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Beyond global scores: Addenbrooke Cognitive Examination III domain-level profiles reveal heterogeneity within
1Rare and Civilization Diseases Research Platform, Mossakowski Medical Research Institute, Polish Academy of Science, Warsaw, Poland.
Background:
Subjective cognitive decline (SCD) is a heterogeneous clinical condition; however, routine cognitive screening primarily relies on global scores, which may obscure meaningful cognitive variability. This study examined whether domain-level analysis of the Addenbrooke's Cognitive Examination III (ACE-III) could identify distinct cognitive profiles within clinically confirmed SCD, even when global cognitive performance is preserved.
Methods:
This retrospective study included 370 help-seeking adults aged ≥60 years with clinically confirmed SCD, established through comprehensive neuropsychological assessment. Gaussian mixture modeling was applied to standardized ACE-III Memory, Fluency, and Visuospatial domain scores to identify latent cognitive profiles.
Results:
Three cognitive profiles were identified: Reassurance (64%), Lower-efficiency (23%), and Visuospatial-low (13%). Visuospatial was the principal domain differentiating the profiles and the only one to distinguish all groups. The greatest between-profile differences were observed for Clock Drawing and other visuoconstructional tasks. Profile membership was not explained by age or educational attainment.
Conclusions:
Clinically confirmed SCD is characterized by meaningful cognitive heterogeneity, even when global cognitive performance is preserved. Qualitative interpretation of ACE-III domain scores may complement conventional total-score assessment and enhance the characterization of cognitive variability in individuals with SCD. Longitudinal studies incorporating biomarkers and neuroimaging are required to determine the prognostic significance of these profiles.
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