ORIGINAL RESEARCH article
Front. Dement.
Sec. Aging and Risk Factors for Dementia
This article is part of the Research TopicInsights in Dementia: 2024View all 10 articles
Accuracy of the revised Addenbrooke Cognitive Examination (ACE-R) and Mini-Mental (MMSE) in a Quilombola community with low education attainment: Results of a cross-sectional study
Provisionally accepted
João de Deus Cabral Júnior1Bruno Luciano Carneiro Alves1
Sharon Sanz Simon2
Jhule Silva Passinho3
Carolina Cappi2
Laiss Bertola4,5
Cândida Lopes Alves3Vanda Simões1
GILBERTO SOUSA ALVES1,3,6*- 1Universidade Federal do Maranhao, São Luís, Brazil
- 2Rutgers Institute for Health Health Care Policy and Aging Research, New Brunswick, United States
- 3Nina Rodrigues Hospital, São Luís do Maranhão, Brazil
- 4Universidade de Sao Paulo, São Paulo, Brazil
- 5Faculdade de Ciencias Medicas de Minas Gerais, Belo Horizonte, Brazil
- 6Universidade Federal do Rio de Janeiro Instituto de Psiquiatria, Rio de Janeiro, Brazil
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ABSTRACT Background: Illiteracy may overestimate screening test interpretation for older adults with suspected cognitive decline. In rural areas of Brazil, the illiteracy rate and the lack of valid cognitive instruments may postpone the diagnosis of cognitive disorders. Objective: To determine the diagnostic accuracy of the Addenbrooke's Cognitive Examination (ACE-R) and Mini-Mental State Exam (MMSE) as well as the prevalence of mild cognitive impairment (MCI) for older adults with low education in a Quilombola community placed in Northeast Brazil, compared to cognitively healthy. Methods: 204 participants were collected from a sociodemographic and clinical evaluation and were subsequently the ACE-R and MMSE. Among them, 25 subjects presented MCI, and 179 were classified as cognitively healthy. Results: The prevalence of MCI was 12.3%; optimal accuracy yielded highest values for the comparison between controls and MCI for both ACE-R [Area Under the Curve (AUC) = 0.96)] and MMSE (AUC= 0.96). Conclusions: These findings support establishing reliable cutoff scores for cognitive assessment of older adults with low educational attainment, living in rural areas.
Keywords: Mild Cognitive Impairment, Cognitive screening, quilombolas, Illiterate, Addenbrooke, accuracy, Mini-Mental State Exam
Received: 25 Jul 2025; Accepted: 08 Dec 2025.
Copyright: © 2025 Cabral Júnior, Carneiro Alves, Simon, Silva Passinho, Cappi, Bertola, Alves, Simões and ALVES. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: GILBERTO SOUSA ALVES
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