Johns Hopkins Adapted Cognitive Exam (ACE)

(Lewin et al., 2012)

Assessment Form

Valid and reliable exam tool on a 100-point scale designed for the assessment and quantification of cognition in critically ill intubated and non-intubated patients using non-verbal gestures to communicate a response.

Areas of assessment

1. Orientation: year, season, date, DOW, country, state, city, type of building

2. Language: The ability to identify item & use; written command following, 3-step command following

3. Registration: show the Patient a specific sequence of fingers (2 fingers, then 1 finger, then 4 fingers) that the Patient has to repeat

4. Attention/Calculation: using flashcards, have the Patient perform simple calculations and match picture to word

5. Recall: have the Patient repeat sequence of fingers from the registration section; recall & perform verbal 3-step command; recall & perform written command

Items required for testing

• Assessment form

• Flashcards for the attention and calculation sections (helpful to laminate for the ability to reuse)

• Pencil or dry erase marker

Scoring

For the multiple-choice questions in the orientation and language sections, scoring is as follows: 0 = inappropriate response, 1 = vastly incorrect choice, 2 = slightly incorrect choice, and 3 = correct choice. If unable to respond rate at UN, not 0. For remaining sections, score varies by question and is listed within the assessment.

Predicted cut points for Cognitive Status Classification

Severely Impaired: </= 28

Moderately Impaired: 29-55

Mildly Impaired or Normal: >/= 56