Institute of Cognitive Neurology (INECO), Buenos Aires, Argentina.
J Neurol Sci. 2012 Nov 15;322(1-2):228-31. doi: 10.1016/j.jns.2012.08.002. Epub 2012 Sep 5.
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 show a 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 the Mini-Mental Sate Examination (MMSE) may overlook at cognitive deficits typical of patients with VaD. The Addenbrooke's Cognitive Examination Revised (ACE-R) is also a brief cognitive screening tool designed to incorporate the items of the MMSE 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 patients with 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-R may 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 and we propose that future studies should evaluate the potential usefulness of combining the ACE-R with a brief screening tool of executive functioning.
血管性痴呆（VaD）是痴呆症最常见的病因之一，在临床实践中经常被误诊和治疗不足。由于神经心理学结果取决于血管性脑损伤的大小和位置等因素，因此 VaD 的认知特征尤其具有挑战性。然而，已经有足够的证据表明注意力和执行功能明显受损，特别是与阿尔茨海默病有关。在床边检测到这些缺陷对于日常临床实践至关重要，但简短的认知筛查工具，如简易精神状态检查（MMSE），可能会忽略 VaD 患者的认知缺陷。Addenbrooke 认知测验修订版（ACE-R）也是一种简短的认知筛查工具，旨在纳入 MMSE 的项目，并进一步扩展测试以评估定向、注意力、语言流畅性、记忆、语言和视空间能力。在这项研究中，我们研究了西班牙版 ACE-R 检测皮质下缺血性血管性痴呆患者认知障碍的能力，并将其在该人群中的有用性与 MMSE 进行了比较。这些测试的分数与阿尔茨海默病患者和匹配的健康对照组进行了比较。ACE-R 提出的 88 分截止值与检测认知障碍的敏感性为 100%和特异性为 100%相关，表明其能力强于 MMSE（23 分截止值的敏感性为 42%）。我们还发现，ACE-R 的语言流畅性子测验可能有助于区分皮质下缺血性血管性痴呆患者和 AD 患者。我们在日常临床实践的背景下讨论了这些发现的实用性，并提出未来的研究应该评估 ACE-R 与简短的执行功能筛查工具相结合的潜在有用性。
