AUTHOR=Brown Pamela , Heirene Robert M. , Gareth-Roderique-Davies  , John Bev , Evans Jonathan J. 

TITLE=Applicability of the ACE-III and RBANS Cognitive Tests for the Detection of Alcohol-Related Brain Damage

JOURNAL=Frontiers in Psychology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2019.02636

DOI=10.3389/fpsyg.2019.02636

ISSN=1664-1078

ABSTRACT=<sec><title>Background and Aims</title><p>Recent investigations have highlighted the value of neuropsychological testing for the assessment and screening of Alcohol-Related Brain Damage (ARBD). The aim of the present study was to evaluate the suitability of the Addenbrooke’s Cognitive Examination (ACE-III) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) for this purpose.</p></sec><sec><title>Methods</title><p>Comparing 28 participants with ARBD (11 with Korsakoff’s Syndrome and 17 with the umbrella “ARBD” diagnosis) and 30 alcohol-dependent participants without ARBD (ALs) we calculated Area Under the Curve (AUC) statistics, sensitivity and specificity values, base-rate adjusted predictive values, and likelihood ratios for both tests.</p></sec><sec><title>Results</title><p>High levels of screening accuracy were found for the total scores of both the ACE-III (<italic>AUC</italic> = 0.823, 95% CIs [0.714, 0.932], <italic>SE</italic> = 0.056; optimal cut-off ≤86: sensitivity = 82%, specificity = 73%) and RBANS (<italic>AUC</italic> = 0.846, 95% CIs [0.746, 0.947], <italic>SE</italic> = 0.052; optimal cut-off ≤83: sensitivity = 89%, specificity = 67%) at multiple cut-off points. Removing participants with a history of polysubstance from the samples (10 ALs and 1 ARBD) improved the diagnostic capabilities of the RBANS substantially (<italic>AUC</italic> = 0.915, 95% CIs [0.831, 0.999], <italic>SE</italic> = 0.043; optimal cut-off ≤85: sensitivity = 98%, specificity = 80%), while only minor improvements to the ACE-III’s accuracy were observed (<italic>AUC</italic> = 0.854, 95% CIs [0.744, 0.963], <italic>SE</italic> = 0.056; optimal cut-off ≤88: sensitivity = 85%, specificity = 75%).</p></sec><sec><title>Conclusion</title><p>Overall, both the ACE-III and RBANS are suitable tools for ARBD screening within an alcohol-dependent population, though the RBANS is the superior of the two. Clinicians using these tools for ARBD screening should be cautious of false-positive outcomes and should therefore combine them with other assessment methods (e.g., neuroimaging, clinical observations) and more detailed neuropsychological testing before reaching diagnostic decisions.</p></sec>