Predictivity of the clock drawing test in the acute phase of cerebrovascular diseases on cognitive decline at a 6-month neuropsychological evaluation

ABSTRACT Cognitive decline can be screened by the clock drawing test (CDT), which has several versions. Objective: This survey aimed to analyze the correlation between two simple methods for scoring the CDT. Methods: This cross-sectional study was nested in the Elo-Creati cohort from Passo Fundo, Brazil and comprised 404 subjects. Two raters underwent previous training and scored the subjects’ CDT according to both the Pfizer and Shulman systems. The inter-observer and intra-observer concordance within each method was analyzed with the Spearman’s rank correlation coefficient, as well as the concordance of the scores between the two methods. Age and scholarity were also correlated with the scores. Results: Most of the participants were women (93.8%) and Caucasian (84.6%), with a mean age of 66.9 (±7.8) years and a scholarity of 10.9 years (±5.6). There was significant inter-observer (Pfizer: r=0.739, p£0.001; Shulman: r=0.727, p£0.001) and intra-observer correlation (Pfizer: rater 1, r=0.628, p≤0.001; rater 2, r=0.821, p≤0.001; Shulman: rater 1, r=0.843, p≤0.001; rater 2: r=0.819; p≤0.001). Intra-observer correlation was also observed comparing Pfizer and Shulman methods (rater 1: r=0.744; p≤0.001; rater 2: r=0.702; p≤0.001). There was weak correlation of the scores with scholarity (Pfizer: r=0.283, p£0.001; Shulman: r=0.244, p£0.001) and age (Pfizer: r=-0.174, p£0.001; Shulman: r=-0.170, p£0.001). More participants were classified with decreased cognition through the Pfizer system (rater 1: 44.3 vs. 26.5%; rater 2: 42.1 vs. 16.3%; p≤0.001). Conclusions: For this population, our results suggest that the Pfizer system of scoring CDT is more suitable for screening cognitive decline.

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VASCULAR RISK FACTORS AND COGNITIVE FUNCTIONS IN THE PATIENTS WITH CEREBROVASCULAR DISEASE

Wiadomości Lekarskie ◽

10.36740/wlek202010128 ◽

2020 ◽

Vol 73 (10) ◽

pp. 2250-2254

Author(s):

Oksana O. Kopchak ◽

Natalia Yu. Bachinskaya ◽

Oleksandr R. Pulyk

Keyword(s):

Risk Factors ◽

Cerebrovascular Disease ◽

Cognitive Decline ◽

Mmse Score ◽

Significant Negative Correlation ◽

Vascular Risk Factors ◽

Vascular Risk ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test

The aim: To assess the severity of cognitive impairment (CI) in patients with cerebrovascular disease (CVD) depending on the number of vascular risk factors (VRF). Materials and methods: The study consisted of five hundred and eighty patients with CVD (247 females and 333 males) aged from 45 to 89 years (mean age: 64,1±8,9 years). The patients were divided into 6 groups (I, II, III, IV, V, VI) depending on the number of VRF. The examination consisted of a standard clinical evaluation, neurological examination, the application of neuropsychological tests (the MMSE; the PALT/The Paired Associates Learning Test; clock drawing test), laboratory tests, MRI of brain. Results: According to ANOVA, the greater the number of VRF the patients had, the lower was their total MMSE score corresponding to more pronounced cognitive decline (F=2,97, p=0,012). A significant negative correlation between patients’ age and their MMSE score was detected regardless of their VRF count. The patients of the V and VI groups had substantially lower parameters of immediate, delayed memory and clock drawing test score comparing to the patients of the I group. Conclusions: The presence of 4 and more VRF was related to more pronounced CI in the patients with CVD. Decline of different aspects of memory, attention, spatial orientation, abstract thinking, planning, concentration, executive and visuospatial skills in groups of patients with 4,5 and 6 vascular risk factors was established. Age was substantially associated with cognitive decline in all the group of patients.

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Does the Clock Drawing Test Predict Cognitive Decline in Older Persons Independent of the Mini-Mental State Examination?

Journal of the American Geriatrics Society ◽

10.1111/j.1532-5415.1996.tb01403.x ◽

1996 ◽

Vol 44 (11) ◽

pp. 1326-1331 ◽

Cited By ~ 68

Author(s):

Luigi Ferrucci ◽

Francesca Cecchi ◽

Jack M. Guralnik ◽

Simona Giampaoli ◽

Cinzia Lo Noce ◽

...

Keyword(s):

Cognitive Decline ◽

Mental State ◽

Older Persons ◽

Mini Mental State Examination ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

State Examination

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Testing Older Adults for Signs of Age-Related Cognitive Decline: Clock Drawing Test vs.Mini-Mental State Examination

Practice in Clinical Psychology ◽

10.18869/acadpub.jpcp.5.2.141 ◽

2017 ◽

Vol 5 (2) ◽

pp. 141-148

Author(s):

Fahimeh Ghavidel ◽

Javad Salehi Fadardi ◽

Fereshteh Sedaghat ◽

Zahra Tabibi ◽

◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Mental State ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

Age Related ◽

Age Related Cognitive Decline ◽

State Examination

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The Clock Drawing Test as a predictor of cognitive decline in non-demented stroke patients

Journal of Neurology ◽

10.1007/s00415-021-10637-z ◽

2021 ◽

Author(s):

Ilaria Cova ◽

Francesco Mele ◽

Federica Zerini ◽

Laura Maggiore ◽

Silvia Rosa ◽

...

Keyword(s):

Cognitive Impairment ◽

Cognitive Decline ◽

Cognitive Assessment ◽

Stroke Patients ◽

Term Care ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

Incident Cases

Abstract Background The early detection of patients at risk of post-stroke cognitive impairment (PSCI) may help planning subacute and long-term care. We aimed to determine the predictivity of two screening cognitive tests on the occurrence of mild cognitive impairment or dementia in acute stroke patients. Methods A cognitive assessment within a few days of ischemic or hemorrhagic stroke was performed in patients consecutively admitted to a stroke unit over 14 months by means of the Clock Drawing Test (CDT) and the Montreal Cognitive Assessment-Basic (MoCA-B). Results Out of 191 stroke survivors who were non-demented at baseline, 168 attended at least one follow-up visit. At follow-up (mean duration ± SD 12.8 ± 8.7 months), 28 (18.9%) incident cases of MCI and 27 (18%) cases of dementia were recorded. In comparison with patients who remained cognitively stable at follow-up, these patients were older, less educated, had more comorbidities, a higher score on the National Institutes of Health Stroke Scale (NIHSS) at admission, more severe cerebral atrophy, and lower MoCA-B and CDT scores at baseline. In multi-adjusted (for age, education, comorbidities score, NIHSS at admission and atrophy score) model, a pathological score on baseline CDT (< 6.55) was associated with a higher risk of PSCI at follow-up (HR 2.022; 95% CI 1.025–3.989, p < 0.05) with respect to non-pathological scores. A pathological baseline score on MoCA-B (< 24) did not predict increased risk of cognitive decline at follow-up nor increased predictivity of stand-alone CDT. Conclusion A bedside cognitive screening with the CDT helps identifying patients at higher risk of PSCI.

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Clock drawing test in mild cognitive impairment: Correlation with cerebral perfusion in single-photon emission computed tomography.

Neuropsychology ◽

10.1037/neu0000549 ◽

2019 ◽

Vol 33 (5) ◽

pp. 617-632 ◽

Cited By ~ 1

Author(s):

Diana Duro ◽

Pedro Cerveira ◽

Beatriz Santiago ◽

Maria João Cunha ◽

João Manuel Pedroso de Lima ◽

...

Keyword(s):

Cerebral Perfusion ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Single Photon Emission ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

Single Photon Emission Computed ◽

Photon Emission Computed Tomography

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Classifying Non-Dementia and Alzheimer’s Disease/Vascular Dementia Patients Using Kinematic, Time-Based, and Visuospatial Parameters: The Digital Clock Drawing Test

Journal of Alzheimer s Disease ◽

10.3233/jad-201129 ◽

2021 ◽

Vol 82 (1) ◽

pp. 47-57 ◽

Cited By ~ 1

Author(s):

Anis Davoudi ◽

Catherine Dion ◽

Shawna Amini ◽

Patrick J. Tighe ◽

Catherine C. Price ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Vascular Dementia ◽

Area Under The Curve ◽

Clock Drawing Test ◽

Digital Clock ◽

Clock Drawing ◽

Drawing Test ◽

Dementia Patients ◽

Optimal Area

Background: Advantages of digital clock drawing metrics for dementia subtype classification needs examination. Objective: To assess how well kinematic, time-based, and visuospatial features extracted from the digital Clock Drawing Test (dCDT) can classify a combined group of Alzheimer’s disease/Vascular Dementia patients versus healthy controls (HC), and classify dementia patients with Alzheimer’s disease (AD) versus vascular dementia (VaD). Methods: Healthy, community-dwelling control participants (n = 175), patients diagnosed clinically with Alzheimer’s disease (n = 29), and vascular dementia (n = 27) completed the dCDT to command and copy clock drawing conditions. Thirty-seven dCDT command and 37 copy dCDT features were extracted and used with Random Forest classification models. Results: When HC participants were compared to participants with dementia, optimal area under the curve was achieved using models that combined both command and copy dCDT features (AUC = 91.52%). Similarly, when AD versus VaD participants were compared, optimal area under the curve was, achieved with models that combined both command and copy features (AUC = 76.94%). Subsequent follow-up analyses of a corpus of 10 variables of interest determined using a Gini Index found that groups could be dissociated based on kinematic, time-based, and visuospatial features. Conclusion: The dCDT is able to operationally define graphomotor output that cannot be measured using traditional paper and pencil test administration in older health controls and participants with dementia. These data suggest that kinematic, time-based, and visuospatial behavior obtained using the dCDT may provide additional neurocognitive biomarkers that may be able to identify and tract dementia syndromes.

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Digital Clock Drawing: Differentiating “Thinking” versus “Doing” in Younger and Older Adults with Depression

Journal of the International Neuropsychological Society ◽

10.1017/s1355617714000757 ◽

2014 ◽

Vol 20 (9) ◽

pp. 920-928 ◽

Cited By ~ 15

Author(s):

Jamie Cohen ◽

Dana L. Penney ◽

Randall Davis ◽

David J. Libon ◽

Rodney A. Swenson ◽

...

Keyword(s):

Motor Performance ◽

Psychomotor Speed ◽

Psychomotor Slowing ◽

Younger Adults ◽

Clock Drawing Test ◽

Digital Clock ◽

Clock Drawing ◽

Time To Completion ◽

Drawing Test ◽

Depressed Group

AbstractPsychomotor slowing has been documented in depression. The digital Clock Drawing Test (dCDT) provides: (i) a novel technique to assess both cognitive and motor aspects of psychomotor speed within the same task and (ii) the potential to uncover subtleties of behavior not previously detected with non-digitized modes of data collection. Using digitized pen technology in 106 participants grouped by Age (younger/older) and Affect (euthymic/unmedicated depressed), we recorded cognitive and motor output by capturing how the clock is drawn rather than focusing on the final product. We divided time to completion (TTC) for Command and Copy conditions of the dCDT into metrics of percent of drawing (%Ink) versus non-drawing (%Think) time. We also obtained composite Z-scores of cognition, including attention/information processing (AIP), to explore associations of %Ink and %Think times to cognitive and motor performance. Despite equivalent TTC, %Ink and %Think Command times (Copy n.s.) were significant (AgeXAffect interaction: p=.03)—younger depressed spent a smaller proportion of time drawing relative to thinking compared to the older depressed group. Command %Think time negatively correlated with AIP in the older depressed group (r=−.46; p=.02). Copy %Think time negatively correlated with AIP in the younger depressed (r=−.47; p=.03) and older euthymic groups (r=−.51; p=.01). The dCDT differentiated aspects of psychomotor slowing in depression regardless of age, while dCDT/cognitive associates for younger adults with depression mimicked patterns of older euthymics. (JINS, 2014, 20, 1–9)

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The Four-Point Scoring System for the Clock Drawing Test Does Not Differentiate between Alzheimer's Disease and Vascular Dementia

Psychological Reports ◽

10.2466/pr0.106.3.941-948 ◽

2010 ◽

Vol 106 (3) ◽

pp. 941-948 ◽

Cited By ~ 8

Author(s):

April R. Wiechmann ◽

James R. Hall ◽

Sid O'bryant

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Vascular Dementia ◽

Sensitivity And Specificity ◽

Scoring System ◽

Cutoff Score ◽

Characteristic Analysis ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test

The purpose of this study was to explore the sensitivity and specificity of the Clock Drawing Test by using a widely employed four-point scoring system to discriminate between patients with Alzheimer's disease or vascular dementia. Receiver operating characteristic analysis indicated that the Clock Drawing Test was able to distinguish between normal elders and those with a dementia diagnosis. The cutoff score for differentiating patients with Alzheimer's disease from normal participants was = 3. The cutoff score for differentiating those with vascular disease from normal participants was = 3. Overall, the four-point scoring system demonstrated good sensitivity and specificity for identifying cognitive dysfunction associated with dementia; however, the current findings do not support the utility of the four-point scoring system in discriminating Alzheimer's disease and vascular dementia.

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