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Title: Adaption and validation of the Addenbrooke's Cognitive Examination (ACE-III) as a cognitive screening tool for dementia for older adults with comorbid hearing impairment
Author: Heatley, Mary
ISNI:       0000 0005 0288 4521
Awarding Body: UCL (University College London)
Current Institution: University College London (University of London)
Date of Award: 2020
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Background: An association between dementia and age-related hearing loss has been consistently established, however current screening measures of cognitive performance may be affected by hearing loss. This potentially influences the accuracy of cognitive estimates. Aims: 1. To develop an adapted version of the Addenbrooke’s Cognitive Examination (ACE-III) for older adults with hearing loss, the HI-ACE-III. 2. To test the ability of the HI-ACE-III to distinguish individuals with a diagnosis of dementia from those without and establish an optimum cut-off. 3. To test HI-ACE-III subscales for convergent and divergent validity against standardised cognitive measures of relevant domains. Method: Adaption, carried out in consultation with experts and potential users, involved converting verbal instructions to visually presented instructions. Two groups of participants with hearing impairment over the age of 65 were recruited, the first were determined to be cognitively intact (HI group; n = 30), the second had an established dementia diagnosis (D-HI group; n = 16). The HI-ACE-III was administered along with additional visually presented cognitive tests; the Rey-Osterrieth Complex Figure (ROFC), Spatial Span (SS) and Graded Naming Test (GNT). Results: The ROC analysis revealed an Area Under the Curve (AUC) value of .960 for the HI-ACE-III, with an optimum cut-off point of <87, achieving 93.8% sensitivity and 93.3% specificity and likelihood ratio of dementia of 14.06:1. Concurrent validity was demonstrated through correlations between HI-ACE-III domain scores and relevant standardised neuropsychological measures. Internal consistency of the HI-ACE-III was verified with Cronbach’s alpha (α = .925). Conclusions: The HI-ACE-III showed good reliability, validity and diagnostic utility for dementia screening in older adults in a hearing impairment context. The adapted HI-ACE-III may offer an accurate and reliable indication of cognitive performance, supporting timely diagnosis of dementia and contributing to future research.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available