Key result
Greek ACE-III scale yields ~0.94 AUC for detecting cognitive impairment compared to MoCA.
Why the study?
Postoperative cognitive dysfunction is highly prevalent in elderly surgical patients, necessitating valid and reliable perioperative cognitive screening tools.
Is the Greek version of the ACE-III scale a valid and reliable screening tool for perioperative cognitive impairment compared to the MoCA scale in elderly surgical patients?
Cross-Sectional (n=128)
Is the Greek version of the ACE-III scale a valid and reliable screening tool for perioperative cognitive impairment compared to the MoCA scale in elderly surgical patients?
The Greek version of the ACE-III scale is a valid and reliable alternative to the MoCA test for screening perioperative cognitive impairment in elderly surgical patients.
Supports Greek ACE-III as alternative to MoCA for cognitive screening in elderly surgical patients; leaves open prospective validation before clinical adoption.
INTRODUCTION: Postoperative cognitive dysfunction constitutes an extremely prevalent implication in individuals subjected to cardiac or noncardiac surgery. This study aimed to assess the validity and reliability of a culturally adapted Greek version of the Addenbrooke's Cognitive Examination III (ACE-III) scale as a screening tool for perioperative neurocognitive status determination in elderly surgical patients. METHODS: A cross-cultural adaptation and validation of instruments throughout the cross-sectional study was conducted. The study sample consisted of 128 individuals over 55 years old scheduled for surgical intervention. All participants were screened twice: at the preadmission clinic and the day before surgery using the already established MoCA scale and the culturally adapted Greek version of the ACE-III scale. Subjects with a MoCA score of <26 constituted the cognitively impaired group. RESULTS: Regarding construct validity, ACE-III's performance in detecting cognitive impairment was excellent (AUC = 0.942; 95% CI: 0.899-0.971). Convergent validity between ACE-III and MoCA scales was excellent (r = 0.876; 95% CI: 0.839-0.905). Known group validity was confirmed since advanced age and lower educational attainment adversely impacted ACE-III's total score (p < 0.001). Additionally, specialists suggested face validity (mean 8.7 out of 10, SD 1.1). In terms of reliability, ACE-III demonstrated good internal consistency (Cronbach's alpha 0.786) and high inter-rater (intraclass correlation coefficient [ICC] = 0.936 [95% CI: 0.921-0.941]) and test-retest reliability (ICC = 0.972 [95% CI: 0.958-0.981]). CONCLUSION: The Greek version of ACE-III is a valid and reliable screening tool that could be routinely employed perioperatively as a valid alternative to the MoCA test to distinguish the mild cognitively impaired from healthy elderly candidates for surgical interventions.
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Tsaousi et al. (2025) conducted a cross-sectional in Perioperative cognitive impairment (n=128). Greek version of the Addenbrooke's Cognitive Examination III (ACE-III) scale vs. MoCA scale was evaluated on Detection of cognitive impairment (AUC 0.942, 95% CI 0.899-0.971). The Greek version of the ACE-III scale demonstrated excellent performance in detecting cognitive impairment compared to the MoCA scale, with an AUC of 0.942 (95% CI: 0.899-0.971).
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