Comparison of Mini-Mental State Examination and Addenbrooke's Cognitive Examination III in detection of cognitive impairment in patients with type 2 diabetes

Introduction There is an increased prevalence of cognitive impairment (CI) in patients with type 2 diabetes; thus, there is a need for a sensitive and a convenient screening tool for its detection. While Mini-Mental State Examination (MMSE) is a widely used tool for the assessment of cognition, it is not available for free for research. Hindi version of Addenbrooke's Cognitive Examination III is a freely available cognition assessment tool that has been widely used on diverse group of diseases including diabetes. Aims and objectives To assess cognitive function in patients with type 2 diabetes using Hindi version of ACE-III and compare its performance with MMSE. Materials and methods Cognition was assessed using validated Hindi version of ACE-III and MMSE among 54 participants with type 2 diabetes and similar number of age, sex, and educational status matched healthy controls. The cut-off for CI was taken at 82/100 for ACE-III, and for MMSE, education level-based cut-offs were used: 21 for the illiterate group, 22 for the low education group, 23 for the middle education group, and 24 for the high education group. Results Mean age of the study population was 64.5 +/- 5.3 years. The average duration of diabetes was 8.5 +/- 6.0 years with mean HbA1C of 8.8 +/- 2.5%. Both the tools showed high prevalence of CI among cases, but ACE-III was more sensitive in detection of CI when compared to MMSE (64.8% vs. 55.6%). There was a good agreement between ACE-III and MMSE outcomes (Cohen's kappa = 0.732). Conclusion Type 2 diabetes mellitus is an independent risk factor for cognitive decline in elderly patients. ACE-III is an easy to use, sensitive, and freely available screening tool for cognition assessment in diabetes population.