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Normative Data for Healthy Middle-Aged and Elderly Performance on the Addenbrooke Cognitive Examination-Revised

Amaral-Carvalho, Viviane MSc*; Caramelli, Paulo MD, PhD*,†

Cognitive and Behavioral Neurology: June 2012 - Volume 25 - Issue 2 - p 72–76
doi: 10.1097/WNN.0b013e318259594b
Original Studies

Objective: To provide normative data for healthy middle-aged and elderly Brazilians' performance on the Addenbrooke Cognitive Examination-Revised (ACE-R) and to investigate the effects of age, sex, and schooling on test performance.

Background: The ACE-R is a brief cognitive battery that assesses various aspects of cognition. Its 5 subdomains (Attention and Orientation, Memory, Verbal Fluency, Language, and Visuospatial Abilities) are commonly impaired in Alzheimer disease or frontotemporal dementia.

Methods: We evaluated 144 cognitively healthy volunteers (50% men, 50% women) aged 50 to 93 years, with 4 to 24 years of schooling. We divided the participants into 4 age groups, each of which was then stratified into 3 groups according to years of education. We assessed all participants with the ACE-R, the Mattis Dementia Rating Scale, and the Cornell Scale for Depression in Dementia.

Results: Years of education affected all ACE-R subscores. Age influenced the Verbal Fluency subscore (P<0.001) and the ACE-R total score (P<0.05). Sex affected the Attention and Orientation (P=0.037) and Mini-Mental State Examination subscores (P=0.048), but not the ACE-R total score (P>0.05).

Conclusions: The performance of healthy middle-aged and elderly individuals on the ACE-R battery is strongly influenced by education and, to a lesser extent, by age. These findings are of special relevance in countries with populations that have marked heterogeneity in educational levels.

*Postgraduate Program in Neurology, University of São Paulo School of Medicine, São Paulo, SP, Brazil

Department of Internal Medicine, Behavioral and Cognitive Neurology Unit, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

P.C. is funded by the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and the Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG), Brazil.

The authors declare no conflicts of interest.

Reprints: Paulo Caramelli, MD, PhD, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Av. Prof. Alfredo Balena, 190 - Room 246 30130-100, Belo Horizonte (MG), Brazil (e-mail:

Received October 2, 2011

Accepted February 8, 2012

© 2012 Lippincott Williams & Wilkins, Inc.