 1.00) for ACE, 0.92 (95%IC: 0.83 – 1.00) for SCOPA-COG and 0.91 (95%IC: 0.83 – 1.00) for MMSE. Best cut-off value for ACE was 83 points (Se= 92%, Sp= 91%, k= 0.79), 20 points for the SCOPA-COG (Se=92%, Sp=87%; K= 0.74) and 26 points for MMSE (Se=61%, Sp=100%; K= 0.69). Conclusion: ACE and SCOPA-COG appears to be valid tools for dementia evaluation in PD. Cut-off point for ACE should probably be set at 83 points. ACE displayed a good correlation either with scales specifically designed for cognitive deficits in PD such as SCOPA-COG or less specific tools such as MMSE.