Not so hard
I don't know how others, but I felt that Madness mode... Isn't mad enough. Alright, it's harder, so game at last poses some challenge (imagine my face, when I died durong fight woth final boss... just to find out that I have two lifes left!). I don't know if I'm so good at it (doubt it) or rather ot runs slow on my computer, still, most bossfights were pretty straight-forward.
As for Madness game as Madness game, I believe this is more Madness rhan Madness Interactive... (Yes, that's a compliment :) ) Still, headshots would be useful, as the game is sometimes overdid. I mean it. In movies, when Hank/Sanfords and Daimos meet unarmed guy, they shoot him or punch him, and he's dead. He wasn't standing up after a while, and giving you faceload of matrix style flying kicks (and you are the one flying :D ).
So, overally, because of some small problems with Hank not listening to you or obeying you too slow, I give the game 90% score, because it deserves it.
(Hey, I haven't given Tom's game 10/10! I hope that won't mean I'll get thrown out of NG or what ;) )