Cultural adaptation and validation of the Addenbrooke’s Cognitive Examination III in a Taiwanese population (T‐ACE‐III) presenting to hospital with suspected dementia

Abstract

AbstractBackgroundThe Addenbrooke’s Cognitive Examination III (ACE‐III) is an effective cognitive test for detecting dementia in many countries and covers a wide range of cognitive domains. However, there has been no study about the usefulness of the ACE‐III in patients with suspected dementia in Taiwan where patients use Traditional Chinese, unlike mainland China. We therefore aimed to culturally adapt and find the sensitivity and specificity of the ACE‐III for investigating people with possible dementia presenting to hospital in Taiwan.MethodWe used the guideline for cross‐cultural adaptation process to culturally adapt the simplified Chinese version (C‐ACE‐III) for Taiwanese populations (T‐ACE‐III). We recruited consenting patients who had presented to clinics with suspected dementia in Northern Taiwan and had been through the diagnostic process. We timed the interviews and conducted receiver operating characteristic (ROC) curve analysis to test the ability of the T‐ACE‐III to differentiate between dementia and non‐dementia using clinical diagnosis as the gold standard. We used linear regression to find significant predictors of ACE‐T score entering age, education, sex, language group, and dementia status as possible predictors.Result110 participants were invited, of whom 91 Chinese/ Hokkien‐speaking individuals aged 49 to 93 years consented to take part and ninety completed the test: 24 males and 33 females with dementia and 12 males and 21 females without. It took on average 16.3 and 24.0 minutes to administer in non‐dementia and dementia group, respectively. The T‐ACE‐III demonstrated a sensitivity of 100.0% and a specificity of 78.8%, for distinguishing dementia from non‐dementia with a cut‐off value of 86/87, a sensitivity of 89.5% and a specificity of 100.0%, with a cut‐off value of 73/74. The area under the curve (AUC) = 0.99 in T‐ACE‐III. The diagnosis of dementia, and language used were significant predictors accounting for 68.1% of the variance in T‐ACE‐III scores.ConclusionThe culturally adapted T‐ACE‐III is a brief, reliable, and acceptable tool for discriminating dementia from non‐dementia cases in a Taiwanese population in a memory clinic setting.