Utility of the Addenbrooke's Cognitive Examination - Revised for the diagnosis of dementia syndromes

Aim: To evaluate the utility of the Addenbrooke's Cognitive Examination - Revised (ACE-R) as a screening tool for dementia. Method: Prospective audit of 122 patients (82 with dementia, 40 with no dementia) referred to a Sydney cognition clinic. Results: An ACE-R cut-off score of 84/100 provided an optimal balance of sensitivity, specificity and positive predictive value (0.85, 0.80 and 0.90, respectively) in identifying patients with dementia. In our sample, the ACE-R was a superior dementia screening tool to the Mini-Mental State Examination in patients with higher levels of education (≥10 years of formal schooling), but not in patients with lower levels of education. Patients misclassified by the instrument had evidence of high levels of education, focal executive dysfunction, medical comorbidities, significant vascular disease and polypharmacology. Conclusions: The ACE-R is a useful screening tool for detecting the presence of dementia in a cognition clinic setting. Caution may be warranted in some patient populations.