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Article Abstract
Introduction: Postoperative cognitive dysfunction constitutes an extremely prevalent implication in individuals subjected to cardiac or noncardiac surgery. This study aimed to assess the validity and reliability of a culturally adapted Greek version of the Addenbrooke's Cognitive Examination III (ACE-III) scale as a screening tool for perioperative neurocognitive status determination in elderly surgical patients.
Methods: A cross-cultural adaptation and validation of instruments throughout the cross-sectional study was conducted. The study sample consisted of 128 individuals over 55 years old scheduled for surgical intervention. All participants were screened twice: at the preadmission clinic and the day before surgery using the already established MoCA scale and the culturally adapted Greek version of the ACE-III scale. Subjects with a MoCA score of <26 constituted the cognitively impaired group.
Results: Regarding construct validity, ACE-III's performance in detecting cognitive impairment was excellent (AUC = 0.942; 95% CI: 0.899-0.971). Convergent validity between ACE-III and MoCA scales was excellent (r = 0.876; 95% CI: 0.839-0.905). Known group validity was confirmed since advanced age and lower educational attainment adversely impacted ACE-III's total score (p < 0.001). Additionally, specialists suggested face validity (mean 8.7 out of 10, SD 1.1). In terms of reliability, ACE-III demonstrated good internal consistency (Cronbach's alpha 0.786) and high inter-rater (intraclass correlation coefficient [ICC] = 0.936 [95% CI: 0.921-0.941]) and test-retest reliability (ICC = 0.972 [95% CI: 0.958-0.981]).
Conclusion: The Greek version of ACE-III is a valid and reliable screening tool that could be routinely employed perioperatively as a valid alternative to the MoCA test to distinguish the mild cognitively impaired from healthy elderly candidates for surgical interventions.
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