Parlak Mümüne Merve, Bizpınar Munis Özlem, Köse Ayşen, Yıldırım Cansu, Ülker Cemil Arcan
Department of Speech and Language Therapy, Faculty of Health Sciences, Ankara Yıldırım Beyazıt University, Ankara, Turkey.
Department of Neurology, Etlik City Hospital, Ankara, Turkey.
Int J Lang Commun Disord. 2025 Jan-Feb;60(1):e13147. doi: 10.1111/1460-6984.13147.
Addenbrooke's Cognitive Examination III (ACE-III) was developed as a screening tool for cognitive disorders. Many countries have proven the cultural adaptation, reliability and validity of ACE-III.
To make cultural adaptations of ACE-III for the Turkish population and to examine its validity and reliability.
METHODS & PROCEDURES: First, ACE-III was translated and adapted into Turkish (ACE-III-TR), then its validity and reliability were examined. The study included 234 people: 93 with dementia (78 Alzheimer's disease (AD) and 15 frontotemporal dementia (FTD)), 46 with mild cognitive impairment (MCI) and 95 healthy. Two blinded speech and language therapists rated the ACE-III-TR simultaneously for interrater validity. The same practitioner retested the same participants 2 weeks later for test-retest reliability. The construct validity of the culturally adapted test was assessed by analysing subsection correlations with the ACE-III-TR total score. The association between the Mini-Mental State Examination (MMSE) total score, relevant subsections and ACE-III-TR total score was examined for criterion validity. Intergroup differences for healthy, MCI and dementia were studied for ACE-III-TR subsections and total score, and cut-off scores were calculated for total score with sensitivity and specificity in differential diagnosis.
RESULTS & OUTCOMES: Attention, memory and ACE-III-TR total scores showed a statistically significant difference between the three groups of dementia, MCI and healthy (p < 0.001). Statistically significant positive correlations ranging from 0.571 to 0.929 were found between ACE-III-TR subsections and total scores (p < 0.05). A highly significant positive correlation was found between MMSE total score and ACE-III-TR total score (r = 0.870). Between the second and first measurements, positive, moderately significant correlations were found for all subsections and ACE-III-TR total (ICC = 0.508-0.784, r = 0.477-0.646). A high level of agreement was found between two raters for all ACE-III-TR subsections and the ACE-III-TR total score (alpha = 0.9296-0.99995). The total ACE-III-TR cut-off score was 79.5 for healthy and MCI and 69.5 for MCI and mild stage dementia.
CONCLUSIONS & IMPLICATIONS: This study found that ACE-III-TR is a sensitive and specific screening test for the diagnosis of MCI and dementia that has high validity and reliability. ACE-III-TR was found to be a valid and reliable tool in dementia, including AD and FTD, and in mild, moderate and advanced dementia. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE-III-TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow-up processes.
What is already known on the subject ACE was used as a screening tool to detect MCI and to differentiate AD from FTD. ACE was revised by Hsieh et al. in 2013 and updated as ACE-III, which has the advantages of assessing five cognitive domains, not requiring the use of additional materials, and providing an effective and sensitive measurement in a short time. However, the validity and reliability study of the ACE-III in Turkish has not been conducted. What this study adds to the existing knowledge This study demonstrates the validity and reliability of the Turkish ACE-III (ACE-III-TR), which is a sensitive and specific screening test for the diagnosis of MCI and dementia. What are the practical and clinical implications of this work? The ACE-III-TR can provide clinicians and patients with a quick and brief general cognitive screening, indicating both the patient's overall cognitive profile and the measures of each of the assessed domains. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE-III-TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow-up processes.
剑桥认知功能量表第三版（ACE-III）被开发作为认知障碍的筛查工具。许多国家已证实了ACE-III的文化适应性、信度和效度。
对ACE-III进行针对土耳其人群的文化调适，并检验其效度和信度。
首先，将ACE-III翻译并改编为土耳其语版本（ACE-III-TR），然后检验其效度和信度。该研究纳入了234人：93例痴呆患者（78例阿尔茨海默病（AD）和15例额颞叶痴呆（FTD））、46例轻度认知障碍（MCI）患者和95名健康人。两名盲法言语和语言治疗师同时对ACE-III-TR进行评分以检验评分者间效度。同一名从业者在2周后对相同参与者进行重新测试以检验重测信度。通过分析各子部分与ACE-III-TR总分的相关性来评估文化调适后测试的结构效度。检验简易精神状态检查表（MMSE）总分、相关子部分与ACE-III-TR总分之间的关联以评估效标效度。研究ACE-III-TR各子部分和总分在健康人、MCI患者和痴呆患者组间的差异，并计算总分在鉴别诊断中的敏感性和特异性的截断分数。
注意力、记忆力和ACE-III-TR总分在痴呆、MCI和健康三组之间存在统计学显著差异（p < 0.001）。ACE-III-TR各子部分与总分之间存在统计学显著的正相关，范围从0.571至0.929（p < 0.05）。MMSE总分与ACE-III-TR总分之间存在高度显著的正相关（r = 0.870）。在第二次和第一次测量之间，所有子部分和ACE-III-TR总分均存在正的、中度显著的相关性（组内相关系数ICC = 0.508 - 0.784，r = 0.477 - 0.646）。两名评分者对所有ACE-III-TR子部分和ACE-III-TR总分的一致性程度较高（阿尔法系数α = 0.9296 - 0.99995）。ACE-III-TR总分的截断分数对于健康人和MCI患者为79.5，对于MCI患者和轻度痴呆阶段为69.5。
本研究发现ACE-III-TR是用于诊断MCI和痴呆的敏感且特异的筛查测试，具有较高的效度和信度。ACE-III-TR被发现是在包括AD和FTD的痴呆以及轻度、中度和重度痴呆中有效的可靠工具。通过对一个人的认知概况提供更全面的评估，它可以帮助临床医生对MCI和痴呆进行鉴别诊断。ACE-III-TR在临床实践、研究和治疗随访过程中监测认知缺陷的进展方面可能有用。
关于该主题已知的信息ACE被用作检测MCI以及区分AD与FTD的筛查工具。Hsieh等人在2013年对ACE进行了修订并更新为ACE-III，其优点是评估五个认知领域，无需使用额外材料，并能在短时间内提供有效且敏感的测量。然而，尚未进行ACE-III在土耳其语中的效度和信度研究。本研究对现有知识的补充本研究证明了土耳其语版ACE-III（ACE-III-TR）的效度和信度，它是用于诊断MCI和痴呆的敏感且特异的筛查测试。这项工作的实际和临床意义是什么？ACE-III-TR可以为临床医生和患者提供快速且简要的一般认知筛查，既表明患者的整体认知概况，也表明每个评估领域的测量结果。通过对一个人的认知概况提供更全面的评估，它可以帮助临床医生对MCI和痴呆进行鉴别诊断。ACE-III-TR在临床实践、研究和治疗随访过程中监测认知缺陷的进展方面可能有用。
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