Dados do Trabalho

Título

ACE-III CUT-OFF SCORES FOR DISCRIMINATING BETWEEN MILD COGNITIVE IMPAIRMENT AND DEMENTIA IN PARKINSON'S DISEASE BY EDUCATIONAL LEVEL

Introdução

Parkinson’s disease (PD) is the second most common neurodegenerative disorder characterized by motor and nonmotor symptoms. Since the early stages, about 20-30% of patients have some cognitive impairment and some of them progress to a dementia syndrome.

Objetivo

To investigate the diagnostic accuracy, sensitivity and specificity, of the Addenbrooke’s Cognitive Examination (ACE-III), by educational level ranges, for the diagnosis of mild cognitive impairment and dementia in PD.

Método

150 patients and 60 healthy controls participated in this study. Normal cognition, mild cognitive impairment and dementia were judged in accordance with the respective criteria of the Movement Disorder Society, level II. The diagnostic accuracy of the battery was investigated through the analysis of the ROC (Receiver Operating Characteristic), 95% CI, curves to check the sensitivity and specificity of the cut-off points (total and domains cut-off scores of the ACE-III), for distinguish between mild cognitive impairment in PD (MCI-PD) and healthy controls, besides dementia in PD (D-PD) and healthy controls. The best cut-off point was chosen to balance sensitivity and specificity. Subsequently, was applied the ROC analysis in comparison of different educational levels.

Resultados

Cut-off scores were better for discriminating healthy controls from D-PD, mainly in the educational level above 10-12, 78 points, 100% sensitivity and 100% specificity, AUC = 1 (95% CI [1;1]), then in the subgroup >= 13 years of schooling, obtaining a score of 83, 75% sensitivity and 100% specificity, AUC = 0.9167 95% CI [0.73; 1]) and, finally, 4-9 years of schooling, with a score of 78, sensitivity of 81.82% and specificity of 62.50%, AUC = 0.8504 (95% CI [0.69; 1]). To distinguish healthy controls from MCI-PD, the cut-off scores were also better in the subgroup with higher schooling, that is, >= 13 years, obtained a score of 91, sensitivity of 73.08% and specificity of 77.78%, AUC = 0.8312 (95% CI [0.67; 0.98]). Then, the subgroup 10-12 years, with a score of 85, sensitivity of 47% and specificity of 74.07%, AUC = 0.7089 (95% CI [0.60; 0.83]). Finally, the subgroup 4-9 years, with a score of 81, sensitivity of 60% and specificity of 50%, AUC = 0.6110 (95% CI [0.46; 0.75]).

Conclusão

This battery can, therefore, be used as a quick and efficient tool in the assessment of PD-associated cognitive deficits in clinical practice, even more so in hospital contexts, where the use of instruments with good discriminatory and brief ability is required.

Palavras-chave

Parkinson's disease; Cognitive dysfunctions; Data accuracy; Educational level.