A reduced scoring system for the Clock Drawing Test using a population-based sample

ABSTRACTBackground: Many scoring systems exist for clock drawing task variants, which are common dementia screening measures, but all have been derived from clinical samples. This study evaluates and combines errors from two published scoring systems for the Clock Drawing Test (CDT), the Lessig and Tuokko methods, in order to create a simple yet optimal scoring procedure to screen for dementia using a Canadian population-based sample.Methods: Clock-drawings from 356 participants (80 with dementia, 276 healthy controls) from the Canadian Study on Health and Aging were analyzed using logistic regression and Receiver Operating Characteristic curves to determine a new, simplified, population-based CDT scoring system. The new Jouk scoring method was then compared to other commonly used systems (e.g. Shulman, Tuokko, Watson, Wolf-Klein).Results: The Jouk scoring system reduced the Lessig system even further to include five critical errors: missing numbers, repeated numbers, number orientation, extra marks, and number distance, and produced a sensitivity of 81% and a specificity of 68% with a cut-off score of one error. With regard to other traditionally used scoring methods, the Jouk procedure had one of the most balanced sensitivities/specificities when using a population-based sample.Conclusions: The results from this study improve our current state of knowledge concerning the CDT by validating the simplified scoring system proposed by Lessig and her colleagues in a more representative sample to mimic conditions a general clinician or researcher will encounter when working among a wide-ranging population and not a dementia/memory clinic. The Jouk CDT scoring system provides further evidence in support of a simple and reliable dementia-screening tool that can be used by clinicians and researchers alike.

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The Clock Drawing Test A review of its accuracy in screening for dementia

Dementia & Neuropsychologia ◽

10.1590/s1980-57642009dn30200002 ◽

2009 ◽

Vol 3 (2) ◽

pp. 74-80 ◽

Cited By ~ 25

Author(s):

Ivan Aprahamian ◽

José Eduardo Martinelli ◽

Anita Liberalesso Neri ◽

Mônica Sanches Yassuda

Keyword(s):

Scoring Systems ◽

The Elderly ◽

The Other ◽

Early Screening ◽

Clock Drawing Test ◽

The Past ◽

Clock Drawing ◽

Dementia Screening ◽

Drawing Test ◽

Diagnosis Of Dementia

Abstract The Clock Drawing Test (CDT) is a simple neuropsychometric instrument that can be easily applied to assess several cognitive functions. Over the past 20 years, the CDT has aroused considerable interest in its role for the early screening of cognitive impairment, especially in dementia. Although the CDT is considered an accurate test for dementia screening, recent studies including comparisons with structured batteries such as the CAMCOG have shown mixed results. Objectives: To investigate the importance of the CDT compared to other commonly used tests, in the diagnosis of dementia in the elderly; (2) to evaluate the reliability and correlation between available CDT scoring scales from recent studies. Methods: A systematic search in the literature was conducted in September 2008 for studies comparing CDT scoring systems and comparing the CDT with neuropsychiatric batteries. Results: Twelve studies were selected for analyses. Seven of these studies compared CDT scoring scales while five compared the CDT against the CAMCOG and the MMSE. Eight studies found good correlation and reliability between the scales and the other tests. Conclusion: Despite the mixed results in these studies, the CDT appears to be a good screening test for dementia.

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Scoring systems for the Clock Drawing Test: A historical review

Dementia & Neuropsychologia ◽

10.1590/1980-57642016dn11-010003 ◽

2017 ◽

Vol 11 (1) ◽

pp. 6-14 ◽

Cited By ~ 15

Author(s):

Bárbara Spenciere ◽

Heloisa Alves ◽

Helenice Charchat-Fichman

Keyword(s):

Historical Review ◽

Scoring Systems ◽

Scoring Methods ◽

Scoring Method ◽

Neuropsychological Screening ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

Dementia Prevention ◽

Different Types

ABSTRACT The Clock Drawing Test (CDT) is a simple neuropsychological screening instrument that is well accepted by patients and has solid psychometric properties. Several different CDT scoring methods have been developed, but no consensus has been reached regarding which scoring method is the most accurate. This article reviews the literature on these scoring systems and the changes they have undergone over the years. Historically, different types of scoring systems emerged. Initially, the focus was on screening for dementia, and the methods were both quantitative and semi-quantitative. Later, the need for an early diagnosis called for a scoring system that can detect subtle errors, especially those related to executive function. Therefore, qualitative analyses began to be used for both differential and early diagnoses of dementia. A widely used qualitative method was proposed by Rouleau et al. (1992). Tracing the historical path of these scoring methods is important for developing additional scoring systems and furthering dementia prevention research.

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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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The Japanese version of the Rapid Dementia Screening Test is effective compared to the clock-drawing test for detecting patients with mild Alzheimer's disease

Psychogeriatrics ◽

10.1111/psyg.12144 ◽

2015 ◽

Vol 16 (4) ◽

pp. 233-239 ◽

Cited By ~ 4

Author(s):

Yasushi Moriyama ◽

Aihide Yoshino ◽

Kaori Yamanaka ◽

Motoichiro Kato ◽

Taro Muramatsu ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Screening Test ◽

Japanese Version ◽

Clock Drawing Test ◽

Clock Drawing ◽

Dementia Screening ◽

Drawing Test

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The Clock Drawing Test: Performance differences between the free-drawn and incomplete-copy versions in patients with MCI and dementia

Dementia & Neuropsychologia ◽

10.1590/s1980-5764-2016dn1003009 ◽

2016 ◽

Vol 10 (3) ◽

pp. 227-231 ◽

Cited By ~ 2

Author(s):

Bárbara Costa Beber ◽

Renata Kochhann ◽

Bruna Matias ◽

Márcia Lorena Fagundes Chaves

Keyword(s):

Cognitive Impairment ◽

Test Performance ◽

Diagnostic Value ◽

Control Group ◽

Cognitive Screening ◽

Scoring Method ◽

Clock Drawing Test ◽

Clock Drawing ◽

Healthy Elderly ◽

Drawing Test

ABSTRACT Background: The Clock Drawing Test (CDT) is a brief cognitive screening tool for dementia. Several different presentation formats and scoring methods for the CDT are available in the literature. Objective: In this study we aimed to compare performance on the free-drawn and "incomplete-copy" versions of the CDT using the same short scoring method in Mild Cognitive Impairment (MCI) and dementia patients, and healthy elderly participants. Methods: 90 participants (controlled for age, sex and education) subdivided into control group (n=20), MCI group (n=30) and dementia group (n=40) (Alzheimer's disease - AD=20; Vascular Dementia - VD=20) were recruited for this study. The participants performed the two CDT versions at different times and a blinded neuropsychologist scored the CDTs using the same scoring system. Results: The scores on the free-drawn version were significantly lower than the incomplete-copy version for all groups. The dementia group had significantly lower scores on the incomplete-copy version of the CDT than the control group. MCI patients did not differ significantly from the dementia or control groups. Performance on the free-drawn copy differed significantly among all groups. Conclusion: The free-drawn CDT version is more cognitively demanding and sensitive for detecting mild/early cognitive impairment. Further evaluation of the diagnostic value (accuracy) of the free-drawn CDT in Brazilian MCI patients is needed.

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Interrater Reliability of Three Clock Drawing Test Scoring Systems

Applied Neuropsychology ◽

10.1207/s15324826an0803_7 ◽

2001 ◽

Vol 8 (3) ◽

pp. 174-179 ◽

Cited By ~ 9

Author(s):

Marne B. South ◽

Kevin W. Greve ◽

Kevin J. Bianchini ◽

Donald Adams

Keyword(s):

Interrater Reliability ◽

Scoring Systems ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

Test Scoring

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Validity and Clinical Utility of Different Clock Drawing Test Scoring Systems in Multiple Forms of Dementia

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/0891988718774432 ◽

2018 ◽

Vol 31 (3) ◽

pp. 114-122 ◽

Cited By ~ 2

Author(s):

Diana Duro ◽

Miguel Tábuas-Pereira ◽

Sandra Freitas ◽

Beatriz Santiago ◽

Maria Amália Botelho ◽

...

Keyword(s):

Clinical Utility ◽

Lewy Bodies ◽

Scoring Systems ◽

Cognitive Screening ◽

Clock Drawing Test ◽

Screening Measure ◽

Clock Drawing ◽

Drawing Test ◽

Tertiary Center ◽

Cognitive Screening Measure

The Clock Drawing Test (CDT) has a known potential for the detection of cognitive impairment in populations with dementia, especially Alzheimer disease (AD). Our aim was to compare the clinical utility of 3 CDT scoring systems (Rouleau, Cahn, and Babins) in several pathologies with cognitive compromise from a tertiary center memory clinic. We selected patients with a clinical diagnosis of mild stage AD, behavioral variant frontotemporal dementia (FTD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and Parkinson disease with dementia (PDD). The results showed significant differences between the several diagnoses with the following pattern of results: AD, DLB < FTD, VaD, PDD. Qualitative analysis of clock drawing errors confirmed the stimulus-bound response as a hallmark of AD, while conceptual deficit was significantly more prevalent in patients with AD and DLB. Our results supported the CDT potential as a cognitive screening measure for mild dementia, particularly sensitive to AD and DLB, especially when we used the Cahn scoring system and its analysis of qualitative errors.

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