Objective: To establish clinical utility of the Addenbrooke’s Cognitive Examination (ACE) in assessing cognition in patients with multiple sclerosis. We have compared the ACE to to the MMSE, and explored relationships between ACE score, EDSS, lesion load on MRI and atrophy.
Methods: Subjects were 83 patients with multiple sclerosis seen at the Gold Coast MS Clinic. ACE and MMSE assessments were undertaken. Demographic and EDSS data were recorded. The total parenchymal lesion load and intercaudate ratio (ICR) calculated from contemporaneous MRI brain images.
Results: 14 patients demonstrated cognitive impairment on the ACE (scoring <86/100), with 8 patients detected by the MMSE (scoring <27/30). A correlation between low ACE score and greater disability was seen. ACE score also correlated with lesion load and ICR.
Discussion: The ACE is a more sensitive screening test than the MMSE in our study. The MMSE has been shown to be insensitive in MS patients but due to familiarity and ease of administration it remains a popular screening tool. The ACE has advantages compared to formal psychometric batteries being quick to administer and also being free. Subcortical atrophy in MS can be approximated by linear measures such as the ICR. Prior studies showed an increased ICR in association with cognitive dysfunction, EDSS and disease duration. Our findings suggest that the ACE can detect the cognitive decline associated with subcortical atrophy. We also find association between higher EDSS scores and measured subcortical atrophy.