An investigation of the reliability of the Addenbrooke's Cognitive Examination – revised (ACE-R) : and clinical research portfolio

Objectives: The Addenbrooke's Cognitive Examination – Revised (ACE-R) is a dementia screening tool. The objectives of this study were to investigate rater accuracy in scoring the ACE-R in terms of its total and subscale scores and to examine whether scoring accuracy is affected by participant experience of using the ACE-R. Methods: Three filmed vignettes of the ACE-R being administered to older adult actors (mock patients) were used to assess scoring accuracy across multiple raters. The vignettes had a pre-determined ‘true score’. Study participants were required to complete ACE-R scoring sheets for each vignette. Participants were Community Nurses and Trainee Clinical Psychologists. Results: Participant scores were compared with the pre-determined true scores as a means of measuring scoring accuracy. The results indicated that the majority of participant scores were either the same as or within a few points of the true scores. However, when compared to the true scores, participant total scores differed significantly on two out of the three vignettes. Scoring accuracy was lowest for the Memory subscale of the ACE-R. Scoring accuracy issues were also identified for the Visuospatial and Attention and orientation subscales. Individual items which had low scoring accuracy were identified. Discussion: The majority of participants scored the same as or within a few points of the true scores, such deviation is likely to be clinically acceptable, providing over-emphasis is not placed on cut off scores. Professionals using the ACE-R should ensure they are familiar with the scoring guidelines for the items highlighted in this study as having low scoring accuracy