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Age and Ageing Advance Access originally published online on March 12, 2008
Age and Ageing 2008 37(3):350-351; doi:10.1093/ageing/afn044
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Copyright © The Author 2008. Published by Oxford University Press on behalf of the British Geriatrics Society.

Reply

SIR—I thank Drs Woodford and George for their comments. Their surmise that ACE-R was compared to clinical diagnostic criteria is correct; hence, the test could not do better than the chosen ‘gold standard’.

An ACE-R sub-score has been reported to be able to distinguish Alzheimer's disease (AD) and frontotemporal dementia (FTD) [1], but I did not examine this. Certainly, I share reservations about the utility of the ACE sub-score for this differentiation of dementia sub-type (low sensitivity for diagnosis of FTD [2]), although a recent review noted that certain ACE sub-tests discriminated well between AD and FTD [3].

As theoretically motivated developments of the Mini-Mental State Examination, aiming to address the shortcomings of the latter in tests of memory, visuo-spatial and executive function, the ACE and ACE-R inevitably take longer to administer. A recent review of screening tests for cognitive impairment found ACE-R to score highly for both validity and content [4].

Hence, I would see ACE-R as most appropriately deployed in specialist (secondary/tertiary) clinics, not as a stand-alone test but as one aspect, namely cognitive assessment, of a comprehensive evaluation also encompassing clinical, behavioural and functional features, supplemented by informant report and neuroimaging.

A. J. Larner

Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ, UK

Email: a.larner{at}thewaltoncentre.nhs.uk

References

  1. Mioshi E, Dawson K, Mitchell J, et al. The Addenbrooke's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry (2006) 21:1078–85.[CrossRef][Web of Science][Medline]
  2. Larner AJ. Addenbrooke's Cognitive Examination (ACE) for the diagnosis and differential diagnosis of dementia. Clin Neurol Neurosurg (2007) 109:491–4.[CrossRef][Medline]
  3. Hutchinson AD, Mathias JL. Neuropsychological deficits in frontotemporal dementia and Alzheimer's disease: a meta-analytic review. J Neurol Neurosurg Psychiatr (2007) 78:917–28.[Abstract/Free Full Text]
  4. Cullen B, O'Neill B, Evans JJ, et al. A review of screening tests for cognitive impairment. J Neurol Neurosurg Psychiatr (2007) 78:790–9.[Abstract/Free Full Text]

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This Article
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