Background: The Addenbrooke’s Cognitive
Examination (ACE-III) was developed to offer a
sensitive screening tool for dementia. Yet despite
limited evidence to support its use, it is increasingly
utilized within neurorehabilitation.
Aim: Our aim was to explore whether the ACEIII norms provide sensitive cut-off values for
assessment in community neurorehabilitation and
examine how the ACE-III correlates with measures
of functional impairment.
Design, subjects and setting: This descriptive
study included 49 traumatic brain injury (TBI)
patients, 39 male, mean age 39.9years (SD=15.2),
assessed within a community head injury service
at a median of 13months (interquartile range
Method: Measures of test utility were performed
on patient ACE-III data using predetermined cutoffs.1 Subsequent correlation analysis was carried
out between ACE-III domains and equivalent
Mayo-Portland Adaptability Inventory (MPAI-IV)
scores, an established measure of functional ability
Results: Based on the cut-offs of 88/82, the ACEIII displayed a sensitivity of 0.59/0.42 and a false
negative rate of 0.41/0.59 at the respective values.
These findings of sensitivity are just above chance
level and suggest that neither the low or high
specificity cut-offs had sufficient predictive value in
our TBI population.
Further analysis specified a weak negative
correlation between the ACE-III total scores
and converted t-scores of the MPAI-IV abilities
subcategory (r=–0.316, P<0.05), indicating
better ACE-III scores are associated with greater
However, subsequent non-parametric tests, despite
showing appropriate directionality, found no
significant correlations between the ACE-III cognitive
domains and the equivalent MPAI-IV scores for
attention (τ=–0.139, P=0.13), memory (τ=–.151,
P=0.09), fluency (τ=–0.083, P=0.24), language (τ=–
0.105, P=0.18) and visuospatial skills (τ=–0.074,
P=0.28). Thus, the relationship between ACE-III
performance and functional abilities is not clear.
Discussion: Our data suggest the ACE-III is not
sensitive enough to be applied quantitatively in
community neurorehabilitation. Yet as ACE-III
performance is correlated with functional abilities,
it may still be a useful qualitative measure in the
neuropsychological evaluation of TBI patients.
Conclusion: The ACE-III should not be
applied as a quantitative measure in community
neurorehabilitation unless further experimental
research can demonstrate its utility in TBI.
1. Hsieh S, Schubert S, Hoon C, et al. Validation of the
Addenbrooke’s cognitive examination III in frontotemporal dementia and Alzheimer’s disease. Dement Geriatr
Cogn Disord 2013; 36: 242–250.
2. Kean J, Malec JF, Altman IM, et al. Rasch measurement
analysis of the mayo-Portland adaptability inventory in
a community-based rehabilitation sample. J Neurotrauma
2011; 28: 745–753.