The Turkish validity and reliability of Addenbrooke's Cognitive Examination III
Authors: Parlak Mümüne Merve , Bizpınar Munis Özlem , Köse Ayşen , Yıldırım Cansu , Ülker Cemil Arcan 
Published: December 2024

Background

Addenbrooke's Cognitive Examination III (ACE‐III) was developed as a screening tool for cognitive disorders. Many countries have proven the cultural adaptation, reliability and validity of ACE‐III.

Aims

To make cultural adaptations of ACE‐III for the Turkish population and to examine its validity and reliability.

Methods & Procedures

First, ACE‐III was translated and adapted into Turkish (ACE‐III‐TR), then its validity and reliability were examined. The study included 234 people: 93 with dementia (78 Alzheimer's disease (AD) and 15 frontotemporal dementia (FTD)), 46 with mild cognitive impairment (MCI) and 95 healthy. Two blinded speech and language therapists rated the ACE‐III‐TR simultaneously for interrater validity. The same practitioner retested the same participants 2 weeks later for test–retest reliability. The construct validity of the culturally adapted test was assessed by analysing subsection correlations with the ACE‐III‐TR total score. The association between the Mini‐Mental State Examination (MMSE) total score, relevant subsections and ACE‐III‐TR total score was examined for criterion validity. Intergroup differences for healthy, MCI and dementia were studied for ACE‐III‐TR subsections and total score, and cut‐off scores were calculated for total score with sensitivity and specificity in differential diagnosis.

Results & Outcomes

Attention, memory and ACE‐III‐TR total scores showed a statistically significant difference between the three groups of dementia, MCI and healthy (p < 0.001). Statistically significant positive correlations ranging from 0.571 to 0.929 were found between ACE‐III‐TR subsections and total scores (p < 0.05). A highly significant positive correlation was found between MMSE total score and ACE‐III‐TR total score (r = 0.870). Between the second and first measurements, positive, moderately significant correlations were found for all subsections and ACE‐III‐TR total (ICC = 0.508–0.784, r = 0.477–0.646). A high level of agreement was found between two raters for all ACE‐III‐TR subsections and the ACE‐III‐TR total score (alpha = 0.9296–0.99995). The total ACE‐III‐TR cut‐off score was 79.5 for healthy and MCI and 69.5 for MCI and mild stage dementia.

Conclusions & Implications

This study found that ACE‐III‐TR is a sensitive and specific screening test for the diagnosis of MCI and dementia that has high validity and reliability. ACE‐III‐TR was found to be a valid and reliable tool in dementia, including AD and FTD, and in mild, moderate and advanced dementia. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE‐III‐TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow‐up processes.

WHAT THIS PAPER ADDS

What is already known on the subject

ACE was used as a screening tool to detect MCI and to differentiate AD from FTD. ACE was revised by Hsieh et al. in 2013 and updated as ACE‐III, which has the advantages of assessing five cognitive domains, not requiring the use of additional materials, and providing an effective and sensitive measurement in a short time. However, the validity and reliability study of the ACE‐III in Turkish has not been conducted.

What this study adds to the existing knowledge

This study demonstrates the validity and reliability of the Turkish ACE‐III (ACE‐III‐TR), which is a sensitive and specific screening test for the diagnosis of MCI and dementia.

What are the practical and clinical implications of this work?

The ACE‐III‐TR can provide clinicians and patients with a quick and brief general cognitive screening, indicating both the patient's overall cognitive profile and the measures of each of the assessed domains. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE‐III‐TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow‐up processes.