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The Amazing Journey of ACE-III: Why has this test become the gold standard in cognitive assessment?
In the world of exploring cognitive health, Addenbrooke's Cognitive Examination-III (ACE-III) is undoubtedly an important tool that has been widely adopted in recent years. ACE-III not only helps medical professionals quickly and accurately assess patients' cognitive function, but also plays a key role in fighting dementia and other mental health challenges.
Historical Background of ACE
The origins of ACE can be traced back to the Mini-Mental State Examination (MMSE), a test designed to measure cognitive function. The birth of ACE aims to fill the theoretical gap of MMSE and further improve its screening effectiveness. The test covers five major cognitive domains: attention/orientation, memory, language, verbal fluency and visuospatial skills, and is scored out of 100, with higher scores indicating better cognitive function.
ACE recommends judgment scores of 88 and 83 and reports good sensitivity and specificity in identifying different forms of dementia and other memory and judgment disorders.
For example, in the initial validation study of ACE, the sensitivity and specificity of ACE could reach 0.93 and 0.71, respectively. This shows the effectiveness of ACE in identifying cognitive impairment at an early stage and lays the foundation for the subsequent development of ACE-R and ACE-III.
Structure and function of ACE-III
The latest version of the ACE-III consists of 19 activities that test five major cognitive domains. Each area has its own specific testing method:
Attention
In the attention test, patients were asked to answer the current date, season and location; repeat three simple words; and perform serial subtraction. This might include problems such as "Subtract 7 from 100, and then continue subtracting 7 from each new number."
Memory
The memory test required patients to recall three words that had just been repeated, as well as remembering and recalling a fictitious name and address, and some well-known historical facts. The memory section is divided into five different sections spread out throughout the test.
Verbal Fluency
Verbal fluency is tested by asking the patient to say the number of words beginning with a specified letter in one minute. For example, the examiner might ask the person to list all the words that begin with the letter C.
Language skills
This section provides a comprehensive test of the patient's language ability, including having the patient complete a sequence of physical instructions, such as "Put the paper on top of the pencil." In addition, they are required to write two grammatically complete sentences, repeat some multi-syllable words and two short proverbs, and name the objects shown in 12 pictures.
Visuospatial Ability
Visual-spatial skills are also extremely important in everyday life. The ACE-III measures visuospatial abilities by asking patients to copy two charts, draw a clock face set to a specific time, and identify partially occluded letters.
Evaluation Criteria
The results of each activity are scored, resulting in an overall score from 0 to 100. Attention accounts for 18 points, memory accounts for 26 points, verbal fluency accounts for 14 points, language accounts for 26 points, and visuospatial processing accounts for 16 points. A normal ACE-III score is 88 or above; scores below 83 are considered abnormal, while scores between 83 and 87 are considered indeterminate.
Effectiveness of ACE-III
Preliminary validity studies have shown that ACE-III, as a rapid cognitive assessment tool, can be completed in about 15 minutes and is highly correlated with ACE-R. According to a 2019 Cochrane systematic review, ACE-III should be used as an adjunct to a comprehensive clinical assessment rather than solely relied upon for screening for dementia or mild cognitive impairment.
Cross-language applications
The ACE-III test has been translated into 19 languages and localized for users in different regions, including Australia, India, the United States, the United Kingdom and New Zealand.
The Birth of Mini ACE
In 2014, a simplified version of ACE-III, Mini-ACE (M-ACE), was born. This version of the test takes no more than five minutes and covers attention, memory, letter fluency, clock drawing and memory recall, with a total score of 30, with higher scores indicating better cognitive function. Scores of 25 and 21 are considered critical scores for this test.
The results of the mini-ACE showed that it is superior to the MMSE in terms of diagnostic utility and should be used as an auxiliary tool for comprehensive clinical assessment.
The development of ACE-III is not only an important milestone in the field of cognitive assessment, but also provides a powerful support tool for medical professionals, especially in the early detection of dementia. In the face of growing cognitive health challenges, should we recognize the potential of these diagnostic tools and incorporate them into our daily health checks?
