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

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. 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. High levels of screening accuracy were found for the total scores of both the ACE-III ( = 0.823, 95% CIs [0.714, 0.932], = 0.056; optimal cut-off ≤86: sensitivity = 82%, specificity = 73%) and RBANS ( = 0.846, 95% CIs [0.746, 0.947], = 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 ( = 0.915, 95% CIs [0.831, 0.999], = 0.043; optimal cut-off ≤85: sensitivity = 98%, specificity = 80%), while only minor improvements to the ACE-III's accuracy were observed ( = 0.854, 95% CIs [0.744, 0.963], = 0.056; optimal cut-off ≤88: sensitivity = 85%, specificity = 75%). 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.