Letter to the Editor
Validation of the Spanish-language version of Mini-Addenbrooke's Cognitive Examination as a dementia screening tool
Validación de la versión española del Mini-Addenbrooke's Cognitive Examination para el cribado de demencias
a Servicio de Neurología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria «San Carlos», Universidad Complutense, Madrid, Spain
b Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Institut d’Investigacions Biosanitàries Sant Pau, Universitat Oberta de Catalunya, Barcelona, Spain
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Matias-Guiu, R. Fernandez-Bobadilla" "autores" => array:2 [ 0 => array:3 [ "nombre" => "J.A." "apellidos" => "Matias-Guiu" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "R." "apellidos" => "Fernandez-Bobadilla" "email" => array:1 [ 0 => "rfernandezd@santpau.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neurología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria «San Carlos», Universidad Complutense, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neurología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Institut d’Investigacions Biosanitàries Sant Pau, Universitat Oberta de Catalunya, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Validación de la versión española del <span class="elsevierStyleItalic">Mini-Addenbrooke's Cognitive Examination</span> para el cribado de demencias" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1833 "Ancho" => 1683 "Tamanyo" => 113095 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">ROC curve for discriminating between patients with mild dementia and healthy controls.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The number of people who seek medical care due to cognitive symptoms has increased significantly in recent years, mainly due to the increase in the population's life expectancy. Cognitive assessments are essential in the differential diagnosis of dementia,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> since they contribute to treatment decision-making, which will affect the quality of life of patients and their families.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Quick cognitive screening tests are especially useful in our setting due to long waiting lists and limited resources that do not allow specialists to administer more thorough neuropsychological tests.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Addenbrooke's Cognitive Examination III (ACE-III)<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> has recently been validated in Spanish.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Both the current and previous versions of this test are widely used in memory units and dementia research centres around the world.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> The ACE-III is known for its ability to detect dementia and differentiate between dementia subtypes.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> However, its use is not as widespread as one might like since it takes 15-20<span class="elsevierStyleHsp" style=""></span>minutes to administer.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Hsieh et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> have developed and validated the Mini-Addenbrooke's Cognitive Examination (M-ACE), a brief version of the ACE-III. These authors reduced the original version using Mokken scaling<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> and administered the new version to patients with Alzheimer-type and frontotemporal dementia and to healthy controls. The Mini-Mental State Examination (MMSE) was used as the gold standard.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The M-ACE includes 5 items (orientation to time, semantic fluency, clock face drawing, immediate recall, and delayed recall) with a maximum score of 30. Maximum administration time is approximately 5<span class="elsevierStyleHsp" style=""></span>minutes. In the original validation study, scores<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>25/30 were identified as the cut-off point for dementia with both high sensitivity (85%) and specificity (87%). The M-ACE was found to be more sensitive than the MMSE and showed a less pronounced ceiling effect.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We have studied the psychometric properties of this new version of the ACE-III in our population using the same methodology applied by its authors and the complete sample recently gathered for the ACE-III validation study.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We selected items from the original questionnaire that are included in the M-ACE and created a new score. Of the 175 subjects comprising the sample, 92 were cognitively healthy controls (age: 77.0<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.4 years; education: 8.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.8 years) and 83 were patients (age: 78.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.8 years; education: 7.4<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>4.7 years) diagnosed with different types of dementia in mild stages: Alzheimer disease (46 patients, 55.4%), vascular dementia (4, 4.8%), mixed dementia (9, 10.8%), dementia associated with Parkinson's disease (11, 13.3%), Lewy body dementia (6, 7.2%); frontotemporal dementia (5, 6%), alcoholic dementia (1, 1.2%), and atypical parkinsonism with dementia (1, 1.2%). All participants were at least 65 and they were recruited from neurology departments at Hospital Clínico San Carlos in Madrid and Hospital de la Santa Creu i Sant Pau in Barcelona.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Our sample was significantly older and had a lower educational level than the sample in the study by Hsieh et al.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> In the reliability analysis, the scale showed high internal consistency (Cronbach <span class="elsevierStyleItalic">α</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.828).</p><p id="par0045" class="elsevierStylePara elsevierViewall">Results on the M-ACE were compared to those on the ACE-III and MMSE; clinical diagnosis of dementia was used as the factor for determining cut-off points (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). With an area under the curve (AUC)<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.94, M-ACE scores<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>16/30 were identified as the cut-off point for dementia with high levels of sensitivity (86.7%) and specificity (87.0%). This means that the M-ACE achieves better discrimination indices than the MMSE (AUC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.91; score<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>24/30; sensitivity<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>88.0; specificity<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>78.3) and the ACE-III (AUC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.92; score<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>65/100; sensitivity<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>83.1; specificity<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>80.4) (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">The M-ACE demonstrated a high diagnostic ability, with values above 85% for discrimination between healthy controls and subjects with mild dementia. The optimal cut-off point was 16.5, although a slightly higher point (17.5) would probably be recommendable to increase sensitivity, since this is the main purpose of a screening test. This cut-off point is below 25, the proposed threshold in the study of the English-language version. However, the original study only included patients with Alzheimer-type and frontotemporal dementia, who were also younger and more educated.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In conclusion, our study is the first to apply the M-ACE to a Spanish-speaking population, and it demonstrates the usefulness of this scale as a cognitive screening test. The short time required to administer the M-ACE suggests that this tool may be useful in centres with a greater care load or in less specialised centres. In addition, the higher sensitivity and specificity of the M-ACE compared to the ACE-III supports using the former even when the original long form is also administered. The M-ACE would therefore serve 2 purposes in neuropsychological assessment: it is a screening tool, especially when combined with the ACE-III, and also a short neuropsychological test since it includes the domains assessed by the ACE-III (attention, language, memory, verbal fluency, and visuospatial fluency).</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Matias-Guiu J, Fernandez-Bobadilla R. Validación de la versión española del <span class="elsevierStyleItalic">Mini-Addenbrooke's Cognitive Examination</span> para el cribado de demencias. Neurología. 2016;31:646–648.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1833 "Ancho" => 1683 "Tamanyo" => 113095 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">ROC curve for discriminating between patients with mild dementia and healthy controls.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The cut-off point found to be optimal is shown in bold.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">NPV: negative predictive value; PPV: positive predictive value; SEN: sensitivity; SPE: specificity.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Score \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">M-ACE</th><th class="td" title="table-head " align="left" valign="top" scope="col">Score \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">MMSE</th><th class="td" title="table-head " align="left" valign="top" scope="col">Score \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">ACE-III</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SEN \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SPE \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PPV (NPV) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SEN \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SPE \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SEN \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">SPE \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">19/20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70.8 (95.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27/28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">40.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">68/69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">18/19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.0 (92.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26/27 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">67/68 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">17/18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">82.8 (92.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25/26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">66/67 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">16/17</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85.7 (87.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">24/25</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">88.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">65/66</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">15/16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">89.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.0 (83.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">23/24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">78.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">87.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64/65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">81.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">14/15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.0 (80.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22/23 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63/64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">80.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1255811.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cut-off points for a diagnosis of mild dementia.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 36 | 7 | 43 |
| 2024 September | 50 | 15 | 65 |
| 2024 August | 34 | 21 | 55 |
| 2024 July | 32 | 8 | 40 |
| 2024 June | 43 | 5 | 48 |
| 2024 May | 25 | 2 | 27 |
| 2024 April | 44 | 13 | 57 |
| 2024 March | 36 | 7 | 43 |
| 2024 February | 34 | 6 | 40 |
| 2024 January | 30 | 4 | 34 |
| 2023 December | 20 | 8 | 28 |
| 2023 November | 36 | 16 | 52 |
| 2023 October | 47 | 29 | 76 |
| 2023 September | 20 | 3 | 23 |
| 2023 August | 19 | 10 | 29 |
| 2023 July | 30 | 7 | 37 |
| 2023 June | 10 | 3 | 13 |
| 2023 May | 15 | 9 | 24 |
| 2023 April | 9 | 1 | 10 |
| 2023 March | 11 | 5 | 16 |
| 2023 February | 21 | 2 | 23 |
| 2023 January | 26 | 2 | 28 |
| 2022 December | 18 | 3 | 21 |
| 2022 November | 37 | 9 | 46 |
| 2022 October | 26 | 10 | 36 |
| 2022 September | 30 | 8 | 38 |
| 2022 August | 27 | 14 | 41 |
| 2022 July | 23 | 9 | 32 |
| 2022 June | 22 | 11 | 33 |
| 2022 May | 25 | 5 | 30 |
| 2022 April | 24 | 8 | 32 |
| 2022 March | 21 | 10 | 31 |
| 2022 February | 14 | 3 | 17 |
| 2022 January | 22 | 5 | 27 |
| 2021 December | 41 | 8 | 49 |
| 2021 November | 39 | 9 | 48 |
| 2021 October | 39 | 13 | 52 |
| 2021 September | 16 | 13 | 29 |
| 2021 August | 23 | 4 | 27 |
| 2021 July | 25 | 15 | 40 |
| 2021 June | 26 | 9 | 35 |
| 2021 May | 28 | 11 | 39 |
| 2021 April | 25 | 16 | 41 |
| 2021 March | 23 | 12 | 35 |
| 2021 February | 19 | 9 | 28 |
| 2021 January | 20 | 11 | 31 |
| 2020 December | 21 | 7 | 28 |
| 2020 November | 16 | 13 | 29 |
| 2020 October | 19 | 9 | 28 |
| 2020 September | 16 | 8 | 24 |
| 2020 August | 17 | 11 | 28 |
| 2020 July | 17 | 11 | 28 |
| 2020 June | 13 | 9 | 22 |
| 2020 May | 25 | 15 | 40 |
| 2020 April | 6 | 6 | 12 |
| 2020 March | 25 | 8 | 33 |
| 2020 February | 11 | 11 | 22 |
| 2020 January | 23 | 12 | 35 |
| 2019 December | 21 | 7 | 28 |
| 2019 November | 10 | 9 | 19 |
| 2019 October | 21 | 4 | 25 |
| 2019 September | 22 | 8 | 30 |
| 2019 August | 12 | 15 | 27 |
| 2019 July | 18 | 14 | 32 |
| 2019 June | 44 | 16 | 60 |
| 2019 May | 148 | 7 | 155 |
| 2019 April | 52 | 10 | 62 |
| 2019 March | 9 | 6 | 15 |
| 2019 February | 9 | 2 | 11 |
| 2019 January | 4 | 10 | 14 |
| 2018 December | 5 | 1 | 6 |
| 2018 November | 14 | 3 | 17 |
| 2018 October | 13 | 1 | 14 |
| 2018 September | 6 | 3 | 9 |
| 2018 August | 4 | 2 | 6 |
| 2018 July | 7 | 2 | 9 |
| 2018 June | 4 | 1 | 5 |
| 2018 May | 8 | 6 | 14 |
| 2018 April | 9 | 1 | 10 |
| 2018 March | 6 | 1 | 7 |
| 2018 February | 5 | 2 | 7 |
| 2018 January | 10 | 5 | 15 |
| 2017 December | 1 | 0 | 1 |
| 2017 November | 8 | 2 | 10 |
| 2017 October | 6 | 4 | 10 |
| 2017 September | 9 | 2 | 11 |
| 2017 August | 10 | 2 | 12 |
| 2017 July | 12 | 2 | 14 |
| 2017 June | 11 | 13 | 24 |
| 2017 May | 13 | 6 | 19 |
| 2017 April | 12 | 9 | 21 |
| 2017 March | 7 | 46 | 53 |
| 2017 February | 21 | 2 | 23 |
| 2017 January | 16 | 1 | 17 |
| 2016 December | 37 | 6 | 43 |
| 2016 November | 14 | 7 | 21 |
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