The Spanish version of the Addenbrooke's Cognitive Examination - Revised (ACE-R) in subcortical ischemic vascular dementia.

CATALINA RAIMONDI; EZEQUIEL GLEICHGERRCHT; PABLO RICHLY; TERESA TORRALVA; MARIA ROCA; JULIETA CAMINO; FACUNDO MANES

JOURNAL OF THE NEUROLOGICAL SCIENCES

ELSEVIER SCIENCE BV

Lugar: Amsterdam; Año: 2012 vol. 322 p. 228 - 231

0022-510X

Vascular dementia (VaD) is one of the most prevalent causes of dementia, and it is frequently misdiagnosed and undertreated in clinical practice. Because neuropsychological outcome depends, among other factors, on the size and location of the vascular brain injury, characterizing the cognitive profile of VaD has been especially challenging. Yet, there has been sufficient evidence to showa marked impairment of attention and executive functions, in particular in relation to Alzheimer disease. Being able to detect these deficits at bedside is crucial for everyday clinical practice, and yet, brief cognitive screening toots such as theMini-Mental Sate Examination (MMSE) may overlook at cognitive deficits typical of patientswith VaD. The Addenbrooke´s Cognitive Examination Revised (ACE-R) is also a brief cognitive screening tool designed to incorporate the items of theMMSE and further extend the test to assess orientation, attention, verbal fluency, memory, language, and visuospatial abilities. In this study, we investigated the ability of the Spanish version of the ACE-R to detect the cognitive impairment showed in patientswith subcortical ischemic vascular dementia, and we compared its usefulness to that of the MMSE in this population. Scores on these tests were compared to those of patients with Alzheimer disease and matched healthy controls. The 88-point cut-off proposed for the ACE-R was associated with a sensitivity of 100% and a specificity of 100% for the detection of cognitive impairment, demonstrating a stronger capacity than the MMSE (sensitivity of 42% with its 23-point cut-off score).We also found that the verbal fluency subtest of the ACE-Rmay be potentially useful in discriminating patients with subcortical ischemic vascular dementia from patients with AD.We discuss the utility of these findings in the context of everyday clinical practice andwe propose that future studies should evaluate the potential usefulness of combining the ACE-R with a brief screening tool of executive functioning