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Clinical Manifestations.

Marnina B Stimmel1, Emmeline Ayers2, Joe Verghese2

  • 1Albert Einstein College of Medicine, Bronx, NY, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 25, 2025
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Summary
This summary is machine-generated.

Certain items on the Addenbrooke's Cognitive Examination-III (ACE-III) show high error rates in cognitively normal, Malayalam-speaking older adults in India, especially those with lower education. These findings suggest cautious interpretation of ACE-III results in this population.

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Area of Science:

  • Neurology
  • Cognitive Science
  • Gerontology

Background:

  • Rising global dementia rates necessitate validated cognitive screening tools.
  • The Addenbrooke's Cognitive Examination-III (ACE-III) is a widely used tool for identifying cognitive impairment.
  • Previous studies indicate potential issues with specific ACE-III items, particularly concerning educational attainment.

Purpose of the Study:

  • To assess the performance of individual ACE-III items in a cohort of cognitively normal, Malayalam-speaking older adults in India.
  • To identify specific ACE-III items that may yield high error rates in this population.
  • To investigate the influence of education level on performance in individual ACE-III items.

Main Methods:

  • 132 Malayalam-speaking older adults from the Kerala Einstein Study participated.
  • Participants underwent the Malayalam version of the ACE-III and a comprehensive neuropsychological battery.
  • Cognitive normality was determined by expert consensus; education was dichotomized (≥10 years vs. <10 years) for analysis.

Main Results:

  • Several ACE-III items were universally credited (e.g., orientation, repetition, comprehension).
  • Over 25% of participants made errors on items like clock drawing, cube copying, and name/address recall.
  • Lower educational attainment was significantly associated with higher error rates on specific ACE-III items.

Conclusions:

  • The ACE-III is a valuable screening tool, but certain items demonstrate limited utility in cognitively normal Malayalam-speaking older adults.
  • High error rates on specific items, particularly among those with lower education, necessitate cautious interpretation.
  • Findings underscore the need to consider educational background when interpreting ACE-III performance to avoid misdiagnosis.