The Clock Drawing Test A review of its accuracy in screening for 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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A reduced scoring system for the Clock Drawing Test using a population-based sample

International Psychogeriatrics ◽

10.1017/s1041610212000804 ◽

2012 ◽

Vol 24 (11) ◽

pp. 1738-1748 ◽

Cited By ~ 8

Author(s):

Alexandra Jouk ◽

Holly Tuokko

Keyword(s):

Scoring System ◽

Scoring Systems ◽

Population Based ◽

Clinical Samples ◽

Scoring Method ◽

Clock Drawing Test ◽

Clock Drawing ◽

Dementia Screening ◽

Drawing Test ◽

Drawing Task

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 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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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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Is the Clock Drawing Test a screening tool for the diagnosis of mild cognitive impairment? A systematic review

International Psychogeriatrics ◽

10.1017/s1041610209990676 ◽

2009 ◽

Vol 22 (1) ◽

pp. 56-63 ◽

Cited By ~ 44

Author(s):

Lena Ehreke ◽

Melanie Luppa ◽

Hans-Helmut König ◽

Steffi G. Riedel-Heller

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Literature Search ◽

Screening Tool ◽

Cognitive Screening ◽

Clock Drawing Test ◽

Clock Drawing ◽

Drawing Test ◽

Diagnosis Of Dementia ◽

Mean Differences

ABSTRACTBackground:The clock drawing test (CDT) is a common and widely used cognitive screening instrument for the diagnosis of dementia. However, it has remained unclear whether it is a suitable method to identify mild cognitive impairment (MCI). The aim of this paper is to review systematically the studies concerning the utility of the CDT in diagnosing MCI.Method:A systematic literature search was conducted. All studies dealing with utility of CDT in diagnosing MCI regardless of the applied CDT scoring system and MCI concept were selected.Results:Nine relevant studies were identified. The majority of the studies compared average CDT scores of cognitively healthy and mildly impaired subjects, and four of them identified significant mean differences. If reported, sensitivity and specificity have been mostly unsatisfactory.Conclusion:CDT should not be used for MCI-screening.

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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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