Validity of the ACE-III Screening Tool After Acquired Brain Injury
Research type
Research Study
Full title
Validity of the ACE-III as a Cognitive Screening Tool After Acquired Brain Injury
IRAS ID
301028
Contact name
Breda Cullen
Contact email
Sponsor organisation
University of Glasgow
Duration of Study in the UK
1 years, 4 months, 30 days
Research summary
Research Summary
Background: Many people who have an acquired brain injury (ABI) (damage to the brain after birth) experience cognitive impairment, such as difficulties with attention, memory, language, problem solving etc.. It is important that healthcare staff can detect cognitive impairment, so that the person can get the right assessment and support. Cognitive screening tools are quick tests which indicate when someone might have cognitive impairment. The Addenbrooke’s Cognitive Examination (ACE-III) is a commonly used cognitive screening tool. However, no research study has checked whether it is a valid for use in patients with ABI (i.e. whether it measures what it claims to measure in this population).
Aims and questions: This project aims to investigate whether the ACE-III is a valid screening tool for use in people with ABI. Key questions are: is the ACE-III a valid screening tool for use in ABI?; how effective is the ACE-III at predicting whether a person with ABI has a cognitive impairment?; and is there a relationship between the person’s ACE-III score and their functional ability (e.g. a person’s ability to do day-to-day tasks)?
Participants: This study will use existing data that is routinely collected by Graham Anderson House (GAH), a brain injury rehabilitation centre. Participants will be all eligible patients admitted from 2013 until the date of data extraction (estimated 2021).
Design: This study will examine each patient’s ACE-III scores and compare them with their scores on a corresponding cognitive test which measures the same aspect of cognitive functioning (e.g. memory). It will determine the optimal cut-off score on the ACE-III for detecting cognitive impairment. It will also compare the patient’s ACE-III score and their score on a measure of functional ability.
Summary of Results
Background: Many people who have an acquired brain injury (ABI) (damage to the brain after birth) experience cognitive impairment, such as difficulties with attention, memory or doing tasks which involve visual information etc. If we can detect when someone is experiencing cognitive impairment, they can get the right assessment and help. Cognitive screening tools, such as the Addenbrooke’s Cognitive Examination (ACE-III) are quick tests which indicate if someone might have cognitive impairment. However, no research study has checked whether the ACE-III is valid for use in patients with ABI (i.e. whether it measures what it claims to measure).
Aims and Questions: This project investigated the relationship between the patient’s score on the different sub-tests of the ACE-III (each of which measures a different aspect of cognitive function e.g. memory) and their score on a more thorough cognitive test. The following key research questions were addressed:
1. Is the ACE-III a valid screening tool for use in ABI?
2. How effective is the ACE-III at predicting whether a person with ABI has a cognitive impairment?Methods: A research database was developed using existing routine clinical data from a brain injury rehabilitation centre. Participants had a diagnosis of ABI. They gave consent for their data to be used for service evaluation; and ethical approval, which took that context into account, was received. Demographic information, their scores on the ACE-III, and additional cognitive tests were collected, and transferred onto an anonymised research database to protect patients identities. Each patient’s ACE-III scores were compared with their scores on a number of different cognitive tests, measuring the same aspects of cognition.
Main Findings: Patients’ scores on the ACE-III and corresponding cognitive tests were correlated with each other for each area of cognitive impairment (including attention, language and visuospatial skills). This provides evidence of the ACE-III’s validity, as it tells us that it appears to measure what it claims to measure (in these areas). A patient’s ACE-III visuospatial subtest score was also able to classify those with and without impairment on a standard cognitive test of visuospatial skills. While these results are promising, because there was a small number of participants and missing data, this meant that it could not be determined if some of the results were significant; and the estimates of correlations were not very precise.
Conclusions: This study found promising initial evidence for the use of the ACE-III cognitive screening tool. The findings suggest that the ACE-III can be used to detect visuospatial impairment, but additional research with larger sample sizes is needed to determine if it is a valid measure of other types of cognitive function.
References:
Hsieh, S., Schubert, S., Hoon, C., Mioshi, E., & Hodges, J. R. (2013). Validation of the Addenbrooke’s Cognitive Examination III in Frontotemporal Dementia and Alzheimer’s Disease. Dementia and Geriatric Cognitive Disorders, 36(3–4), 242– 250. https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fu2790089.ct.sendgrid.net%2Fls%2Fclick%3Fupn%3DXv3JSvJ-2B3M71ppf7N9agbbPMlcDsw8ItxtjdqCCwadoGnyw-2B-2FdA9ptsPfSar5mt-2BH-U0_E1aO2-2BZlVOSJJV-2FajQqskegTd6IRomHYTi-2Fbt8SH3YIG44CQW8scqaPHf04ELVlumMnR72EMdoIrSGYLpaJVS2LvnD-2FPLv5qonDiv-2F2WBXP-2BkgwUJ4QIV-2Bb6EwhsDuleXIsOFPn-2FMW6fnZ-2Bq9BBdkYIul78nzmnh0OhzxBR1hTgUpOvvxv7uxgqh65YsXzlTMM84OpyHP95Xpiu7yCo3zw-3D-3D&data=05%7C01%7Capprovals%40hra.nhs.uk%7Cf6a697d42bf049b21e1008dbef4cece3%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638366885901386122%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=Y9p2xWo2wfetagnfvnquYYb9VaTbwcT4fqZUSQ%2FZ5F4%3D&reserved=0REC name
West of Scotland REC 3
REC reference
21/WS/0116
Date of REC Opinion
4 Oct 2021
REC opinion
Favourable Opinion