ACE III REPORT

Submitted in the Partial Fulfilment of the Requirements for

the Award of Degree of

Master of Science in Psychology (Clinical)

Submitted By,

Sulagna Datta

3MPCL-A

Register Number: 2337457

Department of Psychological Sciences

 Introduction

A thorough cognitive assessment tool that is frequently used in clinical settings to test
cognitive performance across multiple areas is Addenbrooke's Cognitive Examination III
(ACE-III). The Addenbrooke's Cognitive Examination (ACE-III) was designed as an
improved version of the original test. It provides a more organized and improved method of
diagnosing cognitive deficits, such as dementia and other neurodegenerative diseases. The
attention and orientation, memory, verbal fluency, language, and visuospatial skills are the
five core cognitive areas that the ACE-III evaluates. These domains assist clinicians in
pinpointing particular areas of dysfunction while offering a comprehensive assessment of
cognitive health.

Other Screening Tools

To find people who could have neurocognitive impairments and need more testing, screening
methods are utilized. Frequently utilized instruments include of:

The MMSE, or Mini-Mental State Examination: a quick 30-item test measuring language,
visuospatial skills, orientation, registration, attention, computation, recall, and recall.

The MoCA, or Montreal Cognitive Assessment: The MoCA is a more thorough instrument
than the MMSE; it assesses comparable domains but is more accurate in identifying moderate
cognitive impairment (MCI).

The comprehensive cognitive exam known as Addenbrooke's Cognitive Examination

(ACE-III) assesses five domains: language, verbal fluency, attention and orientation, memory,
and visuospatial abilities.

Description of ACE III

The Mini-Mental State Examination (MMSE) became inaccessible after 2001, hence the
Addenbrooke's Cognitive Examination III (ACE-III) was created as a substitute for the
original ACE and its updated version, ACE-R (Seshadri & Mazi, 2012). According to new
guidelines from the Alzheimer's Society and the Department of Health in the UK, the
ACE-III is a good substitute for the MMSE (Ballard et al., 2015). In an effort to increase
diagnostic accuracy, the ACE-III replaced numerous MMSE items that had been included in
the ACE-R.

Some activities on the ACE-III were changed to increase sensitivity to cognitive decline. For
instance, the attention component now only focuses on the subtraction of serial 7s and no
longer includes spelling "WORLD" backwards. The instructions to "close your eyes" were
taken out of the language part, and the objects used for naming were switched from a pencil
and clock to a book and spoon. Three distinct single-step commands were also used in place
of the three-step command. The writing assignment has been modified to call for two or more
sentences rather than simply one. The task of intersecting lemnisci was substituted for the
intersecting pentagons problem in the visuospatial segment (Hodges & Larner, 2017).
According to Hsieh et al. (2013), these modifications made the MMSE scoring system
incompatible with the ACE-III.

The ACE-III also improved upon certain elements of the ACE-R, such as the verbal
repetition item, which had been found lacking in performance among healthy adults (Hodges
& Larner, 2017). The scoring system of the ACE-III remains similar to the ACE-R, with a
total possible score of 100 points, where higher scores reflect better cognitive function.

The ACE-III is structured into five main cognitive domains:

Attention and Orientation: This component evaluates the person's orientation to time and
place as well as their fundamental attentional processes. Simple math problems (such serial
7s) and inquiries about the current time and place are among the tasks.

Memory: Both immediate and delayed recall skills are assessed in this part. It tests both
short-term and long-term memory using exercises like recalling a list of words both
immediately after presentation and again after a lapse in time.

Verbal Fluency: This domain assesses the ability to produce language. Within a
predetermined time limit, the examinee is instructed to come up with as many words as they
can depending on predetermined criteria (e.g., words starting with a given letter or belonging
to a particular category).

Language: A variety of language production and comprehension skills are evaluated in the
language part. Tasks include labeling items, repeating sentences, and adhering to verbal and
written instructions. Updated and more delicate activities are included in the ACE-III, such as
naming a book and a spoon rather than a pencil and clock.

Visuospatial Abilities: This part looks at the person's capacity for processing spatial and
visual data. It consists of exercises that evaluate spatial reasoning and visual memory, such as
copying shapes (such lemnisci that intersect) and drawing from memory.

A total score out of 100 is provided by the ACE-III, with higher values denoting superior
cognitive ability. Because of its sensitivity in identifying cognitive deficits, especially in
diseases like Alzheimer's disease and other dementias, it is frequently utilized in clinical and
research contexts. The exam can be administered to adults from a variety of cultural and
educational backgrounds in 15 to 20 minutes on average.
The ACE-III is valued for its thoroughness and capacity to offer an in-depth analysis of
cognitive strengths and limitations.

Applications of the scale

Multifaceted Evaluation

A wide range of cognitive domains are covered by the ACE-III, such as language, verbal
fluency, attention and orientation, memory, and visuospatial skills. This multifaceted method
aids in pinpointing the precise cognitive processes that are impacted.

Susceptibility to Cognitive Deficits

From mild cognitive impairment (MCI) to more severe forms of dementia, the scale is
intended to be sensitive to different degrees of cognitive impairment. Because of its
sensitivity, it can be used to diagnose dementia as well as early cognitive abnormalities that
might signal the beginning of a neurocognitive problem.

Monitoring Cognitive Shifts

The ACE-III can be performed again and again throughout time to track the development of
cognitive deterioration or improvement.

Cultural and Educational Factors

The ACE-III is appropriate for a wide range of populations because it was created with the
least amount of cultural and educational bias possible.

Administration Ease

It is feasible to administer the test in 15–20 minutes, which makes it useful. Neurologists,
psychiatrists, psychologists, and general practitioners are just a few of the healthcare experts
who can use it because of its grading system and easy instructions.

Complementary Utilization

The ACE-III can be used to offer a thorough assessment of cognitive health in conjunction
with other neuropsychological tests and clinical assessments.

Psychometric Properties

In the first validation study, the ACE-III was determined to be acceptable and rather quick to
administer (15 minutes; AD 28, FTD 33, controls 25). At the previously mentioned cut-off
values (88 and 82), the ACE-III was both sensitive and specific (at 88/100: 1.00 and 0.96,
respectively; at 82/100: 0.93 and 1.00, respectively). The ACE-III and ACE-R showed a good
correlation (r = 0.99). Elamin and colleagues found that the ACE-III distinguished between
early-onset dementia and healthy controls with a high sensitivity (0.915) and specificity
(0.964) at the cut-off of 88, as well as a high sensitivity (0.915) and specificity (0.867) for
subjective memory impairment. The ACE-III is a valid cognitive screening instrument that
has been validated against traditional neuropsychological assessments. The ACE-III should
be used in conjunction with a comprehensive clinical evaluation, not as a stand-alone test, for
the screening of dementia or moderate cognitive impairment in people presenting with or at
risk of cognitive decline, according to the results of a 2019 Cochrane meta-analysis of
published studies.

Scoring and Interpretation

The Attention and Orientation (18 points), Memory (26 points), Verbal Fluency (14 points),
Language (26 points), and Visuospatial Abilities (16 points) domains are the five areas in
which the ACE-III measures cognitive function. There include tasks including drawing
figures, following directions, category and letter fluency, word recall, serial subtraction, and
figure sketching. A score of 90 to 100 represents normal cognitive function, a score below 82
may indicate moderate cognitive impairment (MCI), and a score above 100 indicates normal
cognitive function. The ACE-III is a tool for evaluating general cognitive performance;
population and context-specific interpretations affect its interpretation.

Case Report

Proforma of the participant

● Name: ST
● Date of Birth: 31/03/2002
● Languages Known: English, Hindi
● Native Language: Hindi
● Date of Testing: 29/07/24
● Education: B.A English Hons. (Pursuing)
● Occupation: Musician

Behavioral Observation:
During the evaluation, ST exhibited age appropriate communication skills. Rapport was
established successfully. He was calm and composed during the assessment. He was very
cooperative. He did not have any questions during the assessment. He did especially well in
the attention and visuospatial subtests

Results

Table 1 : Component wise score description

Domain Sub Scales Total Score Obtained

Attention Orientation 10

Registration Of 3 Items 3

Serial Subtraction 5

Total Score 18

Memory Recall of items 3

Anterograde Memory 4
(Name and Address)

Retrograde Memory 7
(Famous People)

Recognition 5

Recall of Name and 7

Address

Total Score 26

Fluency Letter 5
 Animals 7

Total 12

Language Comprehension 3

Sentence Writing 2

Single Word Repetition 2

Proverb Repetition 2

Object Naming 12

Comprehension 4

Reading 1

Total Score 26

Visuospatial Intersecting Infinity Loops 1

3D Wire Cube 2

Clock 5

Counting Dots 4

Identifying Letters 4

Total Score 16

Total 100 98 Exceptional Cognitive Abilities

Summary and Interpretation

ST’s ACE III assessment provided a comprehensive evaluation of cognitive functions, with a
total score of 98 out of 100. The detailed breakdown across the five cognitive domains offers
insight into specific strengths and areas where mild challenges may be present.
Domain Analysis

Attention and Orientation (18/18): ST's high performance in this domain suggests a good
capacity for attentional concentration and spatial and temporal orientation. When it came to
tests like serial subtraction and questions involving temporal and spatial awareness, ST
performed exceptionally well. This suggests that ST can pay attention for extended periods of
time and comprehend its environment and current events.

Memory (26/26): The score in the memory domain indicates some no difficulties with any
areas.

Verbal Fluency (14/14): ST demonstrated good performance on verbal fluency tasks, such as
coming up with words that fall into a certain category or beginning with a particular letter.
This suggests strong executive functioning in relation to verbal activities and good language
production abilities. Swift word retrieval and articulation indicates that ST's linguistic skills
are in good condition, facilitating clear communication and problem-solving skills.

Language (24/26): The high score in this area indicates that ST exhibited strong
understanding and expressive language abilities. The tasks, which included building
sentences, naming things, and following multi-step directions, were completed effectively,
however there were a few little difficulties when it came to recognizing object names from
photographs.

Visuospatial Abilities (16/16): ST received a flawless score in this domain, demonstrating

exceptional skills in activities like sketching a clock face, replicating geometric objects, and
identifying partially completed images. Strong spatial reasoning and visual processing
abilities are demonstrated by this score, which is important for jobs requiring the
interpretation of visual data, like navigation or diagram interpretation.

Interpretation

ST has demonstrated exceptional cognitive abilities across the board, as indicated by a

near-perfect total score of 98 out of 100 on the ACE III assessment. This comprehensive
evaluation provides a detailed snapshot of ST's cognitive strengths and identifies areas where
performance is particularly strong. ST's ability to focus, maintain attention, and orient
themselves in time and space is remarkable. Their performance on tasks requiring sustained
attention, such as serial subtraction, was flawless. This suggests strong executive functioning
and overall cognitive efficiency. Moreover, ST has exhibited exceptional memory skills,
demonstrating an impressive capacity to both store and retrieve information. This is a critical
cognitive function that underlies learning, problem-solving, and daily activities. In terms of
language, ST excels in both understanding and producing language. Their ability to generate
words rapidly and accurately, along with their strong comprehension skills, indicates effective
communication abilities and cognitive flexibility. Furthermore, ST's visuospatial skills are
highly developed. Their ability to analyze and manipulate visual information is evident in
their performance on tasks requiring spatial reasoning and problem-solving. Overall, ST
presents with a robust cognitive profile characterized by exceptional abilities across multiple
domains. These strengths are likely to support academic, professional, and personal success.
ST's performance on the ACE III suggests well-preserved cognitive function across In
conclusion, AR's ACE III results are reassuring, indicating no major cognitive deficits.

Recommendations

Given ST's exceptional performance, specific recommendations are limited. However, to

maintain and potentially enhance cognitive abilities, it is advisable for ST to continue
engaging in mentally stimulating activities, prioritize physical health, manage stress levels,
and consider additional cognitive assessments if needed. While ST's cognitive profile is
currently impressive, ongoing monitoring can help identify any potential changes or areas for
further support. In conclusion, ST's cognitive abilities are truly commendable, positioning
them well for future endeavors.

Conclusion

The ACE-III assessment of ST has provided a comprehensive evaluation of their cognitive

functioning. The results demonstrate an exceptional cognitive profile across all domains
assessed, including attention, memory, verbal fluency, language, and visuospatial abilities.
ST's performance is indicative of strong cognitive health and a high capacity for intellectual
engagement.

While the current assessment indicates no significant cognitive concerns, ongoing monitoring
is recommended to detect any potential changes over time. Continued engagement in
mentally stimulating activities, coupled with a healthy lifestyle, can contribute to maintaining
optimal cognitive function.

Overall, ST's cognitive strengths position them well for academic, professional, and personal
success.
References

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diagnosis of dementia: a critical review</p> Neuropsychiatric Disease and Treatment,

Volume 15, 441–447. https://doi.org/10.2147/ndt.s151253

So, M., Foxe, D., Kumfor, F., Murray, C., Hsieh, S., Savage, G., Ahmed, R. M., Burrell, J. R.,

Hodges, J. R., Irish, M., & Piguet, O. (2018). Addenbrooke’s Cognitive Examination

III: Psychometric Characteristics and Relations to Functional Ability in Dementia.

Journal of the International Neuropsychological Society, 24(8), 854–863.

https://doi.org/10.1017/s1355617718000541

Elamin, M., Holloway, G., Bak, T. H., & Pal, S. (2015). The utility of the Addenbrooke’s

Cognitive Examination Version Three in Early-Onset Dementia. Dementia and

Geriatric Cognitive Disorders, 41(1–2), 9–15. https://doi.org/10.1159/000439248