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The Addenbrooke’s Cognitive Examination (ACE) in the Differential Diagnosis of Early Dementias Versus Affective Disorder

Received March 14, 2003; revised September 15, 2003; July 26, 2004; accepted July 31, 2004. From the Department of Psychiatry, University of Cambridge (RBD,GEB), and the Department of Neurology, University of Cambridge and the MRC Cognition and Brain Sciences Unit (JRH). Send correspondence and reprint requests to Robert B. Dudas, M.D., Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital (Box 189), Hills Road, Cambridge, UK. e-mail: rbd21{at}cam.ac.uk
© 2005 American Association for Geriatric Psychiatry

Objective: The authors describe the profile of performance of patients whose cognitive complaint is due to dementia, affective disorder, or combinations thereof on the Addenbrooke’s Cognitive Examination (ACE) test battery. Methods: Authors tested 90 subjects with dementia (63 Alzheimer disease [AD]; 27 fronto-temporal dementia [FTD]), 60 subjects with "pure" affective disorder (23 major depression [MDD], 37 whose affective symptoms did not meet criteria for major depression [Affective]); 22 patients with symptoms of affective disorder and organic dementia (Mixed); and 127 healthy volunteers (NC). Results: The total ACE scores for the AD, FTD, and Mixed groups were significantly lower than for the NC group. Likewise, on total score, the AD and FTD groups scored significantly lower than either of the "pure" affective-disorder groups. Within the dementia group, the AD group scored significantly lower than the fronto-temporal group. Conclusions: The profile of performance on the ACE of patients with dementia is different from that of patients suffering from affective illness. Mild impairment in the total ACE score, along with a low score on the memory domain tasks and letter fluency (in contrast to normal category fluency), are strongly indicative of an affective, as opposed to organic, pathology. A total score of <88 in suspected dementia patients with affective symptoms appears strongly predictive of an underlying organic disorder.

Key Words: Cognition • Depression • Assessment

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