Interrater Reliability of Three Clock Drawing Test Scoring Systems

The Clock Drawing Test (CDT) is a commonly used tool in clinical practice and research for cognitive screening among older adults. The main goal of the present study was to analyze the interrater reliability of three different CDT scoring systems (by Shulman et al., Babins et al., and Cohen et al.). We used a clock with a predrawn circle. The CDT was evaluated by three independent raters based on the normative data set of healthy older and very old adults and patients with nonamnestic mild cognitive impairment (naMCI; N = 438; aged 61-94). We confirmed a high interrater reliability measured by the intraclass correlation coefficients (ICCs): Shulman ICC = .809, Babins ICC = .894, and Cohen ICC = .862, all p < .001. We found that age and education levels have a significant effect on CDT performance, yet there was no influence of gender. Finally, the scoring systems differentiated between naMCI and age- and education-matched controls: Shulman’s area under the receiver operating characteristic curve (AUC) = .84, Cohen AUC = .71, all p < .001; and a slightly lower discriminative ability was shown by Babins: AUC = .65, p = .012.

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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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Usefulness of the Clock Drawing Test as a Cognitive Screening Instrument for Mild Cognitive Impairment and Mild Dementia: an Evaluation Using Three Scoring Systems

Dementia and Neurocognitive Disorders ◽

10.12779/dnd.2018.17.3.100 ◽

2018 ◽

Vol 17 (3) ◽

pp. 100 ◽

Cited By ~ 6

Author(s):

Sangsoon Kim ◽

Seungmin Jahng ◽

Kyung-Ho Yu ◽

Byung-Chul Lee ◽

Yeonwook Kang

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Scoring Systems ◽

Screening Instrument ◽

Cognitive Screening ◽

Mild Dementia ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test

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Clock Drawing Test Ratings by Dementia Specialists: Interrater Reliability and Diagnostic Accuracy

Journal of Neuropsychiatry ◽

10.1176/jnp.2010.22.1.85 ◽

2010 ◽

Vol 22 (1) ◽

pp. 85-92 ◽

Cited By ~ 21

Author(s):

Anil K. Nair ◽

Brandon E. Gavett ◽

Moniek Damman ◽

Welmoed Dekker ◽

Robert C. Green ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Interrater Reliability ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test

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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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