ORIGINAL RESEARCH article
Front. Hum. Neurosci.
Sec. Brain Health and Clinical Neuroscience
This article is part of the Research TopicNew horizons in stroke management: Volume IIView all 8 articles
Domain-Specific Cognitive Screening in Acute First-Ever Stroke: A Comparative Study of the Oxford Cognitive Screen and ACE-III
Provisionally accepted
- 1University of New South Wales, Sydney, Australia
- 2University of New South Wales, Kensington, Australia
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Introduction: Post-stroke cognitive impairment (PSCI) is common and often under-recognised, particularly in the acute phase. Most cognitive screening tools provide only a global score, overlooking domain-specific deficits that influence functional recovery. The Addenbrooke's Clinical Examination-III (ACE-III) is a comprehensive cognitive test whose utility for acute stroke patients remains under-studied. This study evaluated the diagnostic performance of the ACE-III against the stroke-specific Oxford Cognitive Screen (OCS) in detecting PSCI following first-ever stroke in the acute period. Methods: Patients with first-ever stroke and no history of cognitive impairment were prospectively assessed within seven days of onset using both the OCS and ACE-III. PSCI was defined by impairment in one or more cognitive domains on the OCS. The discriminatory capacity of the ACE-III for detecting PSCI was examined, and associations between specific cognitive deficits and functional dependence were analyzed. Results: The OCS detected PSCI in 70% of the 30 patients that were recruited. The ACE-III demonstrated good discriminatory capacity (AUC = 0.897); however, it failed to detect PSCI in five patients identified by the OCS, and misclassified two aphasic but cognitively intact patients as impaired. Two patients classified as impaired on ACE-III were deemed cognitively intact by OCS, underscoring its limitations in stroke populations. Standard and stroke-specific ACE-III cut-offs demonstrated suboptimal accuracy for acute screening. Conclusions: While ACE-III performs well at the group level, it may miss relevant cognitive impairment in the acute stroke setting. Domain-based, stroke-specific tools such as the OCS more reliably detect deficits and may offer greater clinical utility for early cognitive profiling and rehabilitation.
Keywords: ACE-III, Cognition, Cognitive screening, OCS, post-stroke cognitive impairment, Stroke
Received: 02 Aug 2025; Accepted: 10 Dec 2025.
Copyright: © 2025 Tanglay, Jhunjhnuwala and Huynh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: William Huynh
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