Abstract
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
Keywords
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Article info
Publication history
Published online: September 06, 2012
Accepted:
August 1,
2012
Received:
February 2,
2012
Identification
Copyright
© 2012 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
