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

Area of Science:

• Neurology
• Cognitive Science
• Geriatrics

Background:

• The Mini-Addenbrooke's Cognitive Examination (MACE) is a novel, brief cognitive screening tool for dementia and mild cognitive impairment (MCI).
• Previous data suggested MACE's comparability to the Montreal Cognitive Assessment (MoCA) in secondary care, but direct comparative studies were lacking.

Purpose of the Study:

• To conduct a pragmatic diagnostic accuracy study comparing MACE and MoCA.
• To evaluate the performance of MACE and MoCA in diagnosing dementia and MCI in a secondary care setting.

Main Methods:

• A pragmatic diagnostic accuracy study involving consecutive patients referred to a neurology-led Cognitive Function Clinic over one year.
• Comparison of MACE and MoCA performance using various diagnostic metrics for dementia and MCI.

Main Results:

• Both MACE and MoCA demonstrated high sensitivity (>0.9) for dementia and MCI diagnosis but low specificity.
• Area under the ROC curve was excellent for dementia (>0.9) and good for MCI (MoCA) or fair (MACE).
• Weighted comparison indicated test equivalence for dementia and a slight net benefit for MACE in MCI diagnosis.

Conclusions:

• MACE is an acceptable and accurate cognitive screening test.
• MACE demonstrates comparable performance to MoCA and is a viable alternative for cognitive assessments in secondary care.