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Tafiadis D, Ziavra N, Prentza A, Siafaka V, Zarokanelou V, Voniati L, Konitsiotis S. The Tuokko version of the Clock Drawing Test: A validation study in the Greek population. J Clin Exp Neuropsychol 2022; 43:967-979. [DOI: 10.1080/13803395.2022.2036706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Dionysios Tafiadis
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
- Department of Health Sciences, Speech and Language Therapy, European University Cyprus, Nicosia, Cyprus
| | - Nafsika Ziavra
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Alexandra Prentza
- Department of Linguistics, School of Philology, Faculty of Philosophy, University of Ioannina, Ioannina, Greece
| | - Vassiliki Siafaka
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Vasiliki Zarokanelou
- Department of Speech & Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Louiza Voniati
- Department of Health Sciences, Speech and Language Therapy, European University Cyprus, Nicosia, Cyprus
| | - Spyridon Konitsiotis
- Department of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
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Dong F, Shao K, Guo S, Wang W, Yang Y, Zhao Z, Feng R, Wang J. Clock-drawing test in vascular mild cognitive impairment: Validity of quantitative and qualitative analyses. J Clin Exp Neuropsychol 2020; 42:622-633. [PMID: 32700636 DOI: 10.1080/13803395.2020.1793104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The clock-drawing test (CDT) has been used as a screening tool to identify cognitive deficit in patients with dementia. However, it has not been extensively evaluated for categorizing patients with vascular mild cognitive impairment (vMCI). This study aimed to examine the discrimination of vMCI using various CDT scoring methods. METHOD A total of 120 vMCI patients and 119 normal control (NC) subjects were tested using three CDT quantitative scoring systems: the one from the Montreal Cognitive Assessment (MoCA) (CDT3) and the systems of Rouleau (CDT10) and Babins (CDT18). We used a revised scoring method to evaluate the effectiveness in differentiating vMCI patients from NC subjects, which combined the CDT10 quantitative score and three qualitative errors with a significantly higher prevalence in vMCI group (called hereinafter CDTcomb, including CDTcomb13 and CDTcomb16 based on different weights of the three error types). The sensitivity and specificity of the CDT methods were determined by the receiver operating characteristic (ROC) curve. The results of the scoring systems were compared with those of the Mini-Mental State Examination (MMSE). RESULTS The results of the ROC analyses with the CDT3, CDT10, and CDT18 systems produced a sensitivity of 71.1%, 81.8%, and 60.3%, and a specificity of 66.12%, 58.68%, and 73.55%, respectively, for the diagnosis of vMCI. Compared with the separate MMSE score, the combination of MMSE with the CDT3, CDT10 and CDT18 scores did not increase the sensitivity and specificity. When three qualitative errors were incorporated into the CDT10 quantitative score, CDTcomb13 and CDTcomb16 provided a sensitivity of 87.6% and 86.78%, and a specificity of 74.79% and 80.67%, respectively, in differentiating vMCI patients from the NC group. CONCLUSION Our findings suggest that the combination of CDT quantitative score with qualitative observations of the clock-drawing errors can provide a better discrimination between vMCI patients and cognitively normal subjects.
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Affiliation(s)
- Fangming Dong
- Graduate School, Hebei Medical University , Shijiazhuang, China.,Department of Neurology, Hebei General Hospital , Shijiazhuang, China
| | - Kai Shao
- Graduate School, Hebei Medical University , Shijiazhuang, China.,Department of Neurology, Hebei General Hospital , Shijiazhuang, China
| | - Shangzun Guo
- Department of Neurology, Hebei General Hospital , Shijiazhuang, China.,Graduate School, Hebei North University , Zhangjiakou, China
| | - Wei Wang
- Graduate School, Hebei Medical University , Shijiazhuang, China.,Department of Neurology, Hebei General Hospital , Shijiazhuang, China
| | - Yiming Yang
- Department of Neurology, Hebei General Hospital , Shijiazhuang, China.,Graduate School, Hebei North University , Zhangjiakou, China
| | - Zhongmin Zhao
- Graduate School, Hebei Medical University , Shijiazhuang, China.,Department of Neurology, Hebei General Hospital , Shijiazhuang, China
| | - Rongfang Feng
- Department of Neurology, Hebei General Hospital , Shijiazhuang, China
| | - Jianhua Wang
- Department of Neurology, Hebei General Hospital , Shijiazhuang, China
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Ghafar MZAA, Miptah HN, O'Caoimh R. Cognitive screening instruments to identify vascular cognitive impairment: A systematic review. Int J Geriatr Psychiatry 2019; 34:1114-1127. [PMID: 31050033 DOI: 10.1002/gps.5136] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/19/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Vascular cognitive impairment (VCI) is common and important to detect as controlling risk factors, particularly hypertension, may slow onset and progression. There is no consensus as to which cognitive screening instrument (CSI) is most suitable for VCI. We systematically reviewed the psychometric properties of brief CSIs for vascular mild cognitive impairment (VMCI) and vascular dementia (VaD). METHODS Literature searches were performed using scholarly databases from inception until 31 May 2018. Studies were eligible if participants were aged 18 or older, interviewed face-to-face, and standard diagnostic criteria for VCI were applied, excluding those specifically identifying post-stroke dementia. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. RESULTS Fifteen studies were identified including eight types of CSIs (27 subtests/variants) and 4575 participants (1015 with VCI), mean age range: 51.6 to 75.5 years. Most studies compared more than one instrument. Five papers examined clock-drawing; four, the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE); and three used the Brief Memory and Executive Test (BMET). The MoCA (AUC > 0.90) and MMSE (AUC: 0.86-0.99) had excellent accuracy in differentiating VaD from controls; the MoCA had good internal consistency (Cronbach's α: .83-.88). The MoCA (AUC: 0.87-0.93) and BMET (AUC: 0.94) had the greatest accuracy in separating VMCI from controls. Most studies had low to moderate risk of bias in all domains of the QUIPS. Data were heterogeneous, precluding a meta-analysis. CONCLUSIONS Although few studies were available and further research is required, data suggests that the MoCA is accurate and reliable for differentiating VaD and VMCI from controls.
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Affiliation(s)
- Mohd Zaquan Arif Abd Ghafar
- Clinical Sciences Institute, National University of Ireland, Galway, Galway City, Ireland.,Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway City, Ireland
| | - Hayatul Nawwar Miptah
- Clinical Sciences Institute, National University of Ireland, Galway, Galway City, Ireland
| | - Rónán O'Caoimh
- Clinical Sciences Institute, National University of Ireland, Galway, Galway City, Ireland.,Department of Geriatric and Stroke Medicine, University Hospital Galway, Galway City, Ireland.,Centre for Gerontology and Rehabilitation, University College Cork, Cork City, Ireland.,Department of Geriatric Medicine, Mercy University Hospital, Cork City, Ireland
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Hirjak D, Sambataro F, Remmele B, Kubera KM, Schröder J, Seidl U, Thomann AK, Maier-Hein KH, Wolf RC, Thomann PA. The relevance of hippocampal subfield integrity and clock drawing test performance for the diagnosis of Alzheimer's disease and mild cognitive impairment. World J Biol Psychiatry 2019; 20:197-208. [PMID: 28721741 DOI: 10.1080/15622975.2017.1355474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES The clock drawing test (CDT) is one of the worldwide most used screening tests for Alzheimer's disease (AD). MRI studies have identified temporo-parietal regions being involved in CDT impairment. However, the contributions of specific hippocampal subfields and adjacent extrahippocampal structures to CDT performance in AD and mild cognitive impairment (MCI) have not been investigated so far. It is unclear whether morphological alterations or CDT score, or a combination of both, are able to predict AD. METHODS 38 AD patients, 38 MCI individuals and 31 healthy controls underwent neuropsychological assessment and MRI at 3 Tesla. FreeSurfer 5.3 was used to perform hippocampal parcellation. We used a collection of statistical methods to better understand the relationship between CDT and hippocampal formation. We also tested the clinical feasibility of this relationship when predicting AD. RESULTS Impaired CDT performance in AD was associated with widespread atrophy of the cornu ammonis, presubiculum, and subiculum, whereas MCI subjects showed CDT-related alterations of the CA4-dentate gyrus and subiculum. CDT correlates in AD and MCI showed regional and quantitative overlap. Importantly, CDT score was the best predictor of AD. CONCLUSIONS Our findings lend support for an involvement of different hippocampal subfields in impaired CDT performance in AD and MCI. CDT seems to be more efficient than subfield imaging for predicting AD.
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Affiliation(s)
- Dusan Hirjak
- a Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim , Heidelberg University , Mannheim , Germany.,c Center for Psychosocial Medicine, Department of General Psychiatry , Heidelberg University , Mannheim , Germany
| | - Fabio Sambataro
- b Department of Medicine (DAME) , Udine University , Udine , Italy
| | - Barbara Remmele
- c Center for Psychosocial Medicine, Department of General Psychiatry , Heidelberg University , Mannheim , Germany
| | - Katharina M Kubera
- c Center for Psychosocial Medicine, Department of General Psychiatry , Heidelberg University , Mannheim , Germany
| | - Johannes Schröder
- d Section of Geriatric Psychiatry , Heidelberg University , Mannheim , Germany
| | - Ulrich Seidl
- e Department of Psychiatry , Center for Mental Health , Stuttgart , Germany
| | - Anne K Thomann
- f Department of Internal Medicine II, Medical Faculty Mannheim , Heidelberg University , Mannheim , Germany
| | - Klaus H Maier-Hein
- g Medical Image Computing Group, Div. Medical and Biological Informatics , German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - Robert C Wolf
- c Center for Psychosocial Medicine, Department of General Psychiatry , Heidelberg University , Mannheim , Germany
| | - Philipp A Thomann
- c Center for Psychosocial Medicine, Department of General Psychiatry , Heidelberg University , Mannheim , Germany.,h Center for Mental Health , Odenwald District Healthcare Center , Erbach , Germany
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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. Dement Neurocogn Disord 2018; 17:100-109. [PMID: 30906399 PMCID: PMC6428010 DOI: 10.12779/dnd.2018.17.3.100] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/07/2018] [Accepted: 11/20/2018] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Although the clock drawing test (CDT) is a widely used cognitive screening instrument, there have been inconsistent findings regarding its utility with various scoring systems in patients with mild cognitive impairment (MCI) or dementia. The present study aimed to identify whether patients with MCI or dementia exhibited impairment on the CDT using three different scoring systems, and to determine which scoring system is more useful for detecting MCI and mild dementia. Methods Patients with amnestic mild cognitive impairment (aMCI), vascular mild cognitive impairment (VaMCI), mild Alzheimer's disease (AD), mild vascular dementia (VaD), and cognitively normal older adults (CN) were included. All participants were administered the CDT, the Korean-Mini Mental State Examination (K-MMSE), and the Clinical Dementia Rating scale. The CDT was scored using the 3-, 5-, and 15-point scoring systems. Results On all three scoring systems, all patient groups demonstrated significantly lower scores than the CN. However, while there were no significant differences among patients with aMCI, VaMCI, and AD, those with VaD exhibited the lowest scores. Area under the Receiver Operating Characteristic curves revealed that the three CDT scoring systems were comparable with the K-MMSE in differentiating aMCI, VaMCI, and VaD from CN. In differentiating AD from CN, however, the CDT using the 15-point scoring system demonstrated the most comparable discriminability with K-MMSE. Conclusions The results demonstrated that the CDT is a useful cognitive screening tool that is comparable with the Mini-Mental State Examination, and that simple CDT scoring systems are sufficient for differentiating patients with MCI and mild dementia from CN.
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Salimi S, Irish M, Foxe D, Hodges JR, Piguet O, Burrell JR. Can visuospatial measures improve the diagnosis of Alzheimer's disease? ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2017; 10:66-74. [PMID: 29780858 PMCID: PMC5956809 DOI: 10.1016/j.dadm.2017.10.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction Overlapping and evolving symptoms lead to ambiguity in the diagnosis of dementia. Visuospatial function relies on parietal lobe function, which may be affected in the early stages of Alzheimer's disease (AD). This review evaluates visuospatial dysfunction in patients with AD, frontotemporal dementia, dementia with Lewy bodies, and vascular dementia to determine the diagnostic and prognostic potential of visuospatial tasks in AD. Methods A systematic search of studies (1960–2016) investigating visuospatial dysfunction in dementia was conducted. Results Tests measuring construction, specifically Block Design and Clock Drawing Test, and visual memory, specifically Rey-Osterrieth Complex Figure recall and topographical tasks, show the greatest diagnostic potential in dementia. The Benton visual retention, Doors and People, and topographical memory tests show potential as prognostic markers. Discussion Tests of visuospatial function demonstrate significant diagnostic and prognostic potential in dementia. Further studies with larger samples of pathologically confirmed cases are required to verify clinical utility. Memory deficits have been demonstrated in Alzheimer's and non-Alzheimer's dementias. Parietal lobes are uniquely affected in the early stages of Alzheimer's disease. Visuospatial tasks demonstrate significant diagnostic and prognostic potential. Computerized test protocols have been developed to test aspects of visuospatial function and memory. Novel topographical memory tasks demonstrated the greatest prognostic potential.
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Affiliation(s)
- Shirin Salimi
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Muireann Irish
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - David Foxe
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - John R Hodges
- Central Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Olivier Piguet
- School of Psychology and Brain & Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - James R Burrell
- Central Medical School, The University of Sydney, Sydney, New South Wales, Australia.,Australian Research Council Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia.,Neurosciences, Concord Hospital, Sydney, New South Wales, Australia
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Trojano L, Gainotti G. Drawing Disorders in Alzheimer's Disease and Other Forms of Dementia. J Alzheimers Dis 2017; 53:31-52. [PMID: 27104898 DOI: 10.3233/jad-160009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drawing is a multicomponential process that can be impaired by many kinds of brain lesions. Drawing disorders are very common in Alzheimer's disease and other forms of dementia, and can provide clinical information for the distinction of the different dementing diseases. In our review we started from an overview of the neural and cognitive bases of drawing, and from a recollection of the drawing tasks more frequently used for assessing individuals with dementia. Then, we analyzed drawing disorders in dementia, paying special attention to those observed in Alzheimer's disease, from the prodromal stages of the amnesic mild cognitive impairment to the stages of full-blown dementia, both in the sporadic forms with late onset in the entorhino-hippocampal structures and in those with early onset in the posterior neocortical structures. We reviewed the drawing features that could differentiate Alzheimer's disease from vascular dementia and from the most frequent forms of degenerative dementia, namely frontotemporal dementia and Lewy body disease. Finally, we examined some peculiar aspects of drawing disorders in dementia, such as perseverations, rotations, and closing-in. We argue that a careful analysis of drawing errors helps to differentiate the different forms of dementia more than overall accuracy in drawing.
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Affiliation(s)
- Luigi Trojano
- Department of Psychology, Second University of Naples, Italy.,S. Maugeri Foundation, Scientific Institute of Telese Terme (BN), Italy
| | - Guido Gainotti
- Center for Neuropsychological Research, Institute of Neurology, Catholic University, Rome, Italy.,IRCCS Fondazione Santa Lucia, Department of Clinical and Behavioral Neurology, Rome, Italy
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8
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Abstract
BACKGROUND Studies have shown the clock-drawing test (CDT) to be a useful screening test that differentiates between normal, elderly populations, and those diagnosed with dementia. However, the results of studies which have looked at the utility of the CDT to help differentiate Alzheimer's disease (AD) from other dementias have been conflicting. The purpose of this study was to explore the utility of the CDT in discriminating between patients with AD and other types of dementia. METHODS A review was conducted using MEDLINE, PsycINFO, and Embase. Search terms included clock drawing or CLOX and dementia or Parkinson's Disease or AD or dementia with Lewy bodies (DLB) or vascular dementia (VaD). RESULTS Twenty studies were included. In most of the studies, no significant differences were found in quantitative CDT scores between AD and VaD, DLB, and Parkinson's disease dementia (PDD) patients. However, frontotemporal dementia (FTD) patients consistently scored higher on the CDT than AD patients. Qualitative analyses of errors differentiated AD from other types of dementia. CONCLUSIONS Overall, the CDT score may be useful in distinguishing between AD and FTD patients, but shows limited value in differentiating between AD and VaD, DLB, and PDD. Qualitative analysis of the type of CDT errors may be a useful adjunct in the differential diagnosis of the types of dementias.
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McCabe JJ, Kennelly SP. Acute care of older patients in the emergency department: strategies to improve patient outcomes. Open Access Emerg Med 2015; 7:45-54. [PMID: 27147890 PMCID: PMC4806806 DOI: 10.2147/oaem.s69974] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Older patients in the emergency department (ED) are a vulnerable population who are at a higher risk of functional decline and hospital reattendance subsequent to an ED visit, and have a high mortality rate in the months following an ED attendance. The delivery of acute care in a busy environment to this population presents its own unique challenge. The purpose of this review is to detail the common geriatric syndromes encountered in the ED as well as the appropriate strategies and instruments, which can be utilized to support the clinical decision matrix and improve outcomes.
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Affiliation(s)
- John J McCabe
- Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age-Related Health Care, Tallaght Hospital, Dublin, Ireland
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10
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Nyborn JA, Himali JJ, Beiser AS, Devine SA, Du Y, Kaplan E, O'Connor MK, Rinn WE, Denison HS, Seshadri S, Wolf PA, Au R. The Framingham Heart Study clock drawing performance: normative data from the offspring cohort. Exp Aging Res 2013; 39:80-108. [PMID: 23316738 DOI: 10.1080/0361073x.2013.741996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED BACKGROUND/STUDY CONTEXT: Although the Clock Drawing Test (CDT) is a popular tool used to assess cognitive function, limited normative data on CDT performance exist. The objective of the current study was to provide normative data on an expanded version of previous CDT scoring protocols from a large community-based sample of middle to older adults (aged 43 to 91) from the Framingham Heart Study. METHODS The CDT was administered to 1476 Framingham Heart Study Offspring Cohort participants using a scoring protocol that assigned error scores to drawn features. Total error scores were computed, as well as for subscales pertaining to outline, numeral placement, time-setting, center, and "other." RESULTS Higher levels of education were significantly associated with fewer errors for time-setting (Command: p < .001; Copy: p = .003), numerals (Command: p < .001), and "other" (Command: p < .001) subscales. Older age was significantly associated with more errors for time-setting (Command: p < .001; Copy: p = .003), numerals (Command: p < .001), and "other" (Command: p < .001) subscales. Significant differences were also found between education groups on the Command condition for all but the oldest age group (75+). CONCLUSION Results provide normative data on CDT performance within a community-based cohort. Errors appear to be more prevalent in older compared with younger individuals, and may be less prevalent in individuals who completed at least some college compared with those who did not. Future studies are needed to determine whether this expanded scoring system allows detection of preclinical symptoms of future risk for dementia.
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Affiliation(s)
- Justin A Nyborn
- Department of Neurology, Boston University School of Medicine, Boston, MA 02118, USA
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11
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Clock drawing testing and diffusion tensor imaging among vascular dementia versus Alzheimer's disease. Eur Geriatr Med 2012. [DOI: 10.1016/j.eurger.2012.07.454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Engelhardt E, Tocquer C, André C, Moreira DM, Okamoto IH, Cavalcanti JLDS. Vascular dementia: Cognitive, functional and behavioral assessment. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part II. Dement Neuropsychol 2011; 5:264-274. [PMID: 29213753 PMCID: PMC5619039 DOI: 10.1590/s1980-57642011dn05040004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 11/02/2011] [Indexed: 01/10/2023] Open
Abstract
Vascular dementia (VaD) is the most prevalent form of secondary dementia and the second most common of all dementias. The present paper aims to define guidelines on the basic principles for treating patients with suspected VaD (and vascular cognitive impairment - no dementia) using an evidence-based approach. The material was retrieved and selected from searches of databases (Medline, Scielo, Lilacs), preferentially from the last 15 years, to propose a systematic way to assess cognition, function and behavior, and disease severity staging, with instruments adapted for our milieu, and diagnosis disclosure. The present proposal contributes to the definition of standard diagnostic criteria for VaD based on various levels of evidence. It is noteworthy that only around half of the population of patients with vascular cognitive impairment present with dementia, which calls for future proposals defining diagnostic criteria and procedures for this condition.
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Affiliation(s)
- Eliasz Engelhardt
- Full Professor (retired) – UFRJ, Coordinator of the
Cognitive Neurology and Behavior Sector, INDC, CDA/IPUB, UFRJ, Rio de Janeiro RJ,
Brazil
| | - Carla Tocquer
- Neurologist, Masters and PhD in Neuropsychology, Claude
Bernard University, France
| | - Charles André
- Associate Professor of Neurology, Faculty of Medicine,
UFRJ. Medical Director of SINAPSE Rehabilitation and Neurophysiology, Rio de Janeiro
RJ, Brazil
| | - Denise Madeira Moreira
- Adjunct Professor of Radiology, School of Medicine, UFRJ.
Head of Radiology Sector, INDC, UFRJ, Rio de Janeiro RJ, Brazil
| | - Ivan Hideyo Okamoto
- Department of Neurology Neurosurgery, UNIFESP, Institute
of Memory, UNIFESP, São Paulo SP, Brazil
| | - José Luiz de Sá Cavalcanti
- Adjunct Professor of Neurology, INDC, UFRJ. Cognitive
Neurology and Behavior Sector, INDC, UFRJ, Rio de Janeiro RJ, Brazil
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Bozikas VP, Giazkoulidou A, Hatzigeorgiadou M, Karavatos A, Kosmidis MH. Do age and education contribute to performance on the clock drawing test? Normative data for the Greek population. J Clin Exp Neuropsychol 2008; 30:199-203. [DOI: 10.1080/13803390701346113] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- V. P. Bozikas
- a 2nd Department of Psychiatry , Aristotle University of Thessaloniki , Greece
| | - A. Giazkoulidou
- b School of Psychology , Aristotle University of Thessaloniki , Greece
| | | | - A. Karavatos
- c 1st Department of Psychiatry , Aristotle University of Thessaloniki , Greece
| | - M. H. Kosmidis
- b School of Psychology , Aristotle University of Thessaloniki , Greece
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Flood KL, Rohlfing A, Le CV, Carr DB, Rich MW. Geriatric syndromes in elderly patients admitted to an inpatient cardiology ward. J Hosp Med 2007; 2:394-400. [PMID: 18081154 DOI: 10.1002/jhm.234] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Older adults make up an increasing proportion of patients hospitalized with cardiovascular disease. Such patients often have multiple coexisting geriatric syndromes that may affect management and outcomes and are frequently underdiagnosed and untreated. OBJECTIVES To determine the prevalence of geriatric syndromes and incidence of selected adverse events in hospitalized elderly patients with cardiovascular disease. DESIGN A prospective cohort study. SETTING Urban academic medical center. PATIENTS One hundred patients at least 70 years old with cardiovascular disease hospitalized on a cardiology ward. MEASUREMENTS Standard geriatric screens were administered to assess mood, function, and cognitive status. Patients were followed prospectively for adverse events such as falls, urinary tract infection (UTI), and use of restraints. RESULTS The mean age of the patients was 79.2 +/- 5.5 years, 61% were female, 68% were white, and mean length of stay was 7 days. Geriatric syndromes were prevalent and included functional impairment (35% dependent in >or=1 activity of daily living), cognitive impairment (19% with abnormal results on the Short Blessed Test), and polypharmacy. Thirty-seven percent of patients were prescribed a potentially inappropriate medication on admission or discharge. Patients receiving a Foley catheter were at increased risk for UTI. CONCLUSIONS These findings suggest that geriatric syndromes are prevalent among older patients hospitalized for cardiovascular disease. Further study is needed to determine if interventions designed to increase recognition and treatment of these syndromes can improve outcomes in this patient population.
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Affiliation(s)
- Kellie L Flood
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama 35294-2041, USA.
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Yap PLK, Ng TP, Niti M, Yeo D, Henderson L. Diagnostic Performance of Clock Drawing Test by CLOX in an Asian Chinese population. Dement Geriatr Cogn Disord 2007; 24:193-200. [PMID: 17690551 DOI: 10.1159/000107080] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Clock Drawing Tests are commonly used for cognitive screening, but their clinical utility has not yet been studied in Chinese Singaporeans. We examined the usefulness of a Clock Drawing Test, CLOX, in detecting dementia in our population and explored its performance in the dementia subtypes, Alzheimer's disease (AD), and the vascular composite group (VCG) of AD with cerebrovascular disease and vascular dementia. METHOD CLOX was administered to 73 subjects (49.3%) with dementia and 75 healthy controls (50.7%). Receiver operating characteristic analysis determined the diagnostic accuracy and optimal cut-off scores, stratified by education. Analysis of Variance was used to compare CLOX scores between AD and VCG. RESULTS The diagnostic accuracy (area under the curve) was 84 and 85% for CLOX1 and CLOX2, respectively. Cut-offs at 10 for CLOX1 and 12 for CLOX2 yielded sensitivities of 75.3 and 75%, and specificities of 76 and 80%, respectively. The mean CLOX1 but not CLOX2 scores for AD (8.1) and VCG (5.5) remained significantly different (p = 0.002) after adjustment for the covariates age, gender, education, MMSE and dementia stage. CONCLUSION Our results support CLOX as a valid cognitive screen in Singaporean Chinese with adequate psychometric properties. In addition, CLOX may aid as an adjunct in differentiating AD from dementia with a vascular element, e.g. AD with cerebrovascular disease and vascular dementia.
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Affiliation(s)
- Philip Lin-Kiat Yap
- Gerontological Research Programme, Faculty of Medicine, National University of Singapore, Singapore.
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Adamis D, Morrison C, Treloar A, Macdonald AJD, Martin FC. The performance of the Clock Drawing Test in elderly medical inpatients: does it have utility in the identification of delirium? J Geriatr Psychiatry Neurol 2005; 18:129-33. [PMID: 16100101 DOI: 10.1177/0891988705277535] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Clock Drawing Test is an often-used test for the detection of cognitive impairment, but the few studies that have evaluated its utility in delirium have produced rather inconsistent results. In a longitudinal study of delirium in elderly medical inpatients, we have investigated the relationships between the Clock Drawing Test, the presence and severity of delirium, and cognitive impairment. Using mixed linear model analysis we found that cognitive impairment was the major factor associated with low Clock Drawing Test scores (P < .0001): neither the presence nor the severity of delirium had additional significant effect on the Clock Drawing Test. Thus, we conclude that although the Clock Drawing Test is a good detector of cognitive impairment, it is not a suitable tool for detection of delirium in elderly medical inpatients.
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Heinik J, Solomesh I, Berkman P. Correlation between the CAMCOG, the MMSE, and three clock drawing tests in a specialized outpatient psychogeriatric service. Arch Gerontol Geriatr 2004; 38:77-84. [PMID: 14599707 DOI: 10.1016/j.archger.2003.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Our objective was to assess the correlation between (1) the Cambridge Cognitive Examination (CAMCOG) (including the Mini-Mental State Examination [MMSE]) score and three clock drawing tests (CDT) and (2) the three CDTs independently, in a specialized outpatient psychogeriatric service. One hundred and fourteen subjects completed a comprehensive evaluation and were allocated to one of the following groups: dementia of the Alzheimer's type (DAT) in 52; vascular dementia (VD) in 36; non-dementia (ND; Mood or Anxiety Disorders) in 26. When the entire sample of patients is considered, all three CDTs used were highly and significantly correlated to the MMSE score, the CAMCOG score, and to each other. In this patient population, these cognitive tests may be interchangeable for providing an initial objective measure of cognitive function. However, when the same correlations were studied in the separate diagnostic groups, in the dementia group (DAT and VD) even though the high correlations between the various CDTs themselves did not change, the correlations between the MMSE score, the CAMCOG score and the CDTs decreased, more evidently in the VD group. This trend became even more conspicuous in the ND group, where some of the above mentioned correlations became non-significant. We hypothesize that in a real clinical situation the clinician initially assumes the role of cognitive "evaluator" (in terms of the total sample) followed by the role of cognitive "monitor" (in relation to specific diagnostic groups). In the first instance, CDTs, the MMSE, and the CAMCOG might be considered interchangeable as an initial objective measure of cognitive dysfunction, while in the second role, different CDTs might be diversely used, presumably supplemented by other cognitive tests and clinical methods.
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Affiliation(s)
- Jeremia Heinik
- Margoletz Psychogeriatric Center, Ichilov Hospital, 6 Weizman Street, Tel-Aviv 64239, Israel.
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Heinik J, Solomesh I, Lin R, Raikher B, Goldray D, Merdler C, Kemelman P. Clock Drawing Test-Modified and Integrated Approach (CDT-MIA): description and preliminary examination of its validity and reliability in dementia patients referred to a specialized psychogeriatric setting. J Geriatr Psychiatry Neurol 2004; 17:73-80. [PMID: 15157347 DOI: 10.1177/0891988704264533] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors developed a scoring system for clock drawing, based on modification and integration of 3 established scoring methods. The Clock Drawing Test-Modified and Integrated Approach (CDT-MIA) is a 4-step, 20-item instrument, with a maximum score of 33, which emphasizes differential scoring of contour, numbers, hands, and center. It was administered to 139 patients (93 with and 46 without dementia). Dementia patients revealed significantly more impairment on the CDT-MIA total score and hours and hands subscores. Correlations between CDT-MIA and 2 CDTs were high. With receiver operating characteristics (ROC) curves, the area constructed under CDT-MIA curve was large. The best trade-off between sensitivity and specificity for CDT-MIA was the cut-point 23 (91% and 80%, respectively). The internal consistency of CDT-MIA was high, and there was a high degree of interrater reliability. Thus, CDT-MIA was found to be a valid and reliable evaluation instrument for dementia patients in a specialized setting.
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Affiliation(s)
- Jeremia Heinik
- Margoletz Psychogeriatric Center, Ichilov Hospital, 6 Weizman Street, Tel-Aviv, Israel.
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Shulman KI. Time waits for no man. Int J Geriatr Psychiatry 2003; 18:556. [PMID: 12789684 DOI: 10.1002/gps.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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