Validity of Addenbrooke's Cognitive Examination to Discriminate between Incipient Dementia and Depression in Elderly Patients of a Private Clinic in Lima, Peru

Abstract

Background/aims: Dementia and depression are different clinical conditions, but share common features, and can be indistinguishable in the initial disease stages. We aimed to establish whether the Peruvian version of the Addenbrooke's Cognitive Examination (ACE-Peru) can distinguish between the cognitive profile in patients with incipient dementia and that in patients with depression.

Methods: This was a cross-sectional study to assess the performance on the ACE-Peru of 193 elderly subjects (102 with dementia, 21 with depression, and 70 healthy controls). Depending on the diagnosis, there were two groups of cognitive impairment (CI) - the primary neurodegenerative (PN-CI) subtype and the secondary to depression (SD-CI) subtype - as well as a non-CI group. The area under the curve (AUC) of the receiver-operating characteristic curve was determined to compare the diagnostic performance, using the diagnosis of CI as the gold standard.

Results: In our sample of elderly subjects aged 59-82 years with at least 7 years of education, the ACE-Peru showed a significantly better performance than the MMSE (AUC = 0.997 vs. AUC = 0.887; p < 0.05) for the discrimination between PN-CI and SD-CI.

Conclusions: The ACE-Peru is able to distinguish between the cognitive profile in patients with incipient dementia and that in patients with depression.

Keywords: Addenbrooke's Cognitive Examination; Dementia; Depression; Differential diagnosis.

Fig. 1

ROC curves for the discrimination between SD-CI and PN-CI by means of the ACE in comparison to the MMSE in 193 subjects attending the Neurology Consulting Room of the Clínica Internacional.

Fig. 2

ROC curves for the discrimination between SD-CI and non-CI by means of the ACE in comparison to the MMSE in 193 subjects attending the Neurology Consulting Room of the Clínica Internacional.