Validation Study of the Chinese Version of Addenbrooke's Cognitive Examination III for Diagnosing Mild Cognitive Impairment and Mild Dementia

Abstract

Background and Purpose There are only a few cognitive screening tests for the Chinese-speaking population, and so this study aimed to validate the Chinese version of Addenbrooke's Cognitive Examination III (ACE-III) for detecting mild cognitive impairment (MCI) and mild dementia. Its diagnostic accuracy was compared with the Chinese versions of the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). Methods The 176 included individuals were divided into 3 groups: mild dementia group, MCI group, and normal control group. MMSE, MoCA, and ACE-III were administered to all participants by researchers who were blinded to the clinical grouping. The receiver operating characteristic (ROC) curves were analyzed. Results ACE-III exhibited good internal consistency and convergent validity. Age and education level significantly influenced the total ACE-III scores. When screening MCI, the area under the ROC curve (AUC) was significantly larger for ACE-III than for MMSE (0.88 vs. 0.72, p <0.05) and MoCA (0.88 vs. 0.76, p <0.05). ACE-III showed higher sensitivity (0.75) and specificity (0.89) than MMSE (0.64 and 0.63, respectively) and MoCA (0.67 and 0.77) at the optimal cutoff score of 88/89. For detecting mild dementia, ACE-III yielded satisfactory sensitivity (0.94) and specificity (0.83) at the optimal cutoff score of 74/75. The AUC of ACE-III was 0.95, which was comparable to those of MMSE (0.95) and MoCA (0.91). In participants with ≥12 years of education, the AUC was significantly larger for ACE-III than for MMSE when detecting MCI (0.90 vs. 0.68, p <0.05) and mild dementia (0.97 vs. 0.90, p <0.05). Conclusions The present study has verified that ACE-III is a reliable and accurate tool for screening MCI and mild dementia in the Chinese-speaking population, and is significantly superior to MMSE and MoCA for detecting MCI.

Validation of the Addenbrooke’s Cognitive Examination-III in Mild Cognitive Impairment in Arabic Speakers in Egypt

“…The original validation study of the English-language version of ACE-III did not investigate MCI [4]. Validations of the ACE-III in other languages in MCI revealed comparable optimal cut-off scores to our study: 75/76 for the Thai-language version [11], 73/74 for the Spanish-language version [10], 82 for the Portuguese-language version [9], 88/89 for the Japanese-language version [8], 77/78 for the Malay-language version [6], 88/89 for the Chinese-language version [7], and 71 for the Hindi-language version [12]. A possible explanation for why our sample had a lower cut-off score than the Japanese and Chinese versions might be due to differences in education levels.…”

Validation of the Egyptian-Arabic Version of the Addenbrooke’s Cognitive Examination III (ACE-III) in Diagnosing Dementia

“…Other validations of the ACE-III in different populations with dementia revealed comparable optimal cut-off scores: 74/75 for the Chinese language version (94% sensitivity, 83% specificity) [21]; 74/75 for the Malay language version (90.6% sensitivity, 82% specificity) [22]; 75/76 for the Japanese language version (82% sensitivity, 90% specificity) [23]; 61/62 for the Thai language version (100% sensitivity, 97% specificity) [24]; and 65/66 for the Spanish language version (83% sensitivity, 80% specificity) [25].…”

Psychometric properties of Addenbrooke’s Cognitive Examination III (ACE-III): An item response theory approach

“…It provides information from five cognitive domains (attention, memory, language, verbal fluency, and visuospatial abilities), which makes it an excellent alternative to obtain a deterioration profile [43]. Despite several studies evaluating the validity of ACE-III and its adaptation to a large number of languages and cultural contexts [44], most of these studies focus on analyzing its diagnostic utility and its relation to other tests or variables [45][46][47][48][49][50][51][52][53][54]. At present, few studies have conducted a psychometric analysis of ACE-III from parametric IRT approaches [55].…”