Factors influencing ACE-III performance - Retrospective data analysis

• Research type

  Research Study

• Full title

  Exploring the influence of physical and mental health factors on older adults’ performance on the Addenbrookes Cognitive Examination, 3rd Edition (ACE-III)

• IRAS ID

  317059

• Contact name

  Jonathan Evans

• Contact email

  jonathan.evans@glasgow.ac.uk

• Sponsor organisation

  NHS Greater Glasgow & Clyde

• Duration of Study in the UK

  1 years, 0 months, 23 days

• Research summary

  Background: When investigating whether someone may have dementia, clinicians can make use of a short assessment tool called a cognitive screening test, which looks at different cognitive abilities including memory and language. One commonly used screening test is called the Addenbrooke’s Cognitive Examination III (ACE III). An overall score on this test below a certain value suggests that the person may have a dementia, and so ACE-III results are often used to make a diagnosis of dementia or to decide whether more detailed tests of cognitive abilities are needed.
  Sometimes people who complete the ACE-III get a low score on the test but don’t get a diagnosis of dementia after review by clinicians. In these cases, there are lots of other factors that could be affecting performance, including physical health and mental health conditions that are common in older adults.

  Aims and Questions: This study aims to explore whether different physical and mental health factors have an impact on older adults performance on the ACE-III, and if so, by how much.

  Methods: Participants are adults who have been referred to NHS Greater Glasgow & Clyde Services for an assessment of their memory and completed an ACE-III. This study will only be looking at people who did not get a diagnosis of dementia following assessment of their cognitive abilities. This study will be looking at existing data that has already been collected as part of normal NHS service provision. It will use statistical analysis to look at whether there are any links between ACE-III scores and a range of physical and mental health factors.

  Practical Applications and Dissemination: The findings of this study could help clinicians when they are screening for dementia by making them aware of any physical or mental health factors that can affect performance on the ACE-III.

  Summary of results
  Background
  When investigating whether someone may have dementia, clinicians often use short assessment tools called cognitive screening tests, which look at thinking abilities including memory and language. One commonly used screening test is the Addenbrooke’s Cognitive Examination III (ACE III – Hsieh et al., 2013). An overall score on this test below a certain value suggests that the person may have a dementia, and so ACE-III results are often used, alongside other information, to make a diagnosis of dementia or to decide whether more detailed tests of cognitive abilities are needed.
  Sometimes people who complete the ACE-III get a low score on the test but do not get a diagnosis of dementia, after all the relevant information about that person is put together and reviewed by clinicians. In these cases, there are lots of other factors that could be affecting performance, including physical health and mental health conditions that are common in older adults and their level of intellectual functioning before the onset of any disease.

  Aims
  This study aimed to explore whether different physical and mental health factors have a negative impact on older adults’ performance on the ACE-III, and if so, by how much.

  Methods
  Research was reviewed to identify common physical and mental health conditions in older adults that may influence cognitive functioning. This study utilised existing data and participants were individuals who had received an assessment of their memory in a community mental health service for older adults. Electronic clinical notes were reviewed to identify those that did not get a dementia diagnosis following an assessment of their thinking abilities, to look at the influence of a range of physical health, mental health and demographic factors on participants’ scores on the ACE-III.

  Results
  None of the physical health and mental health factors looked at in the study were associated with scores on the ACE-III. The only factor that was associated with ACE III performance was a measure that estimates intellectual ability. The majority of participants, despite not receiving a diagnosis of dementia at the point of assessment, scored below cut-off used to indicate cognitive difficulties on the ACE-III.

  Conclusions
  Patients assessed in memory clinics often present with complex co-morbid chronic physical and mental health conditions and may often score below cut-off on the ACE-III despite not meeting criteria for a diagnosis of dementia. Although a useful screening measure, the ACE-III should be used alongside other sources of information including clinical history and report from a significant other, as part of the screening process. Developing adjusted cut-offs for the ACE-III according to patient’s education level, may improve its accuracy as a screening tool

• REC name

  East Midlands - Nottingham 1 Research Ethics Committee

• REC reference

  22/EM/0251

• Date of REC Opinion

  14 Nov 2022

• REC opinion

  Favourable Opinion