Supplementary Material for: Adaption and validation of the Greek version of Addenbrooke's Cognitive Examination III scale as a screening tool for perioperative cognitive impairment detection

Introduction: Postoperative cognitive dysfunction constitutes an extremely prevalent implication in individuals subjected to cardiac or non-cardiac surgery. This study aims 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
a 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 (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.

引言：术后认知功能障碍是接受心脏或非心脏手术患者中极为常见的并发症。本研究旨在评估经文化调适的希腊语版爱丁堡认知评估量表第三版（Addenbrooke’s Cognitive Examination III, ACE-III）作为老年手术患者围手术期神经认知状态筛查工具的效度与信度。

方法：本研究为横断面研究，开展了研究工具的跨文化调适与验证工作。研究样本纳入128名年龄55岁以上、拟接受外科手术的受试者。所有受试者均接受两次筛查：分别在术前门诊及手术前一日，使用已成熟的蒙特利尔认知评估量表（Montreal Cognitive Assessment, MoCA）及经文化调适的希腊语版ACE-III量表进行评估。以MoCA得分<26的受试者作为认知功能受损组。

结果：就结构效度而言，ACE-III检测认知功能受损的表现优异（曲线下面积AUC=0.942；95%置信区间CI 0.899~0.971）。ACE-III与MoCA量表间的会聚效度极佳（相关系数r=0.876；95%CI 0.839~0.905）。已知组别效度得到验证，高龄与较低教育水平会对ACE-III总分产生负面影响（p<0.001）。此外，专家评估显示其表面效度良好（平均得分8.7/10，标准差SD=1.1）。在信度方面，ACE-III展现出良好的内部一致性（克朗巴赫α系数Cronbach's alpha=0.786），以及较高的评定者间信度（组内相关系数Intraclass Correlation Coefficient, ICC=0.936，95%CI 0.921~0.941）与重测信度（ICC=0.972，95%CI 0.958~0.981）。

结论：希腊语版ACE-III是一款效度与信度俱佳的筛查工具，可常规应用于围手术期场景，作为MoCA测试的有效替代方案，用于区分轻度认知功能受损者与拟接受外科手术的健康老年受试者。