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The revised Addenbrooke's Cognitive Examination can facilitate differentiation of dementia with Lewy bodies from Alzheimer's disease

Lookup NU author(s): Dr Paul Donaghy, Professor Alan ThomasORCiD, Professor John O'Brien



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


© 2020 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons Ltd. Objectives: Dementia with Lewy bodies (DLB) is a major cause of degenerative dementia, yet the diagnosis is often missed or mistaken for Alzheimer's disease (AD). We assessed whether the revised Addenbrooke's Cognitive Examination (ACE-R), a brief test for dementia, differentiates DLB from AD. Methods: We first compared baseline ACE-R performance in 76 individuals with DLB, 40 individuals with AD and 66 healthy controls. We then investigated the diagnostic accuracy of a simple standardised ‘memory/visuospatial’ ratio calculated from the ACE-R subscores. Finally, as a comparison a logistic regression machine learning algorithm was trained to classify between DLB and AD. Results: Individuals with AD had poorer memory (p = 0.001) and individuals with DLB had poorer visuospatial function (p = 0.005). Receiver operating characteristics curves confirmed that the ACE-R total score could differentiate dementia from non-dementia cases with 98% accuracy, but could not discriminate between dementia types (50%, or chance-level accuracy). However, a ‘memory/visuospatial’ ratio ≥1.1 differentiated DLB from AD with 82% sensitivity, 68% specificity and 77% mean accuracy. The machine learning classifier did not improve the overall diagnostic accuracy (74%) of the simple ACE-R subscores ratio. Conclusions: The ACE-R-based ‘memory/visuospatial’ ratio, but not total score, demonstrates good clinical utility for the differential diagnosis of DLB from AD.

Publication metadata

Author(s): Prats-Sedano MA, Savulich G, Surendranathan A, Donaghy PC, Thomas AJ, Rowe JB, Su L, O'Brien JT

Publication type: Article

Publication status: Published

Journal: International Journal of Geriatric Psychiatry

Year: 2021

Volume: 36

Issue: 6

Pages: 831-838

Print publication date: 01/06/2021

Online publication date: 04/12/2020

Acceptance date: 29/11/2020

Date deposited: 13/01/2021

ISSN (print): 0885-6230

ISSN (electronic): 1099-1166

Publisher: John Wiley and Sons Ltd


DOI: 10.1002/gps.5483

PubMed id: 33275793


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Funder referenceFunder name
The Lewy Body Society UK
NIHR Cambridge Biomedical Research Centre
NIHR Newcastle Biomedical Research Centre