Assessment of the MMSE, MoCA, and ACE-R for Screening Mild Vascular Cognitive Impairment

Aim: Vascular cognitive impairment (VCI), which affects many people, is important to distinguish from other types of cognitive impairment because vascular risk factors can slow the onset and progression of the disease. In our study, we aimed to determine the most appropriate cognitive screening tool. Methods: The study included 110 patients with minor VCI and a control group of 90 volunteers aged over 55 and was conducted between July 2024 and September 2025. The diagnosis of mild VCI was determined according to DSM-5 criteria. The Montreal Cognitive Assessment (MoCA), the Standardized Mini-Mental State Examination (MMSE), and the Addenbrooke's Cognitive Examination Test (ACE-R) were administered to all participants. Results: Our findings demonstrate that all three screening tools significantly differentiate patients with mild VCI from healthy controls. ACE-R had the highest area under the curve (AUC=0.967) and showed 90% sensitivity and 100% specificity at a cutoff point of 68.5. MoCA also showed relatively high sensitivity (86.4%) and specificity (91.1%), with high diagnostic accuracy (AUC = 0.946). In contrast, MMSE showed slightly lower diagnostic performance (AUC=0.926) but still had high specificity (92.2%). Conclusion: Our study shows that ACE-R is the most accurate screening tool for detecting mild vascular cognitive impairment, closely followed by MoCA, while MMSE, though useful, may be less sensitive in the early stages. Further studies involving larger, multicenter cohorts and different subtypes of vascular cognitive impairment are needed.