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

Published online by Cambridge University Press:  07 March 2017

A.J. Larner
A.J. Larner*
Affiliation:
Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
*
Correspondence should be addressed to: A.J. Larner, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK. Email: [email protected].
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Abstract

Background:

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.

Keywords

dementiadiagnosisMACEMCIMoCAmemory clinic
Type
Research Article
Information
International Psychogeriatrics , Volume 29 , Issue 6 , June 2017 , pp. 931 - 937
Copyright
Copyright © International Psychogeriatric Association 2017 

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References

Arevalo-Rodriguez, I. et al. (2015). Mini-Mental State Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database of Systematic Reviews, 5, CD010783. doi: 10.1002/14651858.CD010783.pub2.Google Scholar
Davis, D. H. et al. (2013). Neuropsychological tests for the diagnosis of Alzheimer's disease dementia and other dementias: a generic protocol for cross-sectional and delayed-verification studies. Cochrane Database of Systematic Reviews, 3, CD010460. doi: 10.1002/14651858.CD010460.Google Scholar
Davis, D. H., Creavin, S. T., Yip, J. L., Noel-Storr, A. H., Brayne, C. and Cullum, S. (2015). Montreal cognitive assessment for the diagnosis of Alzheimer's disease and other dementias. Cochrane Database of Systematic Reviews, 10, CD010775. doi: 10.1002/14651858.CD010775.pub2.Google Scholar
Dubois, B. et al. (2014). Advancing research diagnostic criteria for Alzheimer's disease: the IWG-2 criteria. Lancet Neurology, 13, 614–629. doi: 10.1016/S1474-4422(14)70090-0.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Hodges, J. R. and Larner, A. J. (2017). Addenbrooke's cognitive examinations: ACE, ACE-R, ACE-III, ACEapp, and M-ACE. In Larner, A. J. (ed.), Cognitive Screening Instruments: A Practical Approach, 2nd edn (pp. 109–137). London: Springer.Google Scholar
Hsieh, S. et al. (2015). The Mini-Addenbrooke's Cognitive Examination: a new assessment tool for dementia. Dementia and Geriatric Cognitive Disorders, 39, 1–11. doi: 10.1159/000366040.Google Scholar
Julayanont, P. and Nasreddine, Z. S. (2017). Montreal Cognitive Assessment (MoCA): concept and clinical review. In Larner, A. J. (ed.), Cognitive Screening Instruments: a Practical Approach, 2nd edn (pp. 139–195). London: Springer.Google Scholar
Larner, A. J. (2012). Screening utility of the Montreal Cognitive Assessment (MoCA): in place of – or as well as – the MMSE?. International Psychogeriatrics, 24, 391–396. doi: 10.1017/S1041610211001839.CrossRefGoogle ScholarPubMed
Larner, A. J. (2013). Comparing diagnostic accuracy of cognitive screening instruments: a weighted comparison approach. Dementia and Geriatric Cognitive Disorders Extra, 3, 60–65. doi: 10.1159/000348623.CrossRefGoogle ScholarPubMed
Larner, A. J. (2014). Effect size (Cohen's d) of cognitive screening instruments examined in pragmatic diagnostic accuracy studies. Dementia and Geriatric Cognitive Disorders Extra, 4, 236–241. doi: 10.1159/000363735.CrossRefGoogle Scholar
Larner, A. J. (2015a). Mini-Addenbrooke's Cognitive Examination: a pragmatic diagnostic accuracy study. International Journal of Geriatric Psychiatry, 30, 547–548. doi: 10.1002/gps.4258.CrossRefGoogle ScholarPubMed
Larner, A. J. (2015b). Mini-Addenbrooke's Cognitive Examination diagnostic accuracy for dementia: reproducibility study. International Journal of Geriatric Psychiatry, 30, 1103–1104. doi: 10.1002/gps.4334.CrossRefGoogle ScholarPubMed
Larner, A. J. (2015c). The Q* Index: a useful global measure of dementia screening test accuracy?. Dementia and Geriatric Cognitive Disorders Extra, 5, 265–270. doi: 10.1159/000430784.Google Scholar
Larner, A. J. (2015d). Diagnostic Test Accuracy Studies in Dementia. A Pragmatic Approach. London: Springer. doi: 10.1007/978-3-319-16697-1.Google Scholar
Larner, A. J. (2016a). Short performance-based cognitive screening instruments for the diagnosis of mild cognitive impairment. Progress in Neurology and Psychiatry, 20, 21–26. doi: 10.1002/pnp.421.Google Scholar
Larner, A. J. (2016b). M-ACE vs. MoCA. A weighted comparison. International Journal of Geriatric Psychiatry, 31, 1089–1090. doi: 10.1002/gps.4446.CrossRefGoogle Scholar
Larner, A. J. (2016c). Correlation or limits of agreement? Applying the Bland-Altman approach to the comparison of cognitive screening instruments. Dementia and Geriatric Cognitive Disorders, 42, 247–254.Google Scholar
Larner, A. J. (Ed.) (2017). Cognitive Screening Instruments: A Practical Approach, 2nd edn. London: Springer.CrossRefGoogle Scholar
Mallett, S., Halligan, S., Thompson, M., Collins, G. S. and Altman, D. G. (2012). Interpreting diagnostic accuracy studies for patient care. BMJ, 344, e3999. doi: 10.1136/bmj.e3999.CrossRefGoogle Scholar
Matias-Guiu, J. A. and Fernandez de Bobadilla, R. (2016). Validation of the Spanish-language version of Mini-Addenbrooke's Cognitive Examination as a dementia screening tool [in Spanish]. Neurologia, 31, 646–648. doi: 10.1016/j.nrl.2014.10.005.Google Scholar
Metz, C. E. (1978). Basic principles of ROC analysis. Seminars in Nuclear Medicine, 8, 283–298.CrossRefGoogle ScholarPubMed
Mitchell, A. J. (2017). The Mini-Mental State Examination (MMSE): update on its diagnostic accuracy and clinical utility for cognitive disorders. In Larner, A. J. (ed.), Cognitive Screening Instruments: a Practical Approach, 2nd edn (pp. 37–48). London: Springer.Google Scholar
Moons, K. G. M. et al. (1997). Application of treatment thresholds to diagnostic-test evaluation: an alternative to the comparison of areas under receiver operating characteristic curves. Medical Decision Making, 17, 447–454.CrossRefGoogle Scholar
Nasreddine, Z. S. et al. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53, 695–699.Google Scholar
Noel-Storr, A. H. et al. (2014). Reporting standards for studies of diagnostic test accuracy in dementia: the STARDdem Initiative. Neurology, 83, 364–373. doi: 10.1212/WNL.0000000000000621.Google Scholar
Roalf, D. R., Moberg, P. J., Xie, S. X., Wolk, D. A., Moelter, S. T. and Arnold, S. E. (2013). Comparative accuracies of two common screening instruments for the classification of Alzheimer's disease, mild cognitive impairment and healthy aging. Alzheimer's and Dementia, 9, 529–537. doi: 10.1016/j.jalz.2012.10.001.Google Scholar
Trzepacz, P. T., Hochstetler, H., Wang, S., Walker, B., Saykin, A. J., and Alzheimer's Disease Neuroimaging Initiative. (2015). Relationship between the Montreal Cognitive Assessment and Mini-Mental State Examination for assessment of mild cognitive impairment in older adults. BMC Geriatrics, 15, 107. doi: 10.1186/s12877-015-0103-3.CrossRefGoogle ScholarPubMed
Tsoi, K. K., Chan, J. Y., Hirai, H. W., Wong, S. Y., and Kwok, T. C. (2015). Cognitive tests to detect dementia. A systematic review and meta-analysis. JAMA Internal Medicine, 175, 1450–1458. doi: 10.1001/jamainternmed.2015.2152.Google Scholar
Wojtowicz, A. and Larner, A. J. (in press). Pragmatic diagnostic test accuracy studies of cognitive screening instruments in older people attending a neurology-led cognitive disorders clinic. Progress in Neurology and Psychiatry, 21.Google Scholar