| Abstract: | Introduction: Mild Cognitive Impairment (MCI) is often mistaken to be caused by aging, and it is easily neglected among older adults. So far the prevalence among the elders aged 65 or above is about 18.67% in Taiwan. If there is a screening tool with higher sensitivity to assess MCI, it may detect suspected cases and provide relevant treatment to delay cognitive degradation. So far, MMSE is widely adopted domestically and internationally among several cognitive assessment tools. However, MMSE has lower sensitivity in detecting MCI. Thus, developing a cognitive assessment tool with higher sensitivity which is appropriate for Taiwanese population is necessary.
Purpose: In this study, ACE-III and MoCA, two cognitive assessment scales frequently adopted abroad to screen for MCI, were employed and compared with specificity of MMSE. In addition, the appropriate cut-off score of ACE-III to detect MCI for Taiwanese older population was also explored.
Methods: The participants were based on purposive sampling from a convenient community-based sample of older adults who were aged 65 or above from community care centers in Taichung, Taiwan. The data was collected through face-to-face interviews, and in total, 145 people completed the assessment.
Results: When using these cognitive assessment scales to screen for MCI, the weighted kappa of MMSE with ACE-III was 0.556, and that of MMSE with MoCA was 0.518. That indicated moderate consistency, whereas the weighted kappa of ACE-III with MoCA showed substantial consistency. When using MMSE as the golden standard, the sensitivity of ACE-III was 96.9% and its specificity was 37.5%. When using MoCA as the golden standard, the sensitivity of ACE-III was 93.8% and its specificity was 66.7%. When using MMSE and MoCA as validations to practice ROC curve, through the analysis the closest cut-off score between the two validations as 76.5 was selected (sensitivity: 84%, specificity: 85%), and the cut-off score as 76.5 was served as the cut-off in the study to screen for MCI. On the MMSE the findings in this study suggest that the subjects of âaged over 75â are at greater risk of suffering from MCI (OR=5.48, pï¼0.01). Regarding education, the subjects of âprimary high school or aboveâ are at lower risk of suffering from MCI (OR=0.18, pï¼0.05).On ACE-III itâs found that the subjects of âaged over 75â are at greater risk of suffering from MCI (OR=6.31, pï¼0.05). And on MoCA itâs also found that the subjects of âaged over 75â are at greater risk of suffering from MCI (OR=4.24 pï¼0.05); those of âprimary high school or aboveâ are at lower risk of suffering from MCI (OR=0.1, pï¼0.001),and those of âin cardiovascular diseaseâ are at lower risk of suffering from MCI (OR=0.30, pï¼0.05).
Conclusion: ACE-III and MoCA have substantial consistency. Meanwhile, ACE-III measures more dimensions of cognitive function. Thus, the traditional Chinese translation of ACE-III is suitable to be an assessment tool to detect MCI. Itâs suggested the neuropsychiatric assessment by psychiatrists can be combined with the screening assessment tools to detect MCI. We hope that more studies developed in the near future can provide more relevant evidence and make assessment tools with high sensitivity available clinically. |
