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Evaluation of the Addenbrooke's Cognitive Examination's validity in a brain injury rehabilitation setting
1Wrightington, Wigan and Leigh NHS Trust, UK. tgaber@doctors.net.uk
Background:
Several reports have warned of the Mini Mental State Examination's (MMSE) inability to detect gross memory and high executive impairments. Addenbrooke's Cognitive Examination-Revised (ACE-R) has gained enormous popularity in dementia screening as it addresses the main shortcomings of MMSE.
Aim:
This study aimed at evaluating the use of ACE-R and to establish its sensitivity compared to MMSE in a cohort of brain injury patients.
Method:
ACE-R was administered to a cohort of chronic brain injury patients. All patients had a cognitive impairment which was severe enough to prevent them working or studying. Patients with significant mental health, sensory, communication or physical impairments were excluded.
Results:
Thirty-six patients were recruited, 31 males with a mean age of 37 years. For an upper cut-off value of 27/30 for MMSE and 88/100 for ACE-R, their sensitivities were 36% and 72%, respectively. For a lower cut-off value of 24/30 and 82/100 the tests sensitivities were 11% and 56%, respectively. Analysis of the ACE-R sub-tests indicated that memory and verbal fluency sub-tests showed the most dramatic impairment.
Conclusion:
MMSE is insensitive as a screening test in brain injury patients. The results show ACE-R to be a sensitive, easily administered test.
