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. 2019 May 6;9(2):51.
doi: 10.3390/diagnostics9020051.

MACE for Diagnosis of Dementia and MCI: Examining Cut-Offs and Predictive Values

Andrew J Larner  1
Affiliations

MACE for Diagnosis of Dementia and MCI: Examining Cut-Offs and Predictive Values

Andrew J Larner. Diagnostics (Basel). .

Abstract

The definition of test cut-offs is a critical determinant of many paired and unitary measures of diagnostic or screening test accuracy, such as sensitivity and specificity, positive and negative predictive values, and correct classification accuracy. Revision of test cut-offs from those defined in index studies is frowned upon as a potential source of bias, seemingly accepting any biases present in the index study, for example related to sample bias. Data from a large pragmatic test accuracy study examining the Mini-Addenbrooke's Cognitive Examination (MACE) were interrogated to determine optimal test cut-offs for the diagnosis of dementia and mild cognitive impairment (MCI) using either the maximal Youden index or the maximal correct classification accuracy. Receiver operating characteristic (ROC) and precision recall (PR) curves for dementia and MCI were also plotted, and MACE predictive values across a range of disease prevalences were calculated. Optimal cut-offs were found to be a point lower than those defined in the index study. MACE had good metrics for the area under the ROC curve and for the effect size (Cohen's d) for both dementia and MCI diagnosis, but PR curves suggested the superiority for MCI diagnosis. MACE had high negative predictive value at all prevalences, suggesting that a MACE test score above either cut-off excludes dementia and MCI in any setting.

Keywords: Mini-Addenbrooke’s Cognitive Examination; dementia; diagnosis; mild cognitive impairment.

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Conflict of interest statement

The author declares no conflict of interest.

Figures

Figure 1
Figure 1
Mini-Addenbrooke’s Cognitive Examination (MACE) scores versus patient diagnosis (n = 755). MCI: mild cognitive impairment; SMC: subjective memory complaint.
Figure 2
Figure 2
MACE receiver operating characteristic (ROC) plots for the diagnosis of dementia (upper; area under the curve (AUC) = 0.89) and MCI (lower; AUC = 0.81) with chance diagonal (y = x) and anti-diagonal (y = 1 − x) lines.
Figure 3
Figure 3
MACE precision recall (PR) curves for the diagnosis of dementia (lower) and MCI (upper); note the reversal of position versus ROC curves.
See this image and copyright information in PMC

References

    1. Hsieh S., McGrory S., Leslie F., Dawson K., Ahmed S., Butler C.R., Rowe J.B., Mioshi E., Hodges J.R., et al. The Mini-Addenbrooke’s Cognitive Examination: A new assessment tool for dementia. Dement. Geriatr. Cogn. Disord. 2015;39:1–11. doi: 10.1159/000366040. - DOI - PMC - PubMed
    1. Matias-Guiu J.A., Fernandez-Bobadilla R. Validation of the Spanish-language version of Mini-Addenbrooke’s Cognitive Examination as a dementia screening tool [in Spanish] Neurologia. 2016;31:646–648. doi: 10.1016/j.nrl.2014.10.005. - DOI - PubMed
    1. Larner A.J. Mini-Addenbrooke’s Cognitive Examination: A pragmatic diagnostic accuracy study. Int. J. Geriatr. Psychiatry. 2015;30:547–548. doi: 10.1002/gps.4258. - DOI - PubMed
    1. Williamson J.C., Larner A.J. MACE for diagnosis of dementia and MCI: 3-year pragmatic diagnostic test accuracy study. Dement. Geriatr. Cogn. Disord. 2018;45:300–307. doi: 10.1159/000484438. - DOI - PubMed
    1. Larner A.J. Free-Cog: Pragmatic test accuracy study. Dement. Geriatr. Cogn. Disord. 2019;48 accepted. - PubMed