1,111
Views
27
CrossRef citations to date
0
Altmetric
Research Papers

The validity of the Addenbrooke’s Cognitive Examination-Revised (ACE-R) in acute stroke

, &
Pages 189-195 | Accepted 01 May 2011, Published online: 16 Dec 2011
 

Abstract

Purpose: The purpose was to examine the validity of the Addenbrooke’s Cognitive Examination Revised (ACE-R) as a screening measure to detect cognitive impairment after stroke. Methods: Stroke patients in hospital were recruited and the ACE-R, which includes the Mini-Mental Status Examination (MMSE), was administered, followed by a battery of neuropsychological tests, which served as the ‘gold standard’ for classification of cognitive impairment. The diagnostic validity of the ACE-R was determined by ROC analysis. Results: Of the 101 patients who completed the ACE-R, 61 also completed the neuropsychological assessment. Both the MMSE and the ACE-R were found to have inadequate diagnostic validity for the detection of overall cognitive impairment (MMSE AUC = 0.53, p > 0.05; ACE-R AUC = 0.53, p > 0.05). The ACE-R subscales predicted impairment in specific cognitive domains significantly better than chance; Visuospatial (AUC = 0.71, p < 0.05), Fluency (AUC = 0.72, p< 0.05) and Attention and Orientation (AUC = 0.80, p < 0.05). However, no cut-off score for any subscale gave both adequate levels of sensitivity and specificity for the detection of impairment in specific areas of cognitive functioning. Conclusions: The ACE-R was not a suitable measure to screen for overall cognitive impairment in acute stroke patients, but was able to detect impairment in visuospatial, attention and executive domains.

Implications for Rehabilitation

  • Cognitive impairments are common after stroke.

  • Brief screening measures are needed to detect cognitive problems.

  • The Addenbrooke’s cognitive examination–revised (ACE-R) was more accurate for detecting cognitive impairment after stroke than the Mini-Mental State Examination (MMSE), but neither was a satisfactory measure.

  • Stroke specific screening measures need to be developed.

Acknowledgments

We would like to thank Kimberley Fletcher, Daniel Stark, Heather Fergusson and Carmen von Mickwitz (Assistant Psychologists) for their contribution to data collection, Vanessa Dale for supervising some of the assistants and to the staff and patients of Nottingham University Hospitals NHS Trust Stroke Service for their support of this study.

Declaration of interest: The authors report no conflicts of interest.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.