Performance of the Pentagon Drawing test for the screening of older adults with Alzheimer's dementia

ABSTRACT The Pentagon Drawing Test (PDT) is a common cognitive screening test. Objective: The aim of this study was to evaluate performance properties of a specific PDT scoring scale in older adults with Alzheimer's disease (AD) and healthy controls. Methods: A cross-sectional study of 390 elderly patients, aged 60 years or older with at least two years of education was conducted. All participants completed clinical and neuropsychological evaluations, including the Cambridge Cognitive Examination, the Mini-Mental State Examination (MMSE), and the Clock Drawing Test. All PDT were blindly scored with the scale of Bourke et al. Results: PDT analyses of the binary score on the MMSE (0 or 1 point) did not discriminate AD from controls (p = 0.839). However, when PDT was analyzed using the Bourke et al. scale, the two groups could be distinguished (p <0.001). PDT was not affected by education, showed sensitivity of 85.5% and specificity of 66.9%, discriminated different clinical stages of dementia, and correlated with the other cognitive tests (p <0.001). A 1-point difference on the Bourke et al. scale was associated with an odds ratio of 3.46 for AD. Conclusion: PDT can be used as a cognitive screen for suspected cases of dementia, especially AD, irrespective of educational level.

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Evaluation of a Telephone Version for the Montreal Cognitive Assessment: Establishing a Cutoff for Normative Data From a Cross-Sectional Study

Journal of Geriatric Psychiatry and Neurology ◽

10.1177/08919887211002640 ◽

2021 ◽

pp. 089198872110026

Author(s):

Sivan Klil-Drori ◽

Natalie Phillips ◽

Alita Fernandez ◽

Shelley Solomon ◽

Adi J. Klil-Drori ◽

...

Keyword(s):

Cognitive Assessment ◽

Cross Sectional Study ◽

Montreal Cognitive Assessment ◽

Cutoff Score ◽

Cognitive Screening ◽

Cross Sectional ◽

A Prospective Study ◽

Sectional Analysis ◽

State Examination ◽

Normal Cognition

Objective: Compare a telephone version and full version of the Montreal Cognitive Assessment (MoCA). Methods: Cross-sectional analysis of a prospective study. A 20-point telephone version of MoCA (Tele-MoCA) was compared to the Full-MoCA and Mini Mental State Examination. Results: Total of 140 participants enrolled. Mean scores for language were significantly lower with Tele-MoCA than with Full-MoCA (P = .003). Mean Tele-MoCA scores were significantly higher for participants with over 12 years of education (P < .001). Cutoff score of 17 for the Tele-MoCA yielded good specificity (82.2%) and negative predictive value (84.4%), while sensitivity was low (18.2%). Conclusions: Remote screening of cognition with a 20-point Tele-MoCA is as specific for defining normal cognition as the Full-MoCA. This study shows that telephone evaluation is adequate for virtual cognitive screening. Our sample did not allow accurate assessment of sensitivity for Tele-MoCA in detecting MCI or dementia. Further studies with representative populations are needed to establish sensitivity.

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A Novel Exercise for Enhancing Visuospatial Ability in Older Adults with Frailty: Development, Feasibility, and Effectiveness

Geriatrics ◽

10.3390/geriatrics5020029 ◽

2020 ◽

Vol 5 (2) ◽

pp. 29

Author(s):

Miyuki Nemoto ◽

Hiroyuki Sasai ◽

Noriko Yabushita ◽

Keito Tsuchiya ◽

Kazushi Hotta ◽

...

Keyword(s):

Older Adults ◽

Mini Mental State Examination ◽

Exercise Program ◽

Exercise Group ◽

Visuospatial Ability ◽

Clock Drawing Test ◽

Drawing Test ◽

Before And After ◽

Global Cognition ◽

State Examination

We aimed to develop a novel exercise to improve visuospatial ability and evaluate its feasibility and effectiveness in older adults with frailty. A non-randomized preliminary trial was conducted between June 2014 and March 2015. We recruited 35 adults with frailty (24 women), aged 66–92 years. Participants were assigned to either locomotive- or visuospatial-exercise groups. All participants exercised under the supervision of physiotherapists for 90 min/week for 12 weeks. The visuospatial exercise participants used cubes with six colored patterns and were instructed to “reproduce the same colored pattern as shown in the photo”, using the cubes. In the locomotive exercise group, lower extremity functional training was provided. Rates of retention and attendance measured feasibility. Most participants completed the intervention (77.3%, locomotive; 84.6%, visuospatial) and had good attendance (83.8%, locomotive; 90.7%, visuospatial). Mini-mental state examination (MMSE), clock drawing test (CDT), and seven physical performance tests were conducted before and after interventions. The improvement in the MMSE score, qualitative analysis of CDT, grip strength, and sit and reach assessments were significantly greater in the visuospatial exercise group than in the locomotive exercise group. The cube exercise might be a feasible exercise program to potentially improve visuospatial ability and global cognition in older adults with frailty.

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Is the Mini-Mental State Examination the best cognitive screening test for less educated people?

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20190043 ◽

2019 ◽

Vol 77 (5) ◽

pp. 330-334 ◽

Cited By ~ 1

Author(s):

Luis Felipe Scarabelot ◽

Mariane de Moraes Monteiro ◽

Mauren Carneiro da Silva Rubert ◽

Viviane de Hiroki Flumignan Zetola

Keyword(s):

Verbal Fluency ◽

Mini Mental State Examination ◽

Recall Test ◽

Cognitive Screening ◽

Delayed Recall ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

State Examination ◽

Fluency Test

ABSTRACT Mini-Mental State Examination (MMSE) results are strongly influenced by educational level. The Brief Cognitive Screening Battery (BCSB) is an alternative assessment tool that provides more accurate results in individuals with less education. Objective: Our aim was to compare the MMSE and BCSB as screening tests. Methods: The MMSE and BCSB were assessed in 112 participants by two evaluators blind to the other test's result. Participants were classified according to their level of education. The influence of education level was analyzed using the Kruskal-Wallis and multiple comparison tests. Results: Scores of the MMSE (p < 0.0001) and the clock-drawing test (p < 0.0001) were influenced by education level but the delayed recall test score was not (p = 0.0804). The verbal fluency test (p = 0.00035) was influenced only by higher educational levels. It took three minutes less to apply the MMSE than to apply the BCSB (p < 0.0001). Conclusions: These findings suggest that the delayed recall test and the verbal fluency test of the BCSB are better than the MMSE and clock-drawing test as tools for evaluating cognition in people with limited education.

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Cognitive Functions and Cognitive Reserve in Relation to Blood Pressure Components in a Population-Based Cohort Aged 53 to 94 Years

International Journal of Hypertension ◽

10.1155/2012/274851 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 16

Author(s):

Nunzia Giordano ◽

Valérie Tikhonoff ◽

Paolo Palatini ◽

Anna Bascelli ◽

Giovanni Boschetti ◽

...

Keyword(s):

Blood Pressure ◽

Neuropsychological Tests ◽

Cognitive Reserve ◽

Mini Mental State Examination ◽

Population Based ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Clock Drawing Test ◽

Drawing Test ◽

State Examination

In 288 men and women from general population in a cross-sectional survey, all neuropsychological tests were negatively associated with age; memory and executive function were also positively related with education. The hypertensives (HT) were less efficient than the normotensives (NT) in the test of memory with interference at 10 sec (MI-10) (−33%,P=0.03), clock drawing test (CLOX) (−28%,P<0.01), and mini-mental state examination (MMSE) (−6%,P=0.02). Lower MMSE, MI-10, and CLOX were predicted by higher systolic (odds ratio, OR, 0.97,P=0.02; OR 0.98,P<0.005; OR 0.95,P<0.001) and higher pulse blood pressure (BP) (OR 0.97,P=0.02; OR 0.97,P<0.01; and 0.95,P<0.0001). The cognitive reserve index (CRI) was 6% lower in the HT (P=0.03) and was predicted by higher pulse BP (OR 0.82,P<0.001). The BP vectors of lower MMSE, MI-10, and CLOX were directed towards higher values of systolic and diastolic BP, that of low CRI towards higher systolic and lower diastolic. The label of hypertension and higher values of systolic or pulse BP are associated to worse memory and executive functions. Higher diastolic BP, although insufficient to impair cognition, strengthens this association. CRI is predicted by higher systolic BP associated to lower diastolic BP.

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The use of the Clock Drawing Test in bipolar disorder with or without dementia of Alzheimer’s type

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20140153 ◽

2014 ◽

Vol 72 (12) ◽

pp. 913-918 ◽

Cited By ~ 9

Author(s):

Ivan Aprahamian ◽

Marcia Radanovic ◽

Paula Villela Nunes ◽

Rodolfo Braga Ladeira ◽

Orestes Vicente Forlenza

Keyword(s):

Older Adults ◽

Bipolar Disorder ◽

Screening Tests ◽

Elderly Subjects ◽

Limited Data ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

Dementia Of Alzheimer’S Type ◽

State Examination

There is limited data regarding the cognitive profile from screening tests of older adults with bipolar disorder (BD) with dementia. Objective To investigate the Clock Drawing Test (CDT) among older adults with BD with and without Alzheimer’s disease (AD). Method 209 older adults (79 with BD without dementia and 70 controls; 60 with AD, being 27 with BD) were included to evaluate the performance of three CDT scoring scales, beyond the Mini-Mental State Examination (MMSE) and verbal fluency (VFT). Results Patients with BD without dementia presented with lower scores in MMSE, VF and one CDT scoring scale than controls. Patients with BD and AD presented with lower scores in VF and CDT scoring scales than patients with only AD. All CDT scales presented similar sensitivity and specificity for BD and non-BD groups. Conclusion Elderly subjects with BD showed greater impairment in CDT in both groups of normal cognition and AD.

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Opportunistic cognitive screening in Sweden: What the tests mean and do for patients and healthcare professionals

Dementia ◽

10.1177/14713012211035373 ◽

2021 ◽

pp. 147130122110353

Author(s):

Kristin Zeiler ◽

Göran Karlsson ◽

Martin Gunnarson

Keyword(s):

Cognitive Impairment ◽

Science And Technology Studies ◽

Healthcare Professionals ◽

Opportunistic Screening ◽

Cognitive Screening ◽

Clock Drawing Test ◽

Screening Practice ◽

Drawing Test ◽

State Examination

Since 2017, opportunistic screening for cognitive impairment takes place at the geriatric ward of a local hospital in Sweden. Persons above the age of 65 who are admitted to the ward, who have not been tested for cognitive impairment during the last six months nor have a previously known cognitive impairment, are offered the Mini-Mental State Examination and the Clock-Drawing Test. This article analyses what the opportunistic screening practice means for patients and healthcare professionals. It combines a phenomenologically-oriented focus on subjectivity and sense-making with a focus that is inspired by science and technology studies on what the tests become within the specific context in which they are used, which allows a dual focus on subjectivity and performativity. The article shows how the tests become several different, not infrequently seemingly contradictory, things: an offer, an important tool for knowledge-production, something unproblematic yet also emotionally troubling, something one can fail and an indicator that one belongs to a risk group and needs to be tested. Further, the article shows how the practice is shaped by the sociocultural context. It examines the role of the affective responses to the test for subjectivity – particularly patient subjectivity – and offers a set of recommendations, if this practice were to expand to other hospitals.

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Clock drawing test: comparison between the Pfizer and the Shulman systems

Dementia & Neuropsychologia ◽

10.1590/1980-57642021dn15-040009 ◽

2021 ◽

Vol 15 (4) ◽

pp. 480-484

Author(s):

Daniela Bertol Graeff ◽

Jéssica Maldaner Lui ◽

Nathália Dal Prá Zucco ◽

Ana Luisa Sant’Anna Alves ◽

Cassiano Mateus Forcelini ◽

...

Keyword(s):

Cognitive Decline ◽

Rank Correlation ◽

Cross Sectional Study ◽

Cross Sectional ◽

Clock Drawing Test ◽

Clock Drawing ◽

Spearman’S Rank Correlation ◽

Drawing Test ◽

Spearman’S Rank Correlation Coefficient ◽

Previous Training

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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Functioning and Cognition of Portuguese Older Adults Attending in Residential Homes and Day Centers: A Comparative Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18137030 ◽

2021 ◽

Vol 18 (13) ◽

pp. 7030

Author(s):

Manuel José Lopes ◽

Lara Guedes de Pinho ◽

César Fonseca ◽

Margarida Goes ◽

Henrique Oliveira ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

The Elderly ◽

Sociodemographic Factors ◽

Cross Sectional Study ◽

Cross Sectional ◽

Residential Homes ◽

Core Set ◽

Functional Problem ◽

State Examination

The functioning and cognition of older adults can be influenced by different care contexts. We aimed to compare the functioning profiles and cognition of institutionalized and noninstitutionalized older adults and to evaluate the effect of sociodemographic factors on the functioning and cognition. This is a cross-sectional study that included 593 older adults. The data were collected using the Elderly Nursing Core Set and Mini Mental State Examination. Women, older adults who did not attend school and those live in Residential Homes are more likely to have a higher degree of cognitive impairment than men, those who attended school and those frequent Day Centre. The chances of an older adult with moderate or severe cognitive impairment increases with age. Older women, older adults who did not attend school, and older adults who live in Residential Homes had a higher degree of functional problem than men, those who attended school and those who frequent a Day Centre, independently to age. It is necessary to promote the health literacy of older adults throughout life. The implementation of social and health responses should allow older adults to remain in their homes, given the influence of functioning and cognition on self-care and quality of life.

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GAMBARAN FUNGSI KOGNITIF PADA PASIEN RAWAT JALAN DENGAN RIWAYAT STROKE DI POLIKLINIK SARAF RSUP PROF. DR. R.D. KANDOU MANADO

JURNAL BIOMEDIK (JBM) ◽

10.35790/jbm.5.1.2013.2635 ◽

2013 ◽

Vol 5 (1) ◽

Author(s):

Tirzha N. Paparang ◽

Corry N. Mahama ◽

Denny J. Ngantung

Keyword(s):

Cognitive Function ◽

Mini Mental State Examination ◽

Trail Making Test ◽

Cross Sectional ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

Trail Making ◽

Cross Sectional Design ◽

State Examination

Abstract: Stroke is a major cause of cognitive dysfunction. The incidences of cognitive dysfunction increase three-fold after strokes, usually involving impairement of abilities in visuo-spacial, memory, orientation, speech, attention, and performance functions. The rapid, practical, and approved examinations used to evaluate and confirm the decline in cognitive functions are the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT), and the Trail Making Test (TMT). This study aimed to reveal the cognitive functions of outpatients with stroke histories in the Neurology Polyclinic, Prof. Dr. R.D. Kandou Hospital Manado by using the above mentioned examinations. This was a descriptive study with a cross-sectional design conducted in November 2012. The results showed that there were 51 respondents who fulfilled the inclusion criteria consisting of 32 males and 19 females. The highest decline of cognitive function by age, the educational level, and employment was 60-79 years, more than 9 years of education, and retired workers, respectively. The results of the MMSE, CDT, and TMT examinations for cognitive impairment evaluation were as follow: MMSE 62.75%, CDT 56.86%, TMT A 96.08%, and TMT B 84.31%. Conclusion: Most of the outpatients with stroke histories in the Neurology Polyclinic, Prof. Dr. R.D. Kandou Hospital Manado showed cognitive impairments. Keywords: CDT, cognitive function, MMSE, stroke, TMT-A and B. Abstrak: Stroke merupakan penyebab utama gangguan fungsi kognitif. Insiden gangguan kognitif meningkat tiga kali lipat setelah stroke, dan biasanya melibatkan kemampuan visuospasial, memori, orientasi, bahasa, perhatian dan fungsi eksekutif. Pemeriksaan yang digunakan untuk mengevaluasi dan mengonfirmasi penurunan fungsi kognitif yang cepat dan praktis namun bernilai tinggi ialah Mini Mental State Examination (MMSE), Clock Drawing Test (CDT), dan Trail Making Test (TMT). Penelitian ini bertujuan untuk mengetahui gambaran fungsi kognitif pada pasien rawat jalan dengan riwayat stroke di Poliklinik Saraf RSUP Prof. Dr. R.D. Kandou Manado. Penelitian ini bersifat deskriptif dengan cross-sectional design dan dilaksanakan selama bulan November 2012. Hasil penelitian memperlihatkan bahwa 51 responden memenuhi kriteria inklusi, terdiri dari 32 laki-laki dan 19 perempuan. Berdasarkan usia, tingkat pendidikan, dan pekerjaan, penurunan fungsi kognitif terbanyak pada usia 60-79 tahun, tingkat pendidikan terakhir >9 tahun, dan pekerjaan pensiunan. Hasil pemeriksaan MMSE, CDT, dan TMT terhadap fungsi kognitif responden ialah: MMSE 62,75%, CDT 56,86%, TMT A 96,08%, dan TMT B 84,31%. Simpulan: Sebagian besar pasien rawat jalan dengan riwayat stroke di Poliklinik Saraf RSUP Prof. Dr. R.D. Kandou Manado telah memperlihatkan gagguan fungsi kognitif.Kata kunci: stroke, fungsi kognitif, MMSE, CDT, TMT-A dan B.

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The Stick Design Test on the assessment of older adults with low formal education: evidences of construct, criterion-related and ecological validity

International Psychogeriatrics ◽

10.1017/s1041610213001282 ◽

2013 ◽

Vol 25 (12) ◽

pp. 2057-2065 ◽

Cited By ~ 8

Author(s):

Jonas Jardim de Paula ◽

Mônica Vieira Costa ◽

Matheus Bortolosso Bocardi ◽

Mariana Cortezzi ◽

Edgar Nunes De Moraes ◽

...

Keyword(s):

Older Adults ◽

Formal Education ◽

Ecological Validity ◽

Digit Span ◽

Clock Drawing Test ◽

Clock Drawing ◽

Visuospatial Abilities ◽

Drawing Test ◽

Drawing Tasks ◽

State Examination

ABSTRACTBackground:The assessment of visuospatial abilities is usually performed by drawing tasks. In patients with very low formal education, the use of these tasks might be biased by their cultural background. The Stick Design Test was developed for the assessment of this population. We aim to expand the test psychometric properties by assessing its construct, criterion-related and ecological validity in older adults with low formal education.Method:Healthy older adults (n = 63) and Alzheimer's disease patients (n = 92) performed the Stick Design Test, Mini-Mental State Examination, Digit Span Forward and the Clock Drawing Test. Their caregivers answered Personal Care and Instrumental Activities of Daily Living). Construct validity was assessed by factor analysis, convergent correlations (with the Clock Drawing Test), and divergent correlations (with Digit Span Forward); criterion-related validity by receiver operating characteristic curve analysis and binary logistic regression; and Ecological validity by correlations with ADL.Results:The test factor structure was composed by one component (R2 = 64%). Significant correlations with the Clock Drawing Test and Digit Span Forward were found, and the relationship was stronger with the first measure. The test was less associated with formal education than the Clock Drawing Test. It classified about 76% of the participants correctly and had and additive effect with the Mini-Mental State Examination (84% of correct classification). The test also correlated significantly with measures of ADL, suggesting ecological validity.Conclusions:The Stick Design Test shows evidence of construct, criterion-related and ecological validity. It is an interesting alternative to drawing tasks for the assessment of visuospatial abilities.

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