Interpreting ACE-iii score

[Lgh1718]

Hello,
Just joined the forum and hoping to draw on your experiences of assessment and diagnosis.
Mum (82) has shown signs of cognitive decline for years, but for various reasons has not been referred for assessment. She’s lived in a residential home since Jan 2020 due to severe mobility difficulties. She has recently been admitted to hospital as carers were concerned about deteriorating mobility and cognition. So it looks as though we will finally be able to have a formal assessment. I spoke to a ward nurse today who said that Mum had completed the ACE-III screener yesterday and received a score of 50. As cut-off for dementia is 82, clearly that’s what we’re looking at, but I can’t find any information online about how to interpret scores <82. Does a score of 50 indicate moderate or severe dementia? I know this is just one indicator, and hopefully she will soon receive a fuller assessment, but would be grateful for any insight on what this score suggests about the progression of the disease. Thank you

 

[Jaded'n'faded]

If only it were so simple! Everyone with dementia progresses at a different rate and may or may not show all the 'classic' symptoms. Certainly, the ACE test score won't tell you any more than you already know. I think we all want to know what a diagnosis of dementia will mean, how things will progress and what the timeline is but that's like asking 'how long is a piece of string?' I wonder if this overview helps:

Clinical Stages of Alzheimer’s

New York University’s Dr. Barry Reisberg outlines the seven major clinical stages of Alzheimer’s disease. Dr. Reisberg is the Clinical Director of New York University’s Aging and Dementia Research Center.

www.alzinfo.org

 

[Lgh1718]

Thanks for your reply. I know it’s not simple, but have been trying to get an assessment for mum for such a long time and lockdown means I can’t visit her either in hospital or care home. I can’t often speak to her on the phone as she’s lost confidence using it. So I feel very isolated from her and in the dark as to what’s going on. I’ve read a lot about the stages of dementia. I just wondered if anyone could help me interpret the fragments of information I am receiving about my mum’s condition

 

[Jaded'n'faded]

I think really, the care home staff can give you the best information - a doctor can only speculate but the staff are with her 24/7. Maybe you could arrange a proper discussion with the manager?

 

[nitram]

Does a score of 50 indicate moderate or severe dementia?

You asked about severity, the breakdown of the score can help with diagnosing relative severity of main brain functions.

Addenbrooke’s cognitive examination III in the diagnosis of dementia: a critical review

Addenbrooke’s cognitive examination III is a screening test that is composed of tests of attention, orientation, memory, language, visual perceptual and visuospatial skills. It is useful in the detection of cognitive impairment, especially in ...

www.ncbi.nlm.nih.gov

 

[Lgh1718]

Thank you for the helpful reference. I’ll see if I can access the breakdown on mum’s assessment

 

[Agzy]

If only it were so simple! Everyone with dementia progresses at a different rate and may or may not show all the 'classic' symptoms. Certainly, the ACE test score won't tell you any more than you already know. I think we all want to know what a diagnosis of dementia will mean, how things will progress and what the timeline is but that's like asking 'how long is a piece of string?' I wonder if this overview helps:

Clinical Stages of Alzheimer’s

New York University’s Dr. Barry Reisberg outlines the seven major clinical stages of Alzheimer’s disease. Dr. Reisberg is the Clinical Director of New York University’s Aging and Dementia Research Center.

www.alzinfo.org

Once [assed the jargon and translated into ‘my’ language my OH probably stage 5 but some bits here and some bits there so lines obviously not meant to be definitive. Thank you

 

[Jaded'n'faded]

You asked about severity, the breakdown of the score can help with diagnosing relative severity of main brain functions.

Addenbrooke’s cognitive examination III in the diagnosis of dementia: a critical review

Addenbrooke’s cognitive examination III is a screening test that is composed of tests of attention, orientation, memory, language, visual perceptual and visuospatial skills. It is useful in the detection of cognitive impairment, especially in ...

www.ncbi.nlm.nih.gov

I wonder if in years to come they will replace the 'drawing of a clock with hands showing a particular time' question they currently ask?

It's a very useful test but young people don't use clocks and watches much. I recall Joey Essex (when he was on I'm A Celebrity...) saying he didn't know how to tell the time and I was shocked. I've also noticed the symbol we've always recognised as being a telephone has now changed to a mobile phone shape as it was meaningless to younger people.

Sorry - just musing. Clearly I am getting old...

 

[nitram]

Sorry - just musing. Clearly I am getting old...

Things do change, when I took my driving test the 'torch of knowledge' was a road sign - I've removed the text,

Sorry for thread hijack although could be a good image for PWDs to recognise.

 

[Lgh1718]

Things do change, when I took my driving test the 'torch of knowledge' was a road sign - I've removed the text,
View attachment 63901
Sorry for thread hijack although could be a good image for PWDs to recognise.

Just ducking back in to say thanks for the references. Have had further conversation with ward nurse and care home manager and I think we’re looking at mid to late stage 6. My mum has always had some psychiatric problems so the course of the dementia has been particularly hard to track. Feeling very sad but also relieved it looks like we might finally get a diagnosis (well past time) Thanks all

 

[Rosettastone57]

My mother in law had a score of 59 and was deemed to have mid stage dementia. Similar situation to yours, my mother in law had a personality disorder and other mental health issues, so it took family a long time to realise dementia had taken hold.

 

[angelict]

@Rosettastone57 did anyone explain about the personality disorder ?

 

[Lgh1718]

My mother in law had a score of 59 and was deemed to have mid stage dementia. Similar situation to yours, my mother in law had a personality disorder and other mental health issues, so it took family a long time to realise dementia had taken hold.

Thank you, this does sound like a similar situation. Lockdown restrictions have made it harder to gauge the rate of deterioration- I was shocked to learn how poor her score on this test was.

 

[Dimpsy]

Things do change, when I took my driving test the 'torch of knowledge' was a road sign - I've removed the text,
View attachment 63901
Sorry for thread hijack although could be a good image for PWDs to recognise.

Olympic torch; NO, it's the 'torch of knowledge'.
I must be dim, no wonder I failed my first driving test.
Please, what is/was the torch of knowledge.

 

[Rosettastone57]

@Rosettastone57 did anyone explain about the personality disorder ?

I'm not quite sure what you're asking . I'll explain further with some context. My mother in law was widowed young and lived on her own when I met her. My husband and his sister tried several times over many years to get her help with her anxiety, depression, OCD and narcissistic behaviour. Both my husband and his sister were emotionally abused as children. This was decades before her dementia diagnosis. Her GP referred her to psychiatric help and she told my husband that she had been diagnosed with a personality disorder, which she did not accept. As she was a serial liar, we weren't sure what to believe. She refused all help. She had a number of behaviours that are similar to dementia, which we were so used to seeing that we never realised that dementia had developed. I was present at her memory test and I told the nurse her mental health issues. The memory clinic thought her mental health issues had been a substantial risk factor for dementia along with her TIA and deafness.
One of the problems we had was we were never quite sure whether her behaviour was due to dementia or her underlying mental illness.
When she died, we found numerous letters from mental health teams asking her to attend follow up appointments from 20 years previously which she never went to. All these letters showed a diagnosis of narcissistic personality disorder, which in fact fitted with her behaviour.

 

[nitram]

Please, what is/was the torch of knowledge.

Phased out late 50s, early 60s.
Triangle indicates warning, circle for command.

 

[jennifer1967]

my husband remembers them by his school. they left them there in the country for a long times as so many around village schools

 

[Lgh1718]

I'm not quite sure what you're asking . I'll explain further with some context. My mother in law was widowed young and lived on her own when I met her. My husband and his sister tried several times over many years to get her help with her anxiety, depression, OCD and narcissistic behaviour. Both my husband and his sister were emotionally abused as children. This was decades before her dementia diagnosis. Her GP referred her to psychiatric help and she told my husband that she had been diagnosed with a personality disorder, which she did not accept. As she was a serial liar, we weren't sure what to believe. She refused all help. She had a number of behaviours that are similar to dementia, which we were so used to seeing that we never realised that dementia had developed. I was present at her memory test and I told the nurse her mental health issues. The memory clinic thought her mental health issues had been a substantial risk factor for dementia along with her TIA and deafness.
One of the problems we had was we were never quite sure whether her behaviour was due to dementia or her underlying mental illness.
When she died, we found numerous letters from mental health teams asking her to attend follow up appointments from 20 years previously which she never went to. All these letters showed a diagnosis of narcissistic personality disorder, which in fact fitted with her behaviour.

Sounds extremely challenging and very familiar. My mum’s difficulties have been more around extreme anxiety, emotional dysregulation, pathological demand avoidance rather than narcissistic PD (nothing diagnosed formally as she wouldn’t engage with services). She’s always had sleep difficulties and issues with memory/ organisation, so picking out where the dementia started is pretty much impossible. It makes sense that the mental health issues (and associated sleep problems) are a risk factor. Thanks for sharing your experience

 

[Dimpsy]

Phased out late 50s, early 60s.
Triangle indicates warning, circle for command.

Thank you @nitram - it's nice to be able to say I'm too young to remember them! ?

 

[St. Lucia]

Hello, Lgh1718, The score of 50 on her test is wonderful since 30 is the score you want to see when your loved one is being tested. My mother was given the test several years ago even though her Dr. at the time never said anything to her about Dementia. She had scored 20 and was declining at that time. Exercise was something that was stressed to her and to keep on moving which she did. My mother was around 74 years old then and now at 84 she is unable to walk as of this past Thursday. I decided to join this forum today maybe for some answers. Keeping your mother comfortable and bringing in pictures of family and friends for her to see is a good indicator of how much she is remembering. Engaging in activities is also a positive for her. Hope this helps.