Your ACE-III score explained

The standard cut-offs

The Addenbrooke's Cognitive Examination, third edition (ACE-III) is scored out of 100. The widely used cut-offs (Hsieh et al. 2013) are:

• 88 to 100: within the normal range for most adults;
• 82 to 88: borderline range, often reflecting Mild Cognitive Impairment or early dementia, requiring interpretation in context;
• Below 82: clinically significant impairment, supportive of dementia in the appropriate clinical context.

The cut-offs are not absolute. Education, hearing, vision, mood, sleep and English-language background all influence performance, and the score must be interpreted with the clinical picture.

The domain breakdown

Look at the subdomain scores as well as the total. The pattern is often more informative than the total alone.

Attention (out of 18)

Includes orientation, three-word repetition, and a serial calculation or word-spelling task. Attention is often the first domain affected in Delirium and in Vascular Cognitive Impairment.

Memory (out of 26)

Includes recall of the three words after a short delay, learning of a name and address, recall of the name and address after several minutes, recognition of forgotten items, and recall of famous historical and current figures.

Memory is the most affected domain in Alzheimer's Disease. A memory score of 10 to 18 of 26 with relatively preserved other domains is the classic Alzheimer's pattern.

Fluency (out of 14)

Words starting with the letter P (letter fluency, 7 points) and animals in a minute (category fluency, 7 points). Fluency is the most sensitive single domain to Frontotemporal Dementia and is highly sensitive to Vascular changes.

Language (out of 26)

Includes following multi-step commands, writing two sentences, repeating phrases, naming illustrations, defining items, comprehension of pointing tasks, and reading irregular words.

Marked language difficulty without proportionate memory loss raises the question of Primary Progressive Aphasia.

Visuospatial (out of 16)

Includes copying overlapping pentagons and a wire cube, drawing a clock face, counting dots, identifying fragmented letters.

Visuospatial impairment is prominent in Dementia with Lewy Bodies and in Posterior Cortical Atrophy.

What the patterns suggest

These are starting points. The clinician integrates the ACE-III with history, imaging, blood tests and ECG to arrive at the diagnosis.

Reading your score in context

If your score is in the normal range (88+)

Reassuring. Combined with no functional decline and a normal scan, dementia is unlikely. If symptoms persist, address reversible contributors (mood, sleep, medication, vascular risk) and reassess in 12 months.

If your score is borderline (82 to 88)

The borderline range often corresponds to Mild Cognitive Impairment. Daily independence may still be preserved. Action: address reversible contributors, optimise lifestyle, reassess in 6 to 12 months.

If your score is below 82

This is consistent with dementia in the appropriate clinical context, but does not in itself diagnose dementia. The threshold between MCI and dementia is functional (everyday independence), not radiological or score-based. Subtype is determined by the pattern and the wider work-up.

What can lower the score artificially

Several factors reduce ACE-III score without indicating dementia:

• Untreated hearing loss (especially in the attention and language subdomains);
• Uncorrected vision;
• Depression or anxiety (sometimes a 10 to 15 point reduction);
• Untreated Sleep Apnoea or chronic insomnia;
• Recent illness, surgery or acute Delirium;
• Alcohol or sedative medication;
• English not first language without adapted test;
• Limited formal education.

Where these are present and addressed, repeat ACE-III in 3 to 6 months often shows substantial improvement.

What happens next

Your clinician will explain the score alongside the imaging, blood tests, ECG and the history. The next steps depend on the full picture: medication, follow-up, addressing reversible contributors, or further investigations.