Quantitative and qualitative analyses of clock drawing in 
frontotemporal dementia and Alzheimer's disease

The clock drawing test (CDT) is a widely used cognitive screening test. It is useful in identifying focal lesions and cognitive deficits in dementia groups. Lately, several studies attempted its use to differentiate between dementia subtypes. Although many studies have examined the CDT in dementia populations, research into the use of clock drawing in frontotemporal dementia (FTD) is limited. We examined quantitative (global) and qualitative (specific error type) differences on the CDT between FTD (n = 36) and Alzheimer's disease (AD; n = 25) patients and controls without dementia (n = 25). Results showed significantly lower overall scores in the dementia groups compared to the control group, whereas FTD patients scored significantly higher than the AD group. On qualitative analysis, the FTD group had fewer stimulus bound responses, conceptual deficits, and spatial or planning errors compared to the AD group. In conclusion, both global and error analysis of the CDT helped discriminate the FTD group from controls and AD patients. (JINS, 2006, 12, 159–165.)

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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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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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