In plain English
The Mini-ACE is a brief cognitive screening test developed at the University of Cambridge as a shorter version of the Addenbrooke's Cognitive Examination. It takes around 5 minutes, scores out of 30, and is used widely in UK memory clinics, GP practices and care settings.
What the Mini-ACE is
The Mini-Addenbrooke's Cognitive Examination is a five-minute cognitive screen designed to detect significant cognitive impairment. It is a shortened version of the full ACE-III, retaining the most sensitive items. The total score is out of 30.
What it covers
The Mini-ACE contains five sub-tests:
- Time orientation (4 points): day, date, month, year;
- Memory: name and address learning (across the test, 7 points retrieval at the end);
- Verbal fluency: animals in one minute (7 points);
- Clock drawing (5 points);
- Delayed recall of the name and address (7 points).
When the Mini-ACE is used
The Mini-ACE is used when:
- The full ACE-III is not possible due to time or fatigue;
- Quick screening is needed in a GP practice, A&E, ward round or telephone consultation;
- Repeat monitoring is wanted with minimal burden;
- The person finds the full assessment overwhelming.
The Mini-ACE complements rather than replaces the full assessment when a full cognitive picture is required. NHS memory clinics typically use the full ACE-III; primary care often uses the Mini-ACE.
How to interpret the score
- 26 to 30: within the normal range for most adults;
- 21 to 25: borderline; further assessment usually indicated;
- Below 21: suggestive of cognitive impairment requiring further work-up.
As with all cognitive screens, the score must be interpreted with the clinical picture, education, hearing, vision and any reversible contributors.
How the Mini-ACE differs from the MMSE
The Mini-ACE and the Mini Mental State Examination (MMSE) are both brief cognitive screens. Key differences:
- The Mini-ACE includes verbal fluency, a sensitive measure of executive function and Frontotemporal Dementia;
- The Mini-ACE has a tighter focus on memory (delayed recall of a name and address) than the MMSE three-word recall;
- The Mini-ACE is free of copyright for clinical use, whereas the MMSE has licensing restrictions;
- The Mini-ACE has been validated in UK populations and is recommended in some NHS clinical pathways.
When to ask for the full ACE-III
The Mini-ACE is a screen, not a diagnostic test. A full ACE-III, ideally as part of a memory clinic assessment, is preferred when:
- The Mini-ACE result is borderline or below normal;
- Family report concerns despite a normal Mini-ACE;
- The cognitive picture is atypical (visual, language or behavioural rather than memory);
- A diagnostic decision will be made on the basis of the result.
Where The Dementia Service fits in
If a Mini-ACE has flagged a concern and you would like a structured full assessment quickly, The Dementia Service can usually offer an appointment within a few weeks with the full ACE-III, scans and structured ICD-11 aligned reporting to your GP.
Frequently asked questions
How accurate is the Mini-ACE?
The Mini-ACE has good sensitivity and specificity for detecting cognitive impairment in older adults. Below 21 of 30 strongly suggests further assessment is needed. It is a screen, not a diagnosis.
Can I practise to improve my score?
Specific item practice is not recommended; the test is designed to measure usual cognition. Rest, glasses, hearing aids and being well are the most useful preparation.
Will my GP do this in a routine appointment?
Some GP practices use the Mini-ACE; others use briefer screens such as the GPCOG or 6CIT. Any score below the normal range warrants discussion of next steps.
Does the Mini-ACE replace the full ACE-III?
No. The Mini-ACE is a screen. A full ACE-III, as part of a memory clinic assessment, gives the fuller cognitive picture and is preferred for diagnostic decisions.
Is the Mini-ACE done by phone or video?
Adapted versions exist for remote assessment, with appropriate validation. Most face-to-face items work over video, with practical adaptations to the drawing tasks.
References
- Hsieh S et al. The Mini-Addenbrooke's Cognitive Examination: a new assessment tool. Dementia and Geriatric Cognitive Disorders 2015.
- NICE NG97.
- Royal College of Psychiatrists. Memory Services National Accreditation Programme.
- University of Cambridge. Mini-ACE instructions and scoring.