The ACL (Men Cognitive Level Test) is a brief screening tool used to determine ordinal levels of cognitive functioning, relevant to activities of daily living. This standardized test requires a person to replicate three increasingly complex lacing stitches. It has been increasingly useful in screening older persons who are at risk for dementia. Because many older people have poor vision or difficulty with performing fine motor tasks, the original version of the ACL cannot always be successfully administered. This study investigated the validity of using a larger and easier-to-see version of the ACL (LACL). The scores of 83 subiects (34 normal elderly and 49 patients with probable Alzheimer's diiease) on both the ACL the LACL were analyzed to compare the adapted tool to the original. Concurrent validity was established with the Mini Mental State Examination and the Routine Task Inventory. No significant difference was found between scores on the ACL and LACL when practice effect and gender are controlled. However, older control subjects (>75 years) performed more poorly on the ACL than the LACL. The results of this study demonstrated that the use of an enlarged ACL (LACL) can be effectively utilized as a screening tool for cognitive dysfunction in elderly persons who may not be able to see or manipulate the original version.