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Addenbrooke’s Cognitive Examination III: Psychometric Characteristics and Relations to Functional Ability in Dementia

  • Matthew So (a1) (a2), David Foxe (a2) (a3), Fiona Kumfor (a2) (a3), Cynthia Murray (a2) (a3), Sharpley Hsieh (a2) (a3), Greg Savage (a1) (a2), Rebekah M. Ahmed (a2) (a4), James R. Burrell (a2) (a5), John R. Hodges (a4), Muireann Irish (a2) (a3) and Olivier Piguet (a2) (a3)...


Objectives: The Addenbrooke’s Cognitive Examination (ACE) is a common cognitive screening test for dementia. Here, we examined the relationship between the most recent version (ACE-III) and its predecessor (ACE-R), determined ACE-III cutoff scores for the detection of dementia, and explored its relationship with functional ability. Methods: Study 1 included 199 dementia patients and 52 healthy controls who completed the ACE-III and ACE-R. ACE-III total and domain scores were regressed on their corresponding ACE-R values to obtain conversion formulae. Study 2 included 331 mixed dementia patients and 87 controls to establish the optimal ACE-III cutoff scores for the detection of dementia using receiver operator curve analysis. Study 3 included 194 dementia patients and their carers to investigate the relationship between ACE-III total score and functional ability. Results: Study 1: ACE-III and ACE-R scores differed by ≤1 point overall, the magnitude varying according to dementia type. Study 2: a new lower bound cutoff ACE-III score of 84/100 to detect dementia was identified (compared with 82 for the ACE-R). The upper bound cutoff score of 88/100 was retained. Study 3: ACE-III scores were significantly related to functional ability on the Clinical Dementia Rating Scale across all dementia syndromes, except for semantic dementia. Conclusions: This study represents one of the largest and most clinically diverse investigations of the ACE-III. Our results demonstrate that the ACE-III is an acceptable alternative to the ACE-R. In addition, ACE-III performance has broader clinical implications in that it relates to carer reports of functional impairment in most common dementias. (JINS, 2018, 24, 854–863)


Corresponding author

Correspondence and reprint requests to: Olivier Piguet, FRONTIER, Brain and Mind Centre, Level 1, M02F, 94 Mallett Street, Camperdown, NSW 2050. E-mail:


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ABS. (2012). Who are Australia’s older people? Reflecting a nation: Stories from the 2011 Census. Canberra. Retrieved from
Brugnolo, A., Nobili, F., Barbieri, M.P., Dessi, B., Ferro, A., Girtler, N., & Rodriguez, G. (2009). The factorial structure of the mini mental state examination (MMSE) in Alzheimer’s disease. Archives of Gerontology and Geriatrics, 49(1), 180185. doi:
Cheung, G., Clugston, A., Croucher, M., Malone, D., Mau, E., Sims, A., & Gee, S. (2015). Performance of three cognitive screening tools in a sample of older New Zealanders. International Journal of Psychogeriatrics, 27(6), 981989. doi: 10.1017/s1041610214002889
Costa, J., Swash, M., & de Carvalho, M. (2012). Awaji criteria for the diagnosis of amyotrophic lateral sclerosis: A systematic review. Archives of Neurology, 69(11), 14101416. doi: 10.1001/archneurol.2012.254
de Vugt, M.E., & Verhey, F.R.J. (2013). The impact of early dementia diagnosis and intervention on informal caregivers. Progress in Neurobiology, 110, 5462. doi:
DeKosky, S.T., & Marek, K. (2003). Looking backward to move forward: Early detection of neurodegenerative disorders. Science, 302(5646), 830834.
Elamin, M., Holloway, G., Bak, T.H., & Pal, S. (2016). The utility of the Addenbrooke’s Cognitive Examination Version Three in Early-Onset Dementia. Dementia and Geriatric Cognitive Disorders, 41(1–2), 915.
Flanagan, E.C., Tu, S., Ahmed, S., Hodges, J.R., & Hornberger, M. (2014). Memory and orientation in the logopenic and nonfluent subtypes of primary progressive aphasia. Journal of Alzheimer’s Disease, 40(1), 3336.
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research, 12(3), 189198.
Ganguli, M., Ratcliff, G., Huff, F.J., Belle, S., Kancel, M.J., Fischer, L., & Kuller, L.H. (1990). Serial sevens versus world backwards: A comparison of the two measures of attention from the MMSE. Journal of Geriatric Psychiatry and Neurology, 3(4), 203207.
Giebel, C.M., & Challis, D. (2016). Sensitivity of the Mini-Mental State Examination, Montreal Cognitive Assessment and the Addenbrooke’s Cognitive Examination III to everyday activity impairments in dementia: An exploratory study. International Journal of Geriatric Psychiatry. doi: 10.1002/gps.4570
Gorno-Tempini, M.L., Hillis, A.E., Weintraub, S., Kertesz, A., Mendez, M., Cappa, S.F., & Grossman, M. (2011). Classification of primary progressive aphasia and its variants. Neurology, 76(11), 10061014. doi: 10.1212/WNL.0b013e31821103e6
Graham, K.S., Lambon, M.A., & Hodges, R.J.R. (1997). Determining the impact of autobiographical experience on “meaning”: New insights from investigating sports-related vocabulary and knowledge in two cases with semantic dementia. Cognitive Neuropsychology, 14(6), 801837.
Hodges, J.R., Bozeat, S., Ralph, M.A.L., Patterson, K., & Spatt, J. (2000). The role of conceptual knowledge in object use: Evidence from semantic dementia. Brain, 123(9), 19131925. doi: 10.1093/brain/123.9.1913
Hsieh, S., Schubert, S., Hoon, C., Mioshi, E., & Hodges, J.R. (2013). Validation of the Addenbrooke’s Cognitive Examination III in frontotemporal dementia and Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 36(3-4), 242250. doi: 10.1159/000351671
Jubb, M.T., & Evans, J.J. (2015). An investigation of the utility of the Addenbrooke’s Cognitive Examination III in the early detection of dementia in memory clinic patients aged over 75 years. Dementia and Geriatric Cognitive Disorders, 40(3-4), 222232.
Litvan, I., Agid, Y., Calne, D., Campbell, G., Dubois, B., Duvoisin, R.C., & Zee, D.S. (1996). Clinical research criteria for the diagnosis of progressive supranuclear palsy (Steele-Richardson-Olszewski syndrome): Report of the NINDS-SPSP international workshop. Neurology, 47(1), 19.
Mathew, R., Bak, T.H., & Hodges, J.R. (2012). Diagnostic criteria for corticobasal syndrome: A comparative study. Journal of Neurology, Neurosurgery, & Psychiatry, 83(4), 405410. doi: 10.1136/jnnp-2011-300875
Mathuranath, P.S., Nestor, P.J., Berrios, G.E., Rakowicz, W., & Hodges, J.R. (2000). A brief cognitive test battery to differentiate Alzheimer’s disease and frontotemporal dementia. Neurology, 55(11), 16131620.
Matias-Guiu, J.A., Cortes-Martinez, A., Valles-Salgado, M., Rognoni, T., Fernandez-Matarrubia, M., Moreno-Ramos, T., & Matias-Guiu, J. (2017). Addenbrooke’s cognitive examination III: Diagnostic utility for mild cognitive impairment and dementia and correlation with standardized neuropsychological tests. International Psychogeriatrics, 29(1), 105113. doi: 10.1017/s1041610216001496
Matías-Guiu, J.A., Fernández-Bobadilla, R., Fernández-Oliveira, A., Valles-Salgado, M., Rognoni, T., Cortés-Martínez, A., & Matías-Guiu, J. (2016). Normative data for the Spanish version of the Addenbrooke’s Cognitive Examination III. Dementia and Geriatric Cognitive Disorders, 41(5-6), 243250.
Matias-Guiu, J.A., Valles-Salgado, M., Rognoni, T., Hamre-Gil, F., Moreno-Ramos, T., & Matias-Guiu, J. (2017). Comparative diagnostic accuracy of the ACE-III, MIS, MMSE, MoCA, and RUDAS for screening of Alzheimer disease. Dementia and Geriatric Cognitive Disorders, 43(5-6), 237246. doi: 10.1159/000469658
McKhann, G.M., Knopman, D.S., Chertkow, H., Hyman, B.T., Jack, C.R. Jr., Kawas, C.H., & Phelps, C.H. (2011). The diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s & Dementia, 7(3), 263269. doi: 10.1016/j.jalz.2011.03.005
Mioshi, E., Dawson, K., Mitchell, J., Arnold, R., & Hodges, J.R. (2006). The Addenbrooke’s Cognitive Examination Revised (ACE-R): A brief cognitive test battery for dementia screening. International Journal of Geriatric Psychiatry, 21(11), 10781085. doi: 10.1002/gps.1610
Mioshi, E., Flanagan, E., & Knopman, D. (2017). Detecting clinical change with the CDR-FTLD: Differences between FTLD and AD dementia. International Journal of Geriatric Psychiatry, 32(9), 977982.
Mioshi, E., Hsieh, S., Savage, S., Hornberger, M., & Hodges, J.R. (2010). Clinical staging and disease progression in frontotemporal dementia. Neurology, 74(20), 15911597.
Mioshi, E., Kipps, C., Dawson, K., Mitchell, J., Graham, A., & Hodges, J. (2007). Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology, 68(24), 20772084.
Morris, J.C. (1997). Clinical dementia rating: A reliable and valid diagnostic and staging measure for dementia of the Alzheimer type. International Psychogeriatrics, 9(Suppl. 1), 173176; discussion 177–178.
O’Bryant, S.E., Waring, S.C., Cullum, C.M., Hall, J., Lacritz, L., & Massman, P.J., ... Texas Alzheimer’s Research Consortium. (2008). Staging dementia using Clinical Dementia Rating Scale Sum of Boxes scores: A Texas Alzheimer’s Research Consortium Study. Archives of Neurology, 65(8), 10911095. doi: 10.1001/archneur.65.8.1091
O’Connor, C.M., Clemson, L., Hornberger, M., Leyton, C.E., Hodges, J.R., Piguet, O., & Mioshi, E. (2016). Longitudinal change in everyday function and behavioral symptoms in frontotemporal dementia. Neurology: Clinical Practice, 6(5), 419428. doi: 10.1212/cpj.0000000000000264
Pigliautile, M., Ricci, M., Mioshi, E., Ercolani, S., Mangialasche, F., Monastero, R., & Mecocci, P. (2011). Validation study of the Italian Addenbrooke’s Cognitive Examination Revised in a young-old and old-old population. Dementia and Geriatric Cognitive Disorders, 32(5), 301307. doi: 10.1159/000334657
Qassem, T., Khater, M.S., Emara, T., Rasheedy, D., Tawfik, H.M., Mohammedin, A.S., & Abdel Aziz, K. (2015). Normative data for healthy adult performance on the Egyptian–Arabic Addenbrooke’s Cognitive Examination III. Middle East Current Psychiatry, 22(1), 2736. doi: 10.1097/01.XME.0000457267.05731.0f
Rascovsky, K., Hodges, J.R., Knopman, D., Mendez, M.F., Kramer, J.H., Neuhaus, J., & Miller, B.L. (2011). Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain, 134(Pt 9), 24562477. doi: 10.1093/brain/awr179
Strong, M.J., Grace, G.M., Freedman, M., Lomen-Hoerth, C., Woolley, S., Goldstein, L.H., & Figlewicz, D. (2009). Consensus criteria for the diagnosis of frontotemporal cognitive and behavioural syndromes in amyotrophic lateral sclerosis. Amyotrophic Lateral Sclerosis, 10(3), 131146.
Tang-Wai, D.F., Graff-Radford, N.R., Boeve, B.F., Dickson, D.W., Parisi, J.E., Crook, R., & Petersen, R.C. (2004). Clinical, genetic, and neuropathologic characteristics of posterior cortical atrophy. Neurology, 63(7), 11681174.
Torralva, T., Roca, M., Gleichgerrcht, E., Bonifacio, A., Raimondi, C., & Manes, F. (2011). Validation of the Spanish version of the Addenbrooke’s Cognitive Examination-Revised (ACE-R). Neurologia, 26(6), 351356. doi: 10.1016/j.nrl.2010.10.013
Valcour, V.G., Masaki, K.H., & Blanchette, P.L. (2002). The phrase: “no ifs, ands, or buts” and cognitive testing. Lessons from an Asian-American community. Hawaii Nedical Journal, 61(4), 7274.
Weintraub, S., Wicklund, A.H., & Salmon, D.P. (2012). The neuropsychological profile of Alzheimer’s disease. Cold Spring Harbor Perspectives in Medicine, 2(4), a006171. doi: 10.1101/cshperspect.a006171
Yoshida, H., Terada, S., Honda, H., Kishimoto, Y., Takeda, N., Oshima, E., & Uchitomi, Y. (2012). Validation of the revised Addenbrooke’s Cognitive Examination (ACE-R) for detecting mild cognitive impairment and dementia in a Japanese population. International Psychogeriatrics, 24(1), 2837. doi: 10.1017/s1041610211001190


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