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Updated: Aug 21, 2026

Visualizing Visual Adaptation
Published on: April 24, 2017
Adaptation of the ACE for a Malayalam speaking population in southern India
P S Mathuranath1, John R Hodges, Robert Mathew
1Cognition and Behavioural Neurology Center (CBNC), Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India. mathu@sctimist.ac.in
Objective:
To adapt the Addenbrooke's Cognitive Examination (ACE) as a dementia-screening tool in a community in south India. To establish that items in the adapted version are equivalent to that in the original.
Methods:
The ACE was adapted into the local language, Malayalam (m-ACE), following cultural/linguistic modifications. To establish equivalence, qualitative comparisons were made (on the distribution of scores, percentage scoring at ceiling, and relative difficulty across items) between a UK sample receiving the ACE (n = 50; mean age = 67.9 +/- 7.4; education >/= 9, mean = 10.9 +/- 2.5) and a community-based educationally-stratified Indian sample receiving the m-ACE: 'India >/= 9' (n = 50; mean age = 67.8 +/- 5.2; education >/= 9, mean = 13.9 +/- 2.7) and 'India = 8' (n = 50; mean age = 67.1 +/- 5.3; education = 8, mean = 3.1 +/- 2.0).
Results:
Most ACE items were retained. The score distribution (mean +/- 1SD), percentage at ceiling, and relative difficulties across items is comparable between the UK and the educationally equivalent India >/= 9 groups. Language, Naming, Attention and Orientation are relatively easy (>/= 80% at ceiling) and Recall and Verbal fluency are relatively difficult (= 22% at ceiling). Although the percentage at ceiling were lower for the India = 8 group, the order of relative difficulty was similar and the percentage scoring at floor was = 10% on all except visuospatial item.
Conclusions:
The m-ACE provides a culture-fair Malayalam adaptation of the ACE with component items of equivalent difficulty.
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