title: A meta-analysis of the accuracy of the Addenbrooke's Cognitive Examination (ACE) and the Addenbrooke's Cognitive Examination-Revised (ACE-R) in the detection of dementia.
abstract: BACKGROUND
  The Addenbrooke's Cognitive Examination (ACE) and its Revised version (ACE-R) are relatively new screening tools for cognitive impairment that may improve upon the well-known Mini-Mental State Examination (MMSE) and other brief batteries. We systematically reviewed diagnostic accuracy studies of ACE and ACE-R.
  
  
  METHODS
  Published studies comparing ACE, ACE-R and MMSE were comprehensively sought and critically appraised. A meta-analysis of suitable studies was conducted.
  
  
  RESULTS
  Of 61 possible publications identified, meta-analysis of qualifying studies encompassed 5 for ACE (1,090 participants) and 5 for ACE-R (1156 participants); of these, 9 made direct comparisons with the MMSE. Sensitivity and specificity of the ACE were 96.9% (95% CI = 92.7% to 99.4%) and 77.4% (95% CI = 58.3% to 91.8%); and for the ACE-R were 95.7% (95% CI = 92.2% to 98.2%) and 87.5% (95% CI = 63.8% to 99.4%). In a modest prevalence setting, such as primary care or general hospital settings where the prevalence of dementia may be approximately 25%, overall accuracy of the ACE (0.823) was inferior to ACE-R (0.895) and MMSE (0.882). In high prevalence settings such as memory clinics where the prevalence of dementia may be 50% or higher, overall accuracy again favored ACE-R (0.916) over ACE (0.872) and MMSE (0.895).
  
  
  CONCLUSIONS
  The ACE-R has somewhat superior diagnostic accuracy to the MMSE while the ACE appears to have inferior accuracy. The ACE-R is recommended in both modest and high prevalence settings. Accuracy of newer versions of the ACE remain to be determined.
authors.affiliation: Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Larner
authors.affiliation: Department of Psycho-oncology, Leicestershire Partnership NHS Trust, Leicester, UK.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Mitchell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis; D003072:Cognition Disorders / Q000175:diagnosis*; D003704:Dementia / Q000175:diagnosis* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D007802:Language; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards* / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011594:Psychometrics / Q000592:standards; D012372:ROC Curve; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires