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      Brazilian adaptation of the Addenbrooke’s Cognitive Examination-Revised (ACE-R) Translated title: Adaptação brasileira do Exame Cognitivo de Addenbrooke-Revisado

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          Abstract

          The Addenbrooke’s Cognitive Examination-Revised (ACE-R) is a highly sensitive and specific tool for the detection of mild dementia. It is particularly useful in differentiating Alzheimer’s disease from frontotemporal dementia. While the first version of the test battery has been adapted in many countries, its revised version has not, probably because it was published very recently.

          Objective

          To translate and adapt the ACE-R for use in the Brazilian population.

          Methods

          Two independent translations were made from English into Portuguese, followed by two independent back-translations. Few adaptations in accordance to the Brazilian culture and language were made and a first version of the instrument produced. This former version of the ACE-R was administered to 21 cognitively healthy subjects aged 60 years or more, with different educational levels.

          Results

          The mean age of the studied sample of healthy elderly was 75.4 years (ranging from 60 to 89 years). Small additional modifications were necessary after the evaluation of the first ten subjects in order to improve comprehension of the test. The final Portuguese version of the ACE-R was produced and was found to be well understood by the remaining 11 subjects, taking an average of 15 minutes to be administered.

          Conclusions

          The Brazilian version of the ACE-R proved to be a promising cognitive instrument for testing both in research and clinical settings. With this regard, additional studies are currently being carried out in our unit in order to investigate the diagnostic properties of the ACE-R in our milieu.

          Translated abstract

          A Addenbrooke’s Cognitive Examination - Versão Revisada (ACE-R) é um instrumento com elevada sensibilidade e especificidade para detectar demência em estágio leve. Ela é particularmente útil para diferenciar a doença de Alzheimer da demência frontotemporal. Enquanto a primeira versão desta bateria foi adaptada em vários países, a versão revisada ainda não, provavelmente por ter sido publicada muito recentemente.

          Objetivo

          Traduzir e adaptar a ACE-R para uso na população brasileira.

          Métodos

          Foram feitas duas traduções independentes do Inglês para o Português, seguidas de duas retro-traduções também independentes. Algumas adaptações de acordo com a cultura brasileira e a língua portuguesa foram realizadas e a primeira versão brasileira do instrumento produzida. Esta foi administrada a 21 sujeitos saudáveis com idades de 60 anos ou mais, com diferentes níveis de escolaridade.

          Resultados

          A média de idade da amostra de idosos estudada foi de 75,4 anos (variando de 60 a 89 anos de idade). Após a avaliação dos dez primeiros indivíduos foi necessário realizar pequenas alterações com o objetivo de melhorar a compreensão do teste. A versão final em Português da ACE-R foi produzida e se mostrou de fácil entendimento pelos onze participantes restantes, tendo tempo médio de aplicação de 15 minutos.

          Conclusões

          A versão brasileira da ACE-R provou ser um instrumento promissor de avaliação cognitiva promissor para a pesquisa e para a prática clínica. Estudos adicionais estão sendo realizados em nossa unidade para investigar as propriedades diagnósticas da ACE-R em nosso meio.

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          Most cited references41

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          A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia.

          To validate a simple bedside test battery designed to detect mild dementia and differentiate AD from frontotemporal dementia (FTD). Addenbrooke's Cognitive Examination (ACE) is a 100-point test battery that assesses six cognitive domains. Of 210 new patients attending a memory clinic, 139 fulfilled inclusion criteria and comprised dementia (n = 115) and nondementia (n = 24) groups. The composite and the component scores on the ACE for the two groups were compared with those of 127 age- and education-matched controls. Norms and the probability of diagnosing dementia at different prevalence rates were calculated. To evaluate the ACE's ability to differentiate early AD from FTD, scores of the cases diagnosed with dementia with a Clinical Dementia Rating 3.2 for AD was highly discriminating. The ACE is a brief and reliable bedside instrument for early detection of dementia, and offers a simple objective index to differentiate AD and FTD in mildly demented patients.
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            Clock drawing in Alzheimer's disease. A novel measure of dementia severity.

            We have tested a simple and reliable measure of visuospatial ability in Alzheimer patients--the Clock Drawing Test. To determine the usefulness of this measure, we asked 67 Alzheimer patients and 83 normal controls to draw the face of a clock reading the time of 2:45. Six independent observers blindly evaluated the results with ratings from 10 (best) to 1 (worst). The mean performance score of Alzheimer subjects was 4.9 +/- 2.7 compared to 8.7 +/- 1.1 for normal controls (P less than .001). Inter-rater reliability for the clocks drawn by Alzheimer patients was highly significant (r = 0.86; P less than .001), and there was relatively little overlap between ratings for Alzheimer patients and normal controls. Furthermore, correlations were highly significant (P less than .001) between the mean score of clock drawings and three independent global measures of dementia severity. Although the Clock Drawing Test is certainly not a definitive indicator of Alzheimer's disease, the test is easy to administer and provides a useful measure of dementia severity for both research and office settings where sophisticated neuropsychological testing is not available.
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              [The Mini-Mental State Examination in a general population: impact of educational status].

              To assess the influence of age and education on cognitive performance in our population, 530 adults were interviewed using the MMSE (Mini-Mental Status Examination). Education level, classified as illiterate, elementary and middle ( 8 years), was a significant predictor of performance (p or = 65 years). The reference cut-off values were taken from the fifth percent lowest score for each group: illiterate, 13; elementary and middle, 18; and high, 26. When compared to 94 patients with cognitive impairment, our cut-off values achieved high sensitivity (82.4% for illiterates; 75.6% for elementary and middle; 80% for high) and specificity (97.5% for illiterate; 96.6% for elementary and middle; 95.6% for high educational level). Education-specific reference values for the MMSE are necessary in interpreting individual test results in populations of low educational level, in order to reduce the false positive results.
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                Author and article information

                Journal
                Dement Neuropsychol
                Dement Neuropsychol
                dn
                Dementia & Neuropsychologia
                Associação de Neurologia Cognitiva e do Comportamento
                1980-5764
                Apr-Jun 2007
                Apr-Jun 2007
                : 1
                : 2
                : 212-216
                Affiliations
                [1 ]Post-graduate program in Neurology, University of Sao Paulo School of Medicine, São Paulo (SP), Brazil.
                [2 ]Behavioral and Cognitive Neurology Unit, Department of Internal Medicine, Faculty of Medicine of the Federal University of Minas Gerais, Belo Horizonte (MG), Brazil.
                Author notes
                Dr. Paulo Caramelli – Associate Professor of Neurology. Coordinator of the Behavioral and Cognitive Neurology Unit / Faculty of Medicine, Federal University of Minas Gerais - Avenida Prof. Alfredo Balena 190 / Room 4070 - 30130-100 Belo Horizonte MG - Brazil. E-mail: caramelp@ 123456usp.br
                Article
                10.1590/s1980-57642008dn10200015
                5619571
                29213390
                76e5a337-a953-4f06-8a2f-7df86a77bf8c

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Categories
                Original Articles

                dementia,diagnosis,cognitive evaluation,addenbrooke’s cognitive examination-revised,cultural adaptation,brazil

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