Invited commentary. Mini mental status examination and the Addenbrooke's cognitive examination: effect of education and norms for a multicultural population.

Since its initial publication in English in Neurology in interpreting test results and conducting epidemiological 2000, Addenbrooke’s cognitive examination (ACE) has studies: subjects with greater than 12 years of formal earned a respected place in behavioral neurology and education obtained average scores double those of subjects cognitive neuropsychology. It has the considerable benefit with no formal education. Even though low education is of containing all items of the nearly-universally recognized a risk factor for Alzheimer dementia, this is still an Mini Mental State Exam, with a number of added items extraordinary difference. Interestingly, the average score to increase sensitivity to specific dementing diseases such of these highly-educated elders was nonetheless at the as Alzheimer’s disease and fronto-temporal dementia. level of dementia according to the original ACE-English Still, administration time is quite brief. French, German, norms. Clearly, the normal distribution of the MalayalamSpanish and Hebrew adaptations have been published speaking population on the ACE is offset to the left and a revised English version in three parallel forms was compared to the English population, suggesting residual recently published by the original authors. Given the cultural or linguistic effects. Even so, let us hope that the wide international acceptance of English and French as authors will in the future expand their norming study to second languages, brief cognitive assessment to diagnose younger subjects as well. dementia is within reach of most physicians and their educated patients. However, at least two problems remain: Department of Neurology and Agnes Ginges Center for Human not all patients throughout the world are educated and Neurogenetics, Hadassah-Hebrew University Medical Center, linguistic, ethnic, cultural and religious differences P. O. Box 12000 Jerusalem, 91120 Israel. throughout the world make some items either E-mail: [email protected]