Brazilian adaptation of the Addenbrooke's Cognitive Examination-Revised (ACE-R)

Carvalho, Viviane Amaral; Caramelli, Paulo

doi:10.1590/S1980-57642008DN10200015

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.

Key words:
dementia; diagnosis; cognitive evaluation; Addenbrooke's Cognitive Examination-Revised; cultural adaptation; Brazil.

Resumo

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.

Palavras-chave:
demência; diagnóstico; avaliação cognitiva; Addenbrooke's Cognitive Examination-Versão Revisada; adaptação transcultural; Brasil.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

¹
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil: avaliação cognitiva e funcional. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:720-727.
²
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil: avaliação cognitiva e funcional. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:720-727.
³
Bertolucci PHF, Brucki SMD, Campacci S, Juliano Y. O Mini-Exame do Estado Mental em uma população geral. Impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.
⁴
Almeida O. Mini-Exame do Estado Mental e o diagnóstico de demência no Brasil. Arq Neuropsiquiatr 1998;56:605-612.
⁵
Caramelli P, Herrera Jr E, Nitrini R. O Mini-Exame do Estado Mental no diagnóstico de demência em idosos analfabetos. Arq Neuropsiquiatr 1999;57:(Suppl 1):S7.
⁶
Laks J, Batista EMR, Guilherme ERL et al. O Mini Exame do Estado Mental em idosos de uma comunidade: dados parciais de Santo Antonio de Pádua, Rio de Janeiro. Arq Neuropsiquiatr 2003;61:782-785.
⁷
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-181.
⁸
Burns A, Lawlor B, Craig S. Blessed Dementia Scale (incorporating the Information-Memory Concentration (ICM) Test and the Dementia Scale. Assessment Scales in Old Age Psychiatry. London: Martin Dunitz; 1999:40-41.
⁹
Burns A, Lawlor B, Craig S. Cognitive Abilities Screening Instrument (CASI). Assessment Scales in Old Age Psychiatry. London: Martin Dunitz;1999:63.
¹⁰
Ng RTY, Damasceno A, Delicio AM, et al. Validation of mini-test CASI-S in a sample of Brazilian population (Abstr.). J Int Neuropsychol Soc 2001;7:420.
¹¹
Damasceno A, Mazo DFC, Ng RTY, et al. Validation of mini-test CASI-S in a sample of Brazilian population. Arq Neuropsiquiatr 2005;63:416-421.
¹²
Bertolucci PH, Okamoto IH, Brucki SM, Siviero MO, Toniolo J Neto, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001;59:532-536.
¹³
Morris JC, Heyman A, Mohs RC, et al. The Consortium to Establish a Registry for Alzheimer's disease (CERAD): Part 1. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165.
¹⁴
Roth M, Tym E, Mountjoy CQ, et al. CAMDEX - A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry 1986;149:698-709.
¹⁵
Bottino CMC, Stoppe Jr A, Scalco AZ, Ferreira RCR, Hototian SR, Scalco MZ. Validade e confiabilidade da versão brasileira do CAMDEX. Arq Neuropsiquiatr 2001;59(Suppl 3):S20.
¹⁶
Gomes JA. Avaliação neuropsicológica nas fases inicial e moderada da demência do tipo Alzheimer. Dissertação. Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo; 1999.
¹⁷
Ostrosky-Solís F, Roselli MA. NEUROPSI: a brief neuropsychological test battery in Spanish with norms by age and educational level. J Int Neuropsychol Soc 1999;5:413-433.
¹⁸
Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry 1984;141:1356-1364.
¹⁹
Schultz RR. Desempenho de uma população brasileira na sub-escala cognitiva da Escala de Avaliação da Doença de Alzheimer (ADAS-Cog). Dissertação. Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo;1999.
²⁰
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demências. Arq Neuropsiquiatr 1994;52:457-465.
²¹
Nitrini R, Caramelli P, Herrera E Jr, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.
²²
Takada LT, Caramelli P, Fichman HC, et al. Comparison between two tests of delayed recall for the diagnosis of dementia. Arq Neuropsiquiatr 2006;64:35-40.
²³
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dementia & Neuropsychologia 2007;1:32-36.
²⁴
Sunderland T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's disease:A novel measure of dementia severity. J Am Geriatr Soc 1989; 37:725-729.
²⁵
Mathuranath OS, Nestor PJ, Berrios GE, Rakowicz W, Hodges JR. A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia. Neurology 2000;55:1613-1620.
²⁶
Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 2006;21:1078-1085.
²⁷
Gregory CA, Orrell M, Sahakian B, Hodges JR. Can frontotemporal dementia and Alzheimer's disease be differentiated using a brief battery of tests? Int J Geriatr Psychiatry 1997;12:375-383.
²⁸
Hodges JR, Patterson K, Ward R, et al. The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer's disease: a comparative neuropsychological study. Neuropsychology 1999;13:31-40.
²⁹
Pachana NA, Boone KB, Miller BL, Cummings JL, Berman N. Comparison of neuropsychological functioning in Alzheimer's disease and frontotemporal dementia. J Int Neuropsychol Soc 1996;2:505-510.
³⁰
Alexopoulos P, Greim B, Nadler K et al. Validation of the Addenbrooke's cognitive examination for detecting early Alzheimer's disease and mild vascular dementia in a German population. Dement Geriatr Cogn Disord 2006;22:385-391.
³¹
Sarasola D, de Lujan-Calcagno M, Sabe L, et al. Validity of the Spanish version of the Addenbrooke's Cognitive Examination for the diagnosis of dementia and to differentiate Alzheimer's disease and frontotemporal dementia. Rev Neurol 2005;41:717-21.
³²
Bier JC, Donckels V, Van Eyll E, et al. The French Addenbrooke's cognitive examination is effective in detecting dementia in a French-speaking population. Dement Geriatr Cogn Disord. 2005;19:15-7.
³³
Bier JC, Ventura M, Donckels V, et al.. Is the Addenbrooke's cognitive examination effective to detect frontotemporal dementia? J Neurol 2004;251:428-31.
³⁴
Garcia-Caballero A, Garcia-Lado I, Gonzalez-Hermida J, et al. Validation of the Spanish version of the Addenbrooke's Cognitive Examination in a rural community in Spain. Int J Geriatr Psychiatr 2006;21:239-45.
³⁵
Mathuranath PS, Hodges JR, Mathew R, Cherian PJ, George A, Bak TH. Adaptation of the ACE for a Malayalam speaking population in southern India. Int J Geriatr Psychiatry 2004;19:1188-94.
³⁶
Newman JP. Brief assessment of cognitive mental status in Hebrew: Addenbrooke's Cognitive Examination. Isr Med Assoc J 2005;7451-7.
³⁷
Beato RG , Nitrini R, Formigoni AP, Caramelli P. Brazilian version of the frontal assessment battery (FAB): preliminary data on administration to healthy elderly. Dement Neuropsychol 2007;1:59-65.
³⁸
Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology 2000;55:1621-1626.
³⁹
Slachevsky A, Villalpando JM, Sarazin M, Hahn-Barma V, Pillon B, Dubois B. Frontal assessment battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Arch Neurol 2004;61:1104-1107.
⁴⁰
Iavarone A, Ronga B, Pellegrino L et al. The Frontal Assessment Battery (FAB): normative data from an Italian sample and performances of patients with Alzheimer's disease and frontotemporal dementia. Funct Neurol 2004;19:191-5.
⁴¹
Nakaaki S, Murata Y, Sato J et al. Reliability and validity of the Japanese version of the Frontal Assessment Battery in patients with the frontal variant of frontotemporal dementia. Psychiatry Clin Neurosci 2007;61:78-83.

Publication Dates

Publication in this collection
Apr-Jun 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil: avaliação cognitiva e funcional. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:720-727.

[2] ²
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil: avaliação cognitiva e funcional. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:720-727.

[3] ³
Bertolucci PHF, Brucki SMD, Campacci S, Juliano Y. O Mini-Exame do Estado Mental em uma população geral. Impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.

[4] ⁴
Almeida O. Mini-Exame do Estado Mental e o diagnóstico de demência no Brasil. Arq Neuropsiquiatr 1998;56:605-612.

[5] ⁵
Caramelli P, Herrera Jr E, Nitrini R. O Mini-Exame do Estado Mental no diagnóstico de demência em idosos analfabetos. Arq Neuropsiquiatr 1999;57:(Suppl 1):S7.

[6] ⁶
Laks J, Batista EMR, Guilherme ERL et al. O Mini Exame do Estado Mental em idosos de uma comunidade: dados parciais de Santo Antonio de Pádua, Rio de Janeiro. Arq Neuropsiquiatr 2003;61:782-785.

[7] ⁷
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do Mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-181.

[8] ⁸
Burns A, Lawlor B, Craig S. Blessed Dementia Scale (incorporating the Information-Memory Concentration (ICM) Test and the Dementia Scale. Assessment Scales in Old Age Psychiatry. London: Martin Dunitz; 1999:40-41.

[9] ⁹
Burns A, Lawlor B, Craig S. Cognitive Abilities Screening Instrument (CASI). Assessment Scales in Old Age Psychiatry. London: Martin Dunitz;1999:63.

[10] ¹⁰
Ng RTY, Damasceno A, Delicio AM, et al. Validation of mini-test CASI-S in a sample of Brazilian population (Abstr.). J Int Neuropsychol Soc 2001;7:420.

[11] ¹¹
Damasceno A, Mazo DFC, Ng RTY, et al. Validation of mini-test CASI-S in a sample of Brazilian population. Arq Neuropsiquiatr 2005;63:416-421.

[12] ¹²
Bertolucci PH, Okamoto IH, Brucki SM, Siviero MO, Toniolo J Neto, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001;59:532-536.

[13] ¹³
Morris JC, Heyman A, Mohs RC, et al. The Consortium to Establish a Registry for Alzheimer's disease (CERAD): Part 1. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165.

[14] ¹⁴
Roth M, Tym E, Mountjoy CQ, et al. CAMDEX - A standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry 1986;149:698-709.

[15] ¹⁵
Bottino CMC, Stoppe Jr A, Scalco AZ, Ferreira RCR, Hototian SR, Scalco MZ. Validade e confiabilidade da versão brasileira do CAMDEX. Arq Neuropsiquiatr 2001;59(Suppl 3):S20.

[16] ¹⁶
Gomes JA. Avaliação neuropsicológica nas fases inicial e moderada da demência do tipo Alzheimer. Dissertação. Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo; 1999.

[17] ¹⁷
Ostrosky-Solís F, Roselli MA. NEUROPSI: a brief neuropsychological test battery in Spanish with norms by age and educational level. J Int Neuropsychol Soc 1999;5:413-433.

[18] ¹⁸
Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry 1984;141:1356-1364.

[19] ¹⁹
Schultz RR. Desempenho de uma população brasileira na sub-escala cognitiva da Escala de Avaliação da Doença de Alzheimer (ADAS-Cog). Dissertação. Escola Paulista de Medicina da Universidade Federal de São Paulo (UNIFESP), São Paulo;1999.

[20] ²⁰
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demências. Arq Neuropsiquiatr 1994;52:457-465.

[21] ²¹
Nitrini R, Caramelli P, Herrera E Jr, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.

[22] ²²
Takada LT, Caramelli P, Fichman HC, et al. Comparison between two tests of delayed recall for the diagnosis of dementia. Arq Neuropsiquiatr 2006;64:35-40.

[23] ²³
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dementia & Neuropsychologia 2007;1:32-36.

[24] ²⁴
Sunderland T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's disease:A novel measure of dementia severity. J Am Geriatr Soc 1989; 37:725-729.

[25] ²⁵
Mathuranath OS, Nestor PJ, Berrios GE, Rakowicz W, Hodges JR. A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia. Neurology 2000;55:1613-1620.

[26] ²⁶
Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 2006;21:1078-1085.

[27] ²⁷
Gregory CA, Orrell M, Sahakian B, Hodges JR. Can frontotemporal dementia and Alzheimer's disease be differentiated using a brief battery of tests? Int J Geriatr Psychiatry 1997;12:375-383.

[28] ²⁸
Hodges JR, Patterson K, Ward R, et al. The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer's disease: a comparative neuropsychological study. Neuropsychology 1999;13:31-40.

[29] ²⁹
Pachana NA, Boone KB, Miller BL, Cummings JL, Berman N. Comparison of neuropsychological functioning in Alzheimer's disease and frontotemporal dementia. J Int Neuropsychol Soc 1996;2:505-510.

[30] ³⁰
Alexopoulos P, Greim B, Nadler K et al. Validation of the Addenbrooke's cognitive examination for detecting early Alzheimer's disease and mild vascular dementia in a German population. Dement Geriatr Cogn Disord 2006;22:385-391.

[31] ³¹
Sarasola D, de Lujan-Calcagno M, Sabe L, et al. Validity of the Spanish version of the Addenbrooke's Cognitive Examination for the diagnosis of dementia and to differentiate Alzheimer's disease and frontotemporal dementia. Rev Neurol 2005;41:717-21.

[32] ³²
Bier JC, Donckels V, Van Eyll E, et al. The French Addenbrooke's cognitive examination is effective in detecting dementia in a French-speaking population. Dement Geriatr Cogn Disord. 2005;19:15-7.

[33] ³³
Bier JC, Ventura M, Donckels V, et al.. Is the Addenbrooke's cognitive examination effective to detect frontotemporal dementia? J Neurol 2004;251:428-31.

[34] ³⁴
Garcia-Caballero A, Garcia-Lado I, Gonzalez-Hermida J, et al. Validation of the Spanish version of the Addenbrooke's Cognitive Examination in a rural community in Spain. Int J Geriatr Psychiatr 2006;21:239-45.

[35] ³⁵
Mathuranath PS, Hodges JR, Mathew R, Cherian PJ, George A, Bak TH. Adaptation of the ACE for a Malayalam speaking population in southern India. Int J Geriatr Psychiatry 2004;19:1188-94.

[36] ³⁶
Newman JP. Brief assessment of cognitive mental status in Hebrew: Addenbrooke's Cognitive Examination. Isr Med Assoc J 2005;7451-7.

[37] ³⁷
Beato RG , Nitrini R, Formigoni AP, Caramelli P. Brazilian version of the frontal assessment battery (FAB): preliminary data on administration to healthy elderly. Dement Neuropsychol 2007;1:59-65.

[38] ³⁸
Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: a Frontal Assessment Battery at bedside. Neurology 2000;55:1621-1626.

[39] ³⁹
Slachevsky A, Villalpando JM, Sarazin M, Hahn-Barma V, Pillon B, Dubois B. Frontal assessment battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Arch Neurol 2004;61:1104-1107.

[40] ⁴⁰
Iavarone A, Ronga B, Pellegrino L et al. The Frontal Assessment Battery (FAB): normative data from an Italian sample and performances of patients with Alzheimer's disease and frontotemporal dementia. Funct Neurol 2004;19:191-5.

[41] ⁴¹
Nakaaki S, Murata Y, Sato J et al. Reliability and validity of the Japanese version of the Frontal Assessment Battery in patients with the frontal variant of frontotemporal dementia. Psychiatry Clin Neurosci 2007;61:78-83.

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