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Engedal K, Benth JŠ, Wagle J, Gjøra L, Selbæk G, Persson K. Normative Scores on the Clock Drawing Test Among Older Adults from a Large Population Survey in Norway: The HUNT Study. J Alzheimers Dis 2024; 101:223-234. [PMID: 39213081 DOI: 10.3233/jad-231331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Background The Clock Drawing Test (CDT) is used to screen for Alzheimer's disease and other dementia disorders. Normative scores on the version from the Montreal Cognitive Assessment (MoCA) do not exist in the Nordic countries. Objective To examine the normative scores of the CDT among adults aged 70 years and older. Methods We included 4,023 cognitively healthy persons aged 70-97 years from a population survey in Norway. They were examined with the CDT, which has a total score between zero and three. A multiple multinominal regression model was applied with a CDT score as the dependent categorical variable and estimated the probabilities of scoring a particular score, stratified by age, sex, and education. These probabilities correspond to an expected proportion of the normative population scoring at, or below a given percentile. Results None scored zero, 2.1% scored one, 14.9% scored two, and 83% scored three. Higher age, female sex and fewer years of schooling were associated with poorer performance. Scores of zero and one deviated from the normative score regardless of age, sex and education. A score of two was within the norm for a female older than 81 and a male older than 85. Conclusions The majority (83%) of people 70 years and older had a score of three on the CDT. Lower age, male sex, and higher education were associated with a better performance. Scores of zero and one were below the normative score. Except for the very old, a score of two was also well below the normative score.
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Affiliation(s)
- Knut Engedal
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Norway
- Health Service Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Jørgen Wagle
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Linda Gjøra
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Geir Selbæk
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
| | - Karin Persson
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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O'Shea SA, Shih LC. Global Epidemiology of Movement Disorders: Rare or Underdiagnosed? Semin Neurol 2023; 43:4-16. [PMID: 36893797 DOI: 10.1055/s-0043-1764140] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
In this manuscript, we review the epidemiology of movement disorders including Parkinson's disease (PD), atypical parkinsonism, essential tremor, dystonia, functional movement disorders, tic disorders, chorea, and ataxias. We emphasize age-, sex-, and geography-based incidence and prevalence, as well as notable trends including the rising incidence and prevalence of PD. Given the growing global interest in refining clinical diagnostic skills in recognizing movement disorders, we highlight some key epidemiological findings that may be of interest to clinicians and health systems tasked with diagnosing and managing the health of patients with movement disorders.
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Affiliation(s)
- Sarah A O'Shea
- Department of Neurology, Columbia University, Vagelos College of Physicians and Surgeons, New York City, New York
| | - Ludy C Shih
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Department of Neurology, Boston Medical Center, Boston, Massachusetts
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Shao K, Dong FM, Guo SZ, Wang W, Zhao ZM, Yang YM, Wang PP, Wang JH. Clock-drawing test: Normative data of three quantitative scoring methods for Chinese-speaking adults in Shijiazhuang City and clinical utility in patients with acute ischemic stroke. Brain Behav 2020; 10:e01806. [PMID: 32856405 PMCID: PMC7667341 DOI: 10.1002/brb3.1806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The clock-drawing test (CDT) is a widely used screening tool for detecting cognitive decline. However, normative data for Chinese individuals are scarce. Our study aimed to provide standardized values for the three quantitative CDT scoring methods that were tailored for Chinese-speaking adults in Shijiazhuang City and explore the discriminant validity of the CDT scores in patients with acute ischemic stroke. METHODS We conducted the CDT among 418 healthy individuals aged between 35 and 84 years. The CDT was administered and scored by five raters using the method derived from the Montreal Cognitive Assessment (MoCA), Rouleau's, and Babins' scoring systems. The influence of age, education, and sex on the performance in the CDT was analyzed. Furthermore, 336 patients with acute ischemic stroke were enrolled to explore the discriminant validity of CDT scores. RESULTS In all three scoring systems, CDT scores were significantly correlated with age and years of education but not with sex. Normative data stratified for age and years of education were established. Interrater and intersystem reliability were high in our study. CDT total scores and subscores showed significant differences between stroke patients and healthy individuals. CONCLUSIONS Our study provides CDT normative data using three quantitative scoring methods for Chinese-speaking adults in Shijiazhuang City. Age and education level were the key factors that affected the CDT scores. CDT total scores and subscores provided good discriminant validity for patients with acute ischemic stroke.
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Affiliation(s)
- Kai Shao
- Department of Graduate College, Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Fang-Ming Dong
- Department of Graduate College, Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Shang-Zun Guo
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China.,Department of Graduate College, Hebei North University, Zhangjiakou, China
| | - Wei Wang
- Department of Graduate College, Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Zhong-Min Zhao
- Department of Graduate College, Hebei Medical University, Shijiazhuang, China.,Department of Neurology, Hebei General Hospital, Shijiazhuang, China
| | - Yi-Ming Yang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China.,Department of Graduate College, Hebei North University, Zhangjiakou, China
| | - Pan-Pan Wang
- Department of Electromyography, Hebei General Hospital, Shijiazhuang, China
| | - Jian-Hua Wang
- Department of Neurology, Hebei General Hospital, Shijiazhuang, China
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Daily exposure to digital displays may affect the clock-drawing test: from psychometrics to serendipity. Neurol Sci 2020; 41:3683-3690. [PMID: 32506359 DOI: 10.1007/s10072-020-04498-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The clock-drawing test (CDT) is a neuropsychological screening tool largely used to explore cognitive functioning. It requires participants to draw an analog clock face. Many studies have reported a good correlation between the CDT and the Mini-Mental State Examination (MMSE). The CDT has also showed a variable specificity. There are, however, some inconsistencies concerning the effect of sociodemographic variables (sex, age, education) on clock-drawing abilities. The present study aimed at examining these issues in a sample of middle-aged/young-old healthy adults. METHOD Participants (n = 97) performed the MMSE and CDT. Clock drawings were assessed by five formal scoring systems (Wolf-Klein, Watson, Freedman, Manos, Shulman). In addition, three naïve raters provided a dichotomous judgment (normal vs. abnormal) for each clock. RESULTS Sociodemographic variables did not affect CDT performance. Unlike earlier studies, CDT scores did not correlate with MMSE. Moreover, test specificity was appropriate only for Freedman's, Shulman's, and Wolf-Klein's methods. Interestingly, some participants drew clocks with numbers as they appear in digital clocks. By re-running the statistical analyses after removing these atypical clocks, four out of the five formal scores showed a significant correlation with MMSE; furthermore, CDT specificity slightly increased for all scoring systems including naïve ratings. CONCLUSIONS CDT is not affected by sociodemographic variables. The finding of some clocks with digitally represented numbers suggests the need to align neuropsychological assessments with demands from an increasing digitalized environment. Moreover, the occurrence of high false-positives and possible digital contaminations suggest great caution in interpreting the clinical significance of CDT.
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Shanhu X, Linhui C, Xiaoqing J, Jing Y, Saizhu X, Ying X, Caixia L, Yu J. Effects of age and education on clock-drawing performance by elderly adults in China. Clin Neuropsychol 2019; 33:96-105. [PMID: 31322036 DOI: 10.1080/13854046.2019.1640285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Xu Shanhu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Chen Linhui
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Jin Xiaoqing
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Yan Jing
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Xu Saizhu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Xu Ying
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Liu Caixia
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Jin Yu
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
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Park J, Jeong E, Seomun G. The clock drawing test: A systematic review and meta‐analysis of diagnostic accuracy. J Adv Nurs 2018; 74:2742-2754. [DOI: 10.1111/jan.13810] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 05/21/2018] [Accepted: 06/05/2018] [Indexed: 11/30/2022]
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Merims D, Ben Natan M, Milawi D, Boguslavsky T. The clock-drawing test: normative data in adult and elderly Israeli Arabs. Psychogeriatrics 2018; 18:175-181. [PMID: 29415342 DOI: 10.1111/psyg.12305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/20/2017] [Accepted: 10/22/2017] [Indexed: 11/30/2022]
Abstract
AIM Despite the widespread use of the clock-drawing test (CDT), normative data and information regarding the influence of sociodemographic factors on test performance by adult and elderly Israeli Arabs are lacking. The current study aimed to establish normative data for this population group by exploring the impact of sociodemographic factors such as age, education, and gender on CDT performance. In addition, this study examined the association between CDT performance and Mini-Mental State Examination (MMSE) scores. METHODS The sample consisted of 295 community-dwelling healthy adult and elderly Israeli Arabs, aged 20-86 years, with a MMSE score ≥24. The MMSE and the CDT were administered to participants. RESULTS Statistical analyses revealed that age had a negative effect on CDT performance, which was most pronounced in the 60-86 age group, but education and occupation (academic vs non-academic) had a positive effect. Gender and place of residence (urban vs rural) had no effect. CDT performance predicted the MMSE score. CONCLUSIONS The present study provides preliminary normative data on adult and elderly Israeli Arabs. The CDT appears to be applicable to Israeli Arabs, while the normative data might help interpret cognitive function results in this population.
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Affiliation(s)
- Doron Merims
- Department of Geriatrics, Shoham Geriatric Center, Affiliated with the Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Pardes Hana, Israel
| | - Merav Ben Natan
- Pat Matthews Academic School of Nursing, Hillel Yaffe Medical Center, Hadera, Israel
| | - Deep Milawi
- Department of Geriatrics, Shoham Geriatric Center, Affiliated with the Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Pardes Hana, Israel
| | - Tania Boguslavsky
- Director, Shoham Geriatric Center, Affiliated with the Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Pardes Hanna, Israel
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Chen PH, Sheu JJ. Clock-drawing test for cognitive assessment in an older adult with long-term benzodiazepine use. Geriatr Gerontol Int 2017; 17:1135-1137. [PMID: 28741883 DOI: 10.1111/ggi.13026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/15/2017] [Accepted: 01/25/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Pao-Huan Chen
- Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Jau-Jiuan Sheu
- Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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The clock-drawing test as a possible indicator of acute psychosis. Int Clin Psychopharmacol 2016; 31:155-8. [PMID: 26752620 DOI: 10.1097/yic.0000000000000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The clock-drawing test (CDT) is used widely to evaluate cognitive disorders, but its role in the assessment of psychotic disorders has not been studied. We sought to examine whether the CDT plays a role as an indicator of psychosis and to establish its sensitivity to clinical improvement of psychosis. The CDT was administered twice to 53 hospitalized patients without dementia but with psychosis: once at admission and again before discharge. The CDT scores were calculated in a random order by two independent senior psychiatrists who were blinded to the patients' status (admission or discharge). The inter-rater reliability was high (0.89 at admission, 0.85 at discharge, P<0.01 for both). The severity of psychosis was assessed by the Positive and Negative Syndrome Scale (PANSS). Patients had significantly lower CDT scores at admission than at discharge (2.87±1.39 vs. 3.91±1.08, respectively, P<0.01). The PANSS-total score of the patients showed a significant improvement (84.90±17.77 vs. 69.18±16.23, P<0.01). An inverse correlation was found between CDT performance and psychosis severity, as reflected by the PANSS-positive symptom subscale at admission (R=-0.279, P<0.05). Our findings suggest that the CDT may aid in the assessment of psychotic states and in their clinical monitoring.
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Mazancova AF, Nikolai T, Stepankova H, Kopecek M, Bezdicek O. The Reliability of Clock Drawing Test Scoring Systems Modeled on the Normative Data in Healthy Aging and Nonamnestic Mild Cognitive Impairment. Assessment 2016; 24:945-957. [DOI: 10.1177/1073191116632586] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Clock Drawing Test (CDT) is a commonly used tool in clinical practice and research for cognitive screening among older adults. The main goal of the present study was to analyze the interrater reliability of three different CDT scoring systems (by Shulman et al., Babins et al., and Cohen et al.). We used a clock with a predrawn circle. The CDT was evaluated by three independent raters based on the normative data set of healthy older and very old adults and patients with nonamnestic mild cognitive impairment (naMCI; N = 438; aged 61-94). We confirmed a high interrater reliability measured by the intraclass correlation coefficients (ICCs): Shulman ICC = .809, Babins ICC = .894, and Cohen ICC = .862, all p < .001. We found that age and education levels have a significant effect on CDT performance, yet there was no influence of gender. Finally, the scoring systems differentiated between naMCI and age- and education-matched controls: Shulman’s area under the receiver operating characteristic curve (AUC) = .84, Cohen AUC = .71, all p < .001; and a slightly lower discriminative ability was shown by Babins: AUC = .65, p = .012.
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Affiliation(s)
- Adela Fendrych Mazancova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Tomas Nikolai
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Hana Stepankova
- National Institute of Mental Health, Klecany, Czech Republic
| | | | - Ondrej Bezdicek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
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Amodeo S, Mainland BJ, Herrmann N, Shulman KI. The Times They Are a-Changin': Clock Drawing and Prediction of Dementia. J Geriatr Psychiatry Neurol 2015; 28:145-55. [PMID: 25319477 DOI: 10.1177/0891988714554709] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 09/17/2014] [Indexed: 11/16/2022]
Abstract
Identification of individuals who will eventually develop dementia is critical for early intervention, treatment, and care planning. The clock drawing test (CDT) is a widely used cognitive screening tool that has been well accepted among clinicians and patients for its ease of use and short administration time. This review explores the value of the CDT for predicting the later development of dementia in cognitively intact older adults and patients with mild cognitive impairment (MCI). Additionally, we reviewed studies that examined the ability of the CDT to monitor declines in cognitive functioning over time. A PubMed literature search for articles that included a longitudinal analysis of the CDT was conducted. The search included articles published up to June 2013 and manual cross-referencing of bibliographies. Relevant studies were categorized, summarized, and critiqued. The consensus from the studies reviewed suggests that the CDT is a useful measure of cognitive decline over time. Conceptual clock drawing errors (eg, misrepresentation of time) detected this decline most effectively. In addition, the CDT appears to differentiate at baseline between cognitively intact older adults who will develop dementia up to 2 years postbaseline. Finally, the CDT has been found to differentiate between patients with MCI who will progress to dementia up to 6 years postbaseline. The CDT appears useful for the longitudinal assessment of cognitive impairment and together with other validated measures may be helpful for predicting conversion to dementia. Cost-effective and practical ways of predicting risk of dementia will become increasingly critical as we develop disease-modifying treatments.
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Affiliation(s)
- Sean Amodeo
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian J Mainland
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kenneth I Shulman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Konagaya Y, Konagaya M, Watanabe T, Washimi Y. [Quantitative and qualitative analyses for characteristics of the clock drawing in Alzheimer's disease]. Rinsho Shinkeigaku 2014; 54:109-15. [PMID: 24583584 DOI: 10.5692/clinicalneurol.54.109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We analyzed the results of the clock drawing test (CDT) in patients with Alzheimer's disease (AD) by quantitative and qualitative methods to evaluate its significance for cognitive function screening. We administered the CDT and mini-mental state examination (MMSE) to a total of 156 AD patients, and CDT performance was scored quantitatively in accordance with the method by Freedman, while the CDT error types were qualitatively classified by Rouleau's method. We divided AD patients into three groups by their MMSE total score (A: 23 ≤, B: 18~22, C: ≤ 17). The mean total scores of CDT and MMSE in AD were 11.5 ± 3.4 and 19.8 ± 4.7, respectively, and the total CDT scores showed significant positive correlation with the total MMSE scores (r = 0.450). Fewer than 80% of subjects drew the clock correctly for 8 out of 15 sub-items, and fewer were able to correctly draw clock hands than could correctly draw numbers, contour or a center. In analysis of CDT qualitative error types, the most common error types were spatial and/or planning deficit (SPD) (28.2%), and conceptual deficit (CD) (23.7%), which suggested visuospatial impairments and semantic impairments play essential roles in AD patients' poor clock drawings. The frequency of CD and SPD error types significantly increased as severity of cognitive function worsened (p < 0.001, p < 0.05, respectively), and those of stimulus-bound response and perseveration had tendency to increase as severity of cognitive function. The present study suggests that CDT is a useful screening method not only for the impairment of cognitive function and the severity of cognitive dysfunction, but also for identification of specific cognitive function impairments in AD patients.
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Affiliation(s)
- Yoko Konagaya
- Division of Research, Obu Dementia Care and Training Center
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Mainland BJ, Amodeo S, Shulman KI. Multiple clock drawing scoring systems: simpler is better. Int J Geriatr Psychiatry 2014; 29:127-36. [PMID: 23765914 DOI: 10.1002/gps.3992] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 05/06/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The clock drawing test (CDT) is a widely used cognitive screening tool that has been well accepted among clinicians and patients for its ease of use and short administration time. Although there is ample interest in the CDT as a screening instrument, there remains a range of CDT administration and scoring systems with no consensus on which system produces the most valid results while remaining user friendly. The aims of this review are to synthesize the available evidence on CDT scoring systems' effectiveness and to recommend which system is best suited for use at the clinical frontlines. DESIGN A Pubmed literature search was carried out from 2000 to 2013 including manual cross-referencing of bibliographies in order to capture studies published after Shulman's comprehensive review published in 2000. A brief summary of all original scoring systems is included, as well as a review of relevant comparative studies. RESULTS The consensus from multiple comparison studies suggests that increasing the complexity of CDT scoring systems does little to enhance the test's ability to identify significant cognitive impairment. Moreover, increased complexity in scoring adds to the administration time, thereby reducing the test's utility in clinical settings. CONCLUSIONS In comparing scoring systems, no system emerged as consistently superior in terms of predictive validity. The authors conclude that when scoring the CDT as a screening instrument in a primary/general medicine/community setting, simpler is better, and perhaps qualitative assessment of "normal" versus "abnormal" may be sufficient for screening purposes and the establishment of a baseline for follow-up.
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Affiliation(s)
- Brian J Mainland
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
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Kaneda A, Katagai T, Yasui-Furukori N. Comparing the influences of age and disease on the Brief Assessment of Cognition in Schizophrenia in Japanese patients with schizophrenia. Neuropsychiatr Dis Treat 2013; 9:1203-8. [PMID: 23983469 PMCID: PMC3748053 DOI: 10.2147/ndt.s43280] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The Brief Assessment of Cognition in Schizophrenia (BACS) is an evaluation of cognitive function that can be completed with more cases. However, there are few studies that compare which factor, disease or aging, is a better determinant of performance on the BACS. The present study aimed to investigate the influences of disease and aging on BACS performance in schizophrenic patients using subjects with a wide range of ages. METHODS Schizophrenic patients (n = 165) and a comparison group (n = 171) were recruited as subjects. All participants completed the Japanese language version of the BACS (BACS-J), and the influences of disease and aging on performance in the BACS were examined with the use of multiple regression analysis. RESULTS There was a significant influence of diagnosis and level of education on all six tasks of the BACS and the performance and composite scores. In addition, age was found to influence five tasks and the composite score, the duration of illness influenced four tasks and the composite score, and gender influenced one task and the composite score. CONCLUSION The present study suggests that performance on the BACS was impaired not only by disease but also by level of education and aging.
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Affiliation(s)
- Ayako Kaneda
- Department of Neuropsychiatry, Hirosaki University Graduate School of Medicine, Hirosaki, Japan ; Department of Psychiatry, Kuroishi-Akebono Hospital, Kuroishi, Japan
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Caffarra P, Gardini S, Zonato F, Concari L, Dieci F, Copelli S, Freedman M, Stracciari A, Venneri A. Italian norms for the Freedman version of the Clock Drawing Test. J Clin Exp Neuropsychol 2011; 33:982-8. [PMID: 22082081 DOI: 10.1080/13803395.2011.589373] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The Clock Drawing Test (CDT) is a valid screening tool for the evaluation of cognitive decline. This study aimed to compute standardized norms for the Freedman version of the CDT in a population of 248 healthy Italian individuals aged from 20 to 89 years. METHOD The effects of age, education, and gender on performance were assessed. Three conditions were administered: free-drawn clock (FD), which required participants to draw the contour, numbers, hands, and center of the clock; predrawn clock (PD), in which numbers, hands, and center had to be included in a predrawn contour; examiner-drawn clock (ED), in which only hands and center had to be inserted in a template including a predrawn contour and numbers. Scores for each of the single conditions and a total score were calculated. RESULTS Age had no effect on the FD condition, whereas a significant effect of age was found for the PD and ED conditions and the total score. Gender and education had no influence on any of the scores. Correction grids, cutoffs, and equivalent scores were computed. CONCLUSION Standardized norms for the Freedman version of the CDT were collected in a large sample of healthy individuals. No adjustments were required for scores on the free-drawn condition, whereas raw scores on the predrawn and examiner-drawn conditions and the total score needed adjustments to account for age effects. The availability of standardized norms for this version of the CDT could increase the use of this comprehensive tool in the detection of dementia.
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Affiliation(s)
- Paolo Caffarra
- Department of Neuroscience, University of Parma, Parma, Italy.
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Comparing the influences of age and disease on distortion in the clock drawing test in Japanese patients with schizophrenia. Am J Geriatr Psychiatry 2010; 18:908-16. [PMID: 20808150 DOI: 10.1097/jgp.0b013e3181ef7a47] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The Clock Drawing Test (CDT) is commonly used for cognitive screening, but there are few studies that compare performance on the CDT among schizophrenic patients of different ages. The objective of this study was to investigate the influence of schizophrenia and aging on performance in the CDT. METHOD Schizophrenic patients (N = 244) and a comparison group (N = 875) were recruited as subjects. Freedman's CDT was completed by all subjects, and the influences of disease and aging on performance in the CDT were examined. Multiple comparisons of the CDT scores between patients and the comparison group and within three age subgroups (young: less than 40 years, middle aged: 40-59 years, elderly: more than 60 years) were performed. RESULTS There was a significant interaction of diagnosis and age, and the education significantly influenced the total score for all CDT conditions. For almost all age subgroups of patients, individuals with schizophrenia had significantly lower scores on all the CDT conditions than did the comparison group subjects. For patients and the comparison group, the elderly subgroup performed significantly worse than the young and middle-aged subgroups on almost all conditions of the CDT. Qualitative analysis of the clocks drawn revealed that the number of CDT categories in which schizophrenic patients scored significantly lower than the comparison group tended to increase with aging across both groups. CONCLUSIONS This study suggests that performance on the CDT was impaired not only by disease but also by aging. The study confirms that the CDT is sensitive enough to screen for cognitive impairments in schizophrenia.
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