Agreement between cognitive screening tools: a comparison of MoCA, ACE-III, M-ACE, and MoCA-MIS

Despite strong inter-test correlations, substantial divergence in classification outcome was observed, particularly between MoCA and ACE-III. Reliance on a single screening instrument risks misclassification, with implications for both over- and under-diagnosis. Greater harmonization between screening tools is needed to improve diagnostic consistency. Clinical practice should therefore combine multiple-instrument approaches, potentially including premorbid function, and interpret screening test scores cautiously. Comprehensive neuropsychological assessment may provide a more complete picture, particularly in cases where diagnostic confidence is low, although this is not routine practice in all services.