The clock drawing test as a cognitive screening tool for elderly patients in an acute-care hospital

Cognitive Screening Tool for Geriatrics: A Retrospective Observational Study on the Correlation of the Scores in 30-Point Clock Face Test and MMSE

BACKGROUND

Over the past 30 years, the clock drawing test (CDT) has generated considerable interest due to its usefulness in the early detection of cognitive impairments, particularly those seen in neurodegenerative dementias (including Alzheimer's disease), vascular dementia, and mixed dementia. The present study aimed to determine whether the results of the "30-Point Clock Face Test" (CFT-30), a standardized version of the CDT that uses a 30-point scale, correlate with those of the Mini-Mental State Examination (MMSE).

METHODS

This is a retrospective, observational study. All patients hospitalized in a Hospital-University Clinic Geriatrics Unit (Grenoble Alpes University Hospital, Grenoble, France), from January 1, 2017, to December 31, 2018, were included. Patient data and scores were retrieved from hospital archives, and the results of the two tests of interest, MMSE and the CFT-30, were analyzed.

RESULTS

We included 214 patients aged ≥75 years. The mean ± SD age was 86.4 ± 5.6 years, and 68.7% were female. A strongly positive, significant correlation was seen between the CFT-30 and MMSE (r = 0.73, P < 0.001) scores. The total scores obtained by these two tests were identical (t = 1.22, P = 0.22).

CONCLUSION

CFT-30 is a good complement to the tools usually used in the investigation of cognitive impairments in older people. In addition to its metrological qualities, the standardized and normalized CFT-30 is extremely simple and very fast to use.

Does the Clock Drawing Test predict cognitive decline in older persons independent of the Mini-Mental State Examination? The FINE Study Group. Finland, Italy, The Netherlands Elderly

OBJECTIVE

To evaluate the value of the Clock Drawing Test (CDT) in predicting cognitive deterioration over a 4-year period, independent of baseline cognitive status evaluated by the Mini-Mental State Examination (MMSE).

DESIGN

A preplanned analysis of data collected during the second (1991) and the third (1995) follow-up of the Italian rural cohorts of the FINE Study (Finland, Italy, the Netherlands Elderly).

SUBJECTS

Of the 427 men (mean age 77.6 +/- 4.1 years; range 72-90 years) interviewed in 1991, 264 survived and were reinterviewed in 1995. The study population included 247 persons who were interviewed and received a complete cognitive evaluation in both 1991 and in 1995.

MEASUREMENTS

Cognitive assessment in 1991 included the MMSE, the Dementia Rating Scale (DRS), and the CDT. The CDT was classified as normal or pathological, based on previously established criteria. The MMSE and the DRS were repeated in 1995.

RESULTS

Independent of age and baseline MMSE, score, subjects with pathological CDT compared with normal CDT had lower MMSE scores at follow-up (P < .01). These results were also confirmed by evaluating cognitive decline through its impact on change over time in daily life autonomy, as measured by the DRS (P < .01). Among persons scoring more than 21 on the MMSE, compared with persons with a normal CDT, those with pathological CDT performance were 5.4 (95% CI: 2.1-14.2) and 5.5 (95% CI: 1.6-19.6) times more likely to have a MMSE score below 21 and 18, respectively, 4 years later, independent of age and baseline MMSE score.

CONCLUSIONS

Findings suggest that the CDT identifies older persons at high risk of cognitive decline and adds prognostic information that supplements the standard MMSE test.