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Mini-Addenbrooke's Cognitive Examination (MACE): a Useful Cognitive Screening Instrument in Older People?
1Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, United Kingdom.
Background:
The Mini-Addenbrooke's Cognitive Examination (MACE) is a recently described brief cognitive screening instrument.
Objective:
To examine the test accuracy of MACE for the identification of dementia and mild cognitive impairment (MCI) in a cohort of older patients assessed in a neurology-led dedicated cognitive disorders clinic.
Methods:
Cross-sectional assessment of consecutive patients with MACE was performed independent of the reference standard diagnosis based on clinical interview of patient and, where possible, informant and structural brain imaging, and applying standard clinical diagnostic criteria for dementia and MCI. Various test accuracy metrics were examined at two MACE cut-offs ( ≤ 25/30 and ≤ 21/30), comparing the whole patient cohort with those aged ≥ 65 or ≥ 75 years, hence at different disease prevalences.
Results:
Dependent upon the chosen cut-off, MACE was either very sensitive or very specific for the identification of any cognitive impairment in the older patient cohorts with increased disease prevalence. However, at both cut-offs the positive predictive values and post-test odds increased in the older patient cohorts. At the more sensitive cut-off, improvements in some new unitary test metrics were also seen.
Conclusion:
MACE is a valid instrument for identification of cognitive impairment in older people. Test accuracy metrics may differ with disease prevalence.
Insights
The Mini-Addenbrooke's Cognitive Examination (MACE) effectively identifies cognitive impairment in older adults. Its accuracy for dementia and mild cognitive impairment (MCI) varies with chosen cut-offs and disease prevalence.
Area of Science:
- Neurology
- Geriatrics
- Cognitive Science
Background:
- The Mini-Addenbrooke's Cognitive Examination (MACE) is a new, brief cognitive screening tool.
- Cognitive impairment, including dementia and mild cognitive impairment (MCI), significantly impacts older adults.
Purpose of the Study:
- To evaluate the diagnostic accuracy of MACE for dementia and MCI.
- To assess MACE performance in a neurology clinic cohort of older patients.
Main Methods:
- Cross-sectional study of consecutive patients undergoing MACE assessment.
- Diagnosis based on standard clinical criteria, including interviews and neuroimaging.
- Analysis of MACE test accuracy metrics at different cut-offs (≤25/30, ≤21/30) and age groups (≥65, ≥75).
Main Results:
- MACE demonstrated high sensitivity or specificity depending on the chosen cut-off.
- Positive predictive values and post-test odds increased in older patient cohorts.
- Improved unitary test metrics were observed at the more sensitive cut-off.
Conclusions:
- MACE is a validated instrument for identifying cognitive impairment in the elderly.
- Test accuracy of MACE can be influenced by disease prevalence within specific populations.
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