Not all clock-drawing tasks are the same

The global security perspective on the effects of executive cognitive function on complex behavioral screening intervention and HIV/AIDS

The purpose of this quantitative study is to understand the global security perspective on the effects of executive cognitive function (ECF) on Complex Behavioral Screening Intervention and HIV/AIDS. The HIV/AIDS pandemic is as much a social, political, economic, and cultural problem as a biomedical one. HIV/AIDS is associated centrally with the collapse not just of communities and families but potentially of states, with some of the largest public health interventions ever and enormous questions about governance, a huge population of orphans, and deep questions about intergenerational relations and cultural transmission. This study also is to develop a screening instrument that improves quality of life for individuals with executive cognitive impairments and behavior problems in our communities and the global society.

EXIT25 - Executive interview applied to a cognitively healthy elderly population with heterogeneous educational background

Education interferes with the performance in most cognitive tests, including executive function assessment.

Clock-drawing potentially mediates the effect of depression on mortality: replication in three cohorts

OBJECTIVE

Previously studies have associated visuospatial tasks, particularly 'clock-drawing', with mortality. We sought to determine whether clock-drawing also mediates the association between depressive symptoms and mortality.

PARTICIPANTS

Non-institutionalized Hispanic and non-Hispanic White elderly volunteers.

MEASUREMENTS

Survival curves were generated as a function of baseline depressive symptom ratings. Significant models were adjusted for CLOX performance. CLOX is divided into CLOX1, a measure of executive control, and CLOX2, a measure of visuospatial skills.

DESIGN

Retrospective analysis of three longitudinal cohorts.

RESULTS

CLOX2 and depressive symptoms were both associated with mortality in unadjusted models. CLOX2 predicted survival independently of CLOX1 in all three cohorts. CLOX2 also attenuated, and/or mediated the association between depressive symptoms and mortality. These results withstood adjustment for age and education in all three cohorts.

CONCLUSION

Regardless of the sample examined, or the measure of depressive symptoms applied, the association between depressive symptoms and mortality appears to be at least partially mediated by visuospatial skills. This finding supports our hypothesis that right hemisphere structural brain disease, particularly that involving the insula, may mediate depression's effects on mortality.

Cognitive predictors of mortality in elderly retirees: results from the Freedom House study

OBJECTIVE

The objective of this longitudinal cohort study was to study the cognitive domains associated with five-year longitudinal survival among healthy, well-educated, noninstitutionalized elderly.

METHODS

Survival curves were generated as a function of cross-sectional baseline cognitive test performance.

RESULTS

Nonverbal tests were significantly associated with survival. This finding was markedly consistent. Several nonverbal tasks were each significantly associated with survival independently of age, gender, baseline level of care, and healthcare utilization. In a multivariate model, copying a clock made the strongest, independent contribution to survival.

CONCLUSIONS

Right hemisphere integrity in general and nonverbal drawing tasks in particular have been associated with survival in conditions as diverse as Alzheimer disease, stroke, and epilepsy. This study extends this association to "normal" aging. The mechanism by which nonverbal cognitive function is related to mortality remains unclear but may be mediated by changes in right hemisphere cortical control of autonomic function. Nondemented older persons may be at risk. Clock drawing may provide a simple means of identifying them.

Risk of Cognitive Decline in Older Patients After Carotid Endarterectomy: An Observational Study

OBJECTIVES

To determine whether patients undergoing carotid endarterectomy (CE) for symptomatic left internal carotid artery (LICA) stenosis have greater risk of cognitive decline than patients with asymptomatic LICA disease or right internal carotid artery (RICA) disease.

DESIGN

Observational.

SETTING

Vascular surgery day hospital.

PARTICIPANTS

The analysis included 103 patients (mean age 72.6+/-7.0, 73 men), of whom 50 had LICA disease (29 symptomatic).

MEASUREMENTS

Cognitive function was evaluated (age- and education-adjusted Mini-Mental State Examination (MMSE), and Clock tests (CLOX1 and 2)) at baseline and at the end of the study period (average follow-up+/-standard deviation 44.4+/-14.3 months) in a sample of patients aged 65 and older, free from cognitive impairment, consecutively undergoing CE.

RESULTS

At the end of the study period, MMSE, CLOX1, and CLOX2 scores were significantly lower in patients with symptomatic LICA disease (P<.001, P<.001, and P=.002, respectively) and not in the other groups of patients. Patients with symptomatic LICA disease had greater risk of cognitive decline than other individuals according to MMSE score (F=5.18, P=.002) or CLOX1 and 2 scores (F=5.66, P=.001, and F=4.33, P=.006, respectively).

CONCLUSION

Patients undergoing CE for symptomatic LICA disease appear to be at greater risk of cognitive decline than other subjects. These findings suggest that future studies should evaluate the effects on cognitive function of different timing for CE in patients with LICA and RICA disease.

Executive Control Function: A Clinically Practical Assessment

Intact executive control function is emerging as a determinant of functional status and independent living. Multiple causes of impaired executive control function including subclinical impairments exist. Integration of bedside executive control function assessment into routine nursing assessment and documentation provides a quantitative measure of an individual's ability to provide self-care.

Clock drawing, clock reading, clock setting, and judgment of clock faces in elderly people with dementia and depression

OBJECTIVES

To assess patient performance on different clock tasks.

DESIGN

Group comparisons.

SETTING

A hospital-based memory clinic; inpatient and outpatient memory clinic.

PARTICIPANTS

Patients with dementia (n=30), patients with depression (n=30), and healthy controls (n=30).

MEASUREMENTS

General neuropsychological tests, clock drawing tests, and three additional clock tasks: clock reading, clock setting, and judgment of clock faces (each comprising 12 items).

RESULTS

Demented patients differed significantly from the control and depression groups on all clock tasks; controls and depressed patients differed only in the clock-setting task. A comparison between tasks showed that clock setting was the most difficult, which differentiated best between diagnostic groups. Groups differed not only in overall performance scores, but also in error characteristics.

CONCLUSION

Overall, study results indicate that clock setting is a sensitive task that may prove to be a valuable tool when screening for dementia.

Correlation between the CAMCOG, the MMSE, and three clock drawing tests in a specialized outpatient psychogeriatric service

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.