Applying ACE-III, M-ACE and MMSE to Diagnostic Screening Assessment of Cognitive Functions within the Polish Population
Abstract
:1. Introduction
2. Methods
2.1. Patients
2.2. Measurements
2.2.1. Mini-Mental State Examination (MMSE)
2.2.2. ACE-III
- Attention: score 0–18,
- Memory: score 0–26,
- Verbal Fluency: score 0–14,
- Language: score 0–26,
- Visuospatial Abilities: score 0–16.
2.2.3. M-ACE
2.3. Procedure
- A partly structured interview was conducted, comprising the educational and professional background, selected aspects of social functioning, health and conditions, which could impact cognitive functions, such as hypothyroidism, cardiovascular diseases, mental disorders and others. Participants with the following conditions were excluded from the study: sense organ disorders (unless participants had the recommended prescriptive glasses or a hearing aid), intractable non-nociceptive pain, suspected but untreated cases of severe depression, psychiatric disorders severe enough to prevent assessment. Participants who displayed any of the symptoms above were referred to a specialist for diagnosis and treatment. People over 60 years of age, capable of linguistic, visual and auditory communication in a stable somatic state, were included in the study. Persons declaring severe somatic complaints or pain, as well as those whose mental state required medical intervention in the first place, were excluded.
- MMSE and ACE-III screening tests were conducted, and the results were used to calculate the M-ACE results.
- In accordance with the standards of psychological assessment, each participant was presented with the results of the assessment and further recommendations.
2.4. Data Analysis
2.4.1. Data Analysis for a Single Assessment to Establish Group Characteristics and Test Results Analysis
- raw MMSE results and age, sex or years of schooling;
- ACE-III results and age, sex or years of schooling;
- results of M-ACE and age, sex or years of schooling.
2.4.2. Comparing the Sensitivity of the Screening Tests
- r = 0—no correlation,
- 0 < r < 0.2—remote correlation,
- 0.2 ≤ r < 0.4—weak correlation,
- 0.4 ≤ r < 0.6—average (medium) correlation,
- 0.6 ≤ r < 0.8—high (strong) correlation,
- 0.8 ≤ r < 1—very high (very strong) correlation,
- r = 1—perfect correlation (complete).
- MMSE and ACE-III,
- MMSE and M-ACE,
- ACE-III and M-ACE.
2.4.3. Analysing Cross-Category Migration—Norms, MCI and Dementia
2.4.4. Analysing Lower Cut-Off Domains for ACE-III against the MMSE Norm Range
3. Results
3.1. Test Group Profile
3.2. Results for Each Scale
3.2.1. MMSE
Age and Raw MMSE Data
Years of Schooling and MMSE Results
3.2.2. ACE-III
- Attention (pts)—15.5 ± 2.9 (17.0; 5.0–18.0), range 0–18 pts;
- Fluency (pts)—9.0 ± 3.5 (9.0; 0.0–25.0), range 0–14 pts;
- Memory (pts)—18.1 ± 6.9 (21.0; 25.0–26.0), range 0–26 pts;
- Language (pts)—22.7 ± 4.0 (24.0; 2.0–26.0), range 0–26 pts;
- Visuospatial Abilities (pts)—13.2 ± 2.6 (14.0; 5.0–16.0), range 0–16 pts.
3.2.3. M-ACE
3.2.4. Comparing the Scales against MMSE
- MMSE and ACE-III—a very high correlation with the strength of r = 0.817. As the ACE-III test results grew, the MMSE test results increased as well (Figure 7).
- MMSE and M-ACE—a very high correlation with the strength of r = 0.753. As the M-ACE test results grew, the MMSE scores increased as well (Figure 8).
- ACE-III and M-ACE—a very high correlation with the strength of r = 0.942. As the ACE-III test results grew, the M-ACE test results also increased (Figure 9).
3.2.5. ACE-III and MMSE
ACE-III and MMSE—Two Categories (below the Norm and Norm)
- true positive—159,
- false positive—77,
- false negative—10,
- true negative—140.
ACE-III—ROC Curve
ACE-III and MMSE—Three Categories (Dementia, MCI, Norm)
- Two people (0.5%) whose MMSE results allocated them to the category of dementia received the status of MCI in ACE-III.
- Ten people (2.6%) whose scores assigned them to the category of MCI in MMSE were classified within the norm in ACE-III.
- For 132 respondents (34.1%), the category obtained in ACE-III was lower as compared with MMSE.
- Fifty-five people (14.2%) who were categorised as MCI in MMSE obtained results classified as dementia in ACE-III.
- Thirty-one people (8.0%) whose scores classified them as within the norm in MMSE obtained results classified as dementia in ACE-III.
- Forty-six people (11.9%) whose scores allocated them within the norm in MMSE obtained the status of MCI in ACE-III.
Analysing Undercut Areas for ACE-III against the MMSE Norm Range
- Attention 1 pt = 5.6%,
- Fluency 1 pt = 7.1%,
- Memory/Language 1 pt = 3.8%,
- Visuospatial Abilities 1 pt = 6.3%.
3.2.6. M-ACE and MMSE
M-ACE (Cut-Off Point of 25) and MMSE—Two Categories (below Norm and within Norm)
- true positive—158,
- false positive—90,
- false negative—11,
- true negative—127.
M-ACE—ROC Curve
- Three people (0.8%) who were assigned to the category of dementia in MMSE received the category of MCI in M-ACE;
- One person (0.3%) whom the MMSE test results placed in the category of dementia obtained the status of MCI in M-ACE;
- Ten people (2.6%) whose scores categorised them as MCI in MMSE were allocated within the norm in M-ACE.
- Forty-four people (11.4%) who were assigned MCI in MMSE obtained the category of dementia in M-ACE;
- Twenty-six people (6.7%) whose scores allocated them to within the norm in MMSE were classified as dementia in M-ACE;
- Sixty-four people (16.6%) who scored within the norm in MMSE received the status of MCI in M-ACE.
4. Discussion
4.1. Notes on the Test Group Profile
4.2. Assessment with the Use of Three Screening Tests
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Age | n | MMSE [pts] | H | p | |
---|---|---|---|---|---|
up to 70 years old [G1] | 108 | 28.0 ± 2.7 (29.0; 11–30) | 97.6 | 0.0000 | |
71–75 years old [G2] | 60 | 27.0 ± 3.7 (28.0; 10–30) | |||
76–80 years old [G3] | 73 | 26.2 ± 3.6 (27.0; 14–30) | [G1] p = 0.0009 | ||
over 80 years old [G4] | 145 | 23.3 ± 4.6 (24.0; 10–30) | [G1] and [G2] p < 0.0001 [G3] p = 0.0001 |
Scale | ACE-III | n | Mean, SD, Median, Range | Mann–Whitney U-Test | |
---|---|---|---|---|---|
Z | p | ||||
Attention (pts) | below | 77 | 16.9 ± 1.4 (17.0; 11–18) | −4.46 | 0.0000 |
norm | 140 | 17.6 ± 0.7 (18.0; 15–18) | |||
Verbal Fluency (pts) | below | 77 | 8.3 ± 2.3 (9.0; 2–12) | −9.58 | 0.0000 |
norm | 140 | 12.0 ± 2.2 (12.0; 6–25) | |||
Memory (pts) | below | 77 | 18.6 ± 4.6 (20.0; 7–25) | −9.53 | 0.0000 |
norm | 140 | 23.9 ± 2.3 (24.0; 9–29) | |||
Language (pts) | below | 77 | 22.9 ± 2.5 (24.0; 15–26) | −8.55 | 0.0000 |
norm | 140 | 25.3 ± 1.0 (26.0; 21–26) | |||
Visuospatial Abilities (pts) | below | 77 | 13.2 ± 2.2 (13.0; 5–16) | −6.92 | 0.0000 |
norm | 140 | 15.0 ± 1.2 (15.0; 10–16) |
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Kaczmarek, B.; Ilkowska, Z.; Kropinska, S.; Tobis, S.; Krzyminska-Siemaszko, R.; Kaluzniak-Szymanowska, A.; Wieczorowska-Tobis, K. Applying ACE-III, M-ACE and MMSE to Diagnostic Screening Assessment of Cognitive Functions within the Polish Population. Int. J. Environ. Res. Public Health 2022, 19, 12257. https://doi.org/10.3390/ijerph191912257
Kaczmarek B, Ilkowska Z, Kropinska S, Tobis S, Krzyminska-Siemaszko R, Kaluzniak-Szymanowska A, Wieczorowska-Tobis K. Applying ACE-III, M-ACE and MMSE to Diagnostic Screening Assessment of Cognitive Functions within the Polish Population. International Journal of Environmental Research and Public Health. 2022; 19(19):12257. https://doi.org/10.3390/ijerph191912257
Chicago/Turabian StyleKaczmarek, Beata, Zofia Ilkowska, Sylwia Kropinska, Sławomir Tobis, Roma Krzyminska-Siemaszko, Aleksandra Kaluzniak-Szymanowska, and Katarzyna Wieczorowska-Tobis. 2022. "Applying ACE-III, M-ACE and MMSE to Diagnostic Screening Assessment of Cognitive Functions within the Polish Population" International Journal of Environmental Research and Public Health 19, no. 19: 12257. https://doi.org/10.3390/ijerph191912257