The Addenbrooke's Cognitive Examination Revised (ACE‐R): a brief cognitive test battery for dementia screening

TLDR

The study aimed to validate a revised Addenbrooke's Cognitive Examination (ACE‑R) that incorporates five sub‑domain scores to provide a brief, sensitive, and specific dementia screening tool. The authors evaluated the ACE‑R in 241 participants—including Alzheimer’s, frontotemporal dementia, Lewy body dementia, MCI, and controls—using standard dementia screening metrics and found a high internal consistency (α = 0.80). The ACE‑R showed significant correlation with the Clinical Dementia Scale (r = −0.321), yielded two optimal cut‑offs (88 and 82) with high sensitivity and specificity, produced a 100:1 likelihood ratio at the 82 cut‑off, and distinguished MCI from controls and AD, confirming its validity as a sensitive dementia screening test.

Abstract

There is a clear need for brief, but sensitive and specific, cognitive screening instruments as evidenced by the popularity of the Addenbrooke's Cognitive Examination (ACE).We aimed to validate an improved revision (the ACE-R) which incorporates five sub-domain scores (orientation/attention, memory, verbal fluency, language and visuo-spatial).Standard tests for evaluating dementia screening tests were applied. A total of 241 subjects participated in this study (Alzheimer's disease=67, frontotemporal dementia=55, dementia of Lewy Bodies=20; mild cognitive impairment-MCI=36; controls=63).Reliability of the ACE-R was very good (alpha coefficient=0.8). Correlation with the Clinical Dementia Scale was significant (r=-0.321, p<0.001). Two cut-offs were defined (88: sensitivity=0.94, specificity=0.89; 82: sensitivity=0.84, specificity=1.0). Likelihood ratios of dementia were generated for scores between 88 and 82: at a cut-off of 82 the likelihood of dementia is 100:1. A comparison of individual age and education matched groups of MCI, AD and controls placed the MCI group performance between controls and AD and revealed MCI patients to be impaired in areas other than memory (attention/orientation, verbal fluency and language).The ACE-R accomplishes standards of a valid dementia screening test, sensitive to early cognitive dysfunction.