Sensitivity of the Mini-Mental State Examination, Montreal Cognitive Assessment and the Addenbrooke’s Cognitive Examination III to everyday activity impairments in dementia: An exploratory study

Clarissa M. Giebel, David Challis

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Objective: The Mini-Mental State Examination (MMSE) is one of the most frequently used cognitive measures for dementia severity, and linked to deficits in everyday functioning. Recently, the Montreal Cognitive Assessment (MoCA) and the Addenbrooke's Cognitive Examination III (ACE-III) increasingly substitute for the MMSE. However, there are no specific cut offs in the ACE-III for mild dementia. The objectives of this exploratory study were to assess the sensitivity of each scale to everyday functioning and to examine the cut offs between mild and moderate dementia on the ACE-III.
Methods: People with mild dementia completed the MMSE, MoCA and ACE-III, whilst informal carers completed the Revised Interview for Deteriorations in Daily Living Activities for Dementia to rate their relative’s initiative and performance of instrumental activities of daily living, and the Katz activities of daily living scale. Data were analysed using correlation analysis, raw score comparisons, Cohen’s kappa and Receiver Operating Characteristics analysis.
Results: Thirty-three dyads completed the measures. The ACE-III was the most sensitive tool for everyday functioning performance, whilst its language sub-scale was specifically related to initiation of activities. The most suitable cut off on the ACE-III between mild and moderate dementia was 61.
Conclusions: Findings suggest ACE-III more efficiently identifies everyday functional impairments. Further research is required to confirm these exploratory analyses of the cut off between mild and moderate dementia on the ACE-III. Both functional impairment and stage of dementia are needed in the diagnostic process and in the clinical assessment of people with dementia.
Original languageEnglish
Pages (from-to)1085–1093
Number of pages9
JournalInternational Journal of Geriatric Psychiatry
Issue number10
Early online date5 Sep 2016
Publication statusPublished - Oct 2017


  • Dementia
  • Cognition
  • Diagnosis

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