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Plantinga L, Yazdany J, Bowling CB, Dunlop-Thomas C, Hoge C, Pearce BD, Lim SS, Katz P. Comparison of cognitive performance measures in individuals with systemic lupus erythematosus. Lupus Sci Med 2024; 11:e001151. [PMID: 38627039 PMCID: PMC11029380 DOI: 10.1136/lupus-2024-001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/09/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Cognitive impairment is a common complaint in SLE, but approaches to measuring cognitive performance objectively vary. Leveraging data collected in a population-based cohort of individuals with validated SLE, we compared performance and potential impairment across multiple measures of cognition. METHODS During a single study visit (October 2019-May 2022), times to complete the Trail Making Test B (TMTB; N=423) were recorded; potential impairment was defined as an age-corrected and education-corrected T-score <35 (>1.5 SD longer than the normative time). A clock drawing assessment (CLOX; N=435) with two parts (free clock draw (CLOX1) and copy (CLOX2)) was also performed (score range: 0-15; higher scores=better performance); potential impairment was defined as CLOX1 <10 or CLOX2 <12. Fluid cognition (N=199; in-person visits only) was measured via the National Institutes of Health (NIH) Toolbox Fluid Cognition Battery and expressed as age-corrected standard scores; potential impairment was defined by a score <77.5 (>1.5 SD lower the normative score). RESULTS Participants (mean age 46 years; 92% female; 82% black) had a median (IQR) TMTB time of 96 (76-130) s; median (IQR) CLOX1 and CLOX2 scores of 12 (10-13) and 14 (13-15); and a mean (SD) fluid cognition standard score of 87.2 (15.6). TMTB time and fluid cognition score (ρ=-0.53, p<0.001) were the most highly intercorrelated measures. Overall, 65%, 55% and 28% were potentially impaired by the TMTB test, CLOX task and NIH Toolbox Fluid Cognition Battery, respectively. While there was overlap in potential impairment between TMTB and CLOX, more than half (58%) had impairment by only one of these assessments. Few (2%) had impairment in fluid cognition only. CONCLUSION The TMTB, CLOX and NIH Fluid Cognition Battery each provided unique and potentially important information about cognitive performance in our SLE cohort. Future studies are needed to validate these measures in SLE and explore interventions that maintain or improve cognitive performance in this population.
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Affiliation(s)
- Laura Plantinga
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jinoos Yazdany
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - C Barrett Bowling
- Durham Veterans Affairs Medical Center, Durham, North Carolina, USA
- Department of Medicine, Duke University, Durham, North Carolina, USA
| | | | - Courtney Hoge
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Brad D Pearce
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - S Sam Lim
- Department of Medicine, Emory University, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University, Atlanta, Georgia, USA
| | - Patricia Katz
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Esteves CDS, Oliveira CRD, Lima MP, Gonzatti V, Irigary TQ. Teste do Desenho do Relógio: Dados Normativos Para Idosos. PSICO-USF 2022. [DOI: 10.1590/1413-82712027270306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Resumo Trata-se de um estudo quantitativo, retrospectivo, correlacional e de corte transversal, com objetivo de fornecer dados normativos do TDR para idosos, levando em consideração diferentes faixas etárias e níveis de escolaridade. Duzentos e trinta e cinco foram entrevistados individualmente, distribuídos em cinco grupos etários e quatro níveis de escolaridade. Os instrumentos foram Ficha de Dados Sociodemográficos, Miniexame do Estado Mental (MEEM), Escala de Depressão Geriátrica, versão reduzida (GDS-15), Tarefa de Fluência Verbal Semântica (TFVS) e o TDR. Utilizou-se estatísticas descritivas, correlação de Pearson e análise univariada (one-way ANOVA) com post hoc Scheffe. Os escores do TDR apresentaram associações significativas com os anos de idade, anos de escolaridade, MEEM, TFVS e GDS-15. Houve diferença de desempenho no TDR ao considerarem os grupos por idade. O estudo fornece valores normativos para o TDR em uma amostra de idosos do sul do Brasil que foram influenciados pela idade, escolaridade, sintomatologia depressiva e fluência verbal.
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Nejtek VA, James RN, Salvatore MF, Alphonso HM, Boehm GW. Premature cognitive decline in specific domains found in young veterans with mTBI coincide with elder normative scores and advanced-age subjects with early-stage Parkinson's disease. PLoS One 2021; 16:e0258851. [PMID: 34788310 PMCID: PMC8598036 DOI: 10.1371/journal.pone.0258851] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022] Open
Abstract
Importance Epidemiologists report a 56% increased risk of veterans with (+) mild traumatic brain injury (mTBI) developing Parkinson’s disease (PD) within 12-years post-injury. The most relevant contributors to this high risk of PD in veterans (+) mTBI is unknown. As cognitive problems often precede PD diagnosis, identifying specific domains most involved with mTBI-related PD onset is critical. Objectives To discern which cognitive domains underlie the mTBI-PD risk relationship proposed in epidemiology studies. Design and setting This exploratory match-controlled, cross-sectional study was conducted in a medical school laboratory from 2017–2020. Participants Age- and IQ-matched veterans with (+) and without mTBI, non-veteran healthy controls, and IQ-matched non-demented early-stage PD were compared. Chronic neurological, unremitted/debilitating diseases, disorders, dementia, and substance use among others were excluded. Exposure Veterans were or were not exposed to non-penetrating combat-related mTBI occurring within the past 7-years. No other groups had recent military service or mTBI. Main outcomes / measures Cognitive flexibility, attention, memory, visuospatial ability, and verbal fluency were examined with well-known standardized neuropsychological assessments. Results Out of 200 volunteers, 114 provided evaluable data. Groups significantly differed on cognitive tests [F (21,299) = 3.09, p<0.0001]. Post hoc tests showed veterans (+) mTBI performed significantly worse than matched-control groups on four out of eight cognitive tests (range: p = .009 to .049), and more often than not performed comparably to early-stage PD (range: p = .749 to .140). Conclusions and relevance We found subtle, premature cognitive decline occurring in very specific cognitive domains in veterans (+) mTBI that would typically be overlooked in a clinic setting, This result potentially puts them at-risk for continual cognitive decline that may portend to the eventual onset of PD or some other neurodegenerative disease.
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Affiliation(s)
- Vicki A Nejtek
- University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Rachael N James
- University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Michael F Salvatore
- University of North Texas Health Science Center, Fort Worth, Texas, United States of America
| | - Helene M Alphonso
- University of North Texas Health Science Center, Fort Worth, Texas, United States of America.,John Peter Smith Health Network, Fort Worth, Texas, United States of America
| | - Gary W Boehm
- Texas Christian University, Fort Worth, Texas, United States of America
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Singh A, Kumar R, Singh NP, Yadav R, Kumar A. Evaluation of Cognitive Functions in Traumatic Brain Injury Patients Using Mini Mental State Examination and Clock Drawing Test. Asian J Neurosurg 2021; 16:99-105. [PMID: 34211875 PMCID: PMC8202381 DOI: 10.4103/ajns.ajns_331_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/05/2020] [Accepted: 10/20/2020] [Indexed: 11/27/2022] Open
Abstract
Background: Traumatic brain injuries (TBIs) are the leading cause of morbidity, mortality, disability, and socioeconomic losses globally, but of more concern, in India and other developing countries. The Mini mental state examination (MMSE) and clock drawing test (CDT) are the two mostly adapted methods for cognitive impairment screening. Therefore, it is necessary to establish a robust evaluation system exclusively for post-TBI cognitive impairment. Materials and Methods: One hundred and thirty-four cases treated previously at the health facility for TBIs were evaluated for cognitive functions during the follow-up period ranging from 3 weeks to 6 months in the out-patient department. All cases underwent mini-mental score examination (MMSE) and CDT to assess their cognitive performances. The data were analyzed statistically using Chi-square and ANOVA tests of significance. Results: Statistically significant association (P < 0.001) between the cognitive status of patients on the basis of overall MMSE score and the site of brain injury was observed. It was noted that 76 (56.7%) of the cases had cognitive impairment (MMSE score <24) with majority 44 (32.8%) patients having frontal lobe injuries, followed by 14 (10.1%) having brain injuries in the temporal lobe. On the other hand, using CDT score, it was observed that 102 (76.1%) of the cases had cognitive impairment (CDT score <5) with the majority 49 (36.6%) cases having frontal lobe injury followed by 19 (14.2%) having brain injury in the parietal lobe. Conclusion: The CDT was able to access cognitive function disruption in those patients, in whom the mini-mental score examination was not able to assess the same, and this difference in detection capabilities of both the tests was statistically found significant.
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Affiliation(s)
- Anamika Singh
- Department of Physiology, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India
| | - Raj Kumar
- Department of Neurosurgery, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India
| | - Naresh Pal Singh
- Department of Community Medicine, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India
| | - Ramakant Yadav
- Department of Neurology, Uttar Pradesh University of Medical Sciences, Etawah, Uttar Pradesh, India
| | - Arushi Kumar
- Research Scholar, Uttar Pradesh University of Medical Sciences, Uttar Pradesh, India
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Garrett SL, Kennedy RE, Sawyer P, Williams CP, Brown CJ, Allman RM. Association Between Executive Dysfunction and Instrumental Activities of Daily Living: Racial and Ethnic Differences Among Community-Dwelling Older Adults in the Southeastern US. J Natl Med Assoc 2018; 111:320-327. [PMID: 30527966 DOI: 10.1016/j.jnma.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/06/2018] [Accepted: 11/08/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Examining cultural differences in assessment of cognitive/functional disability among older Americans is needed. This analysis examined associations between day-to-day function, measured by activities of daily living (ADL), and cognition, measured by CLOX scores, among older African American (AA) and non-Hispanic White (nHW) community-dwelling women and men. METHODS Design- Cross-sectional. SETTING Homes of community-dwelling older adults. Participants- 893 Medicare beneficiaries >65 living in west-central Alabama, without diagnoses of dementia, who were participants in the University of Alabama at Birmingham (UAB) Study of Aging, and who had complete data. Measurements- Physical function was assessed by self-reported ADL difficulty; cognitive function by CLOX, a clock drawing-task. Multivariable, linear regression models were used to examine associations within race/sex specific groups. RESULTS After controlling for socio-demographic factors and comorbidities, CLOX1 scores were inversely and significantly correlated with ADL for AA men (β = -0.205, P = 0.003). CLOX2 scores were similarly associated with ADL and IADL for the total group (β = -0.118, P = 0.001, and β = -0.180, P < 0.001, respectively); for ADL, significant associations were seen for AA men and nHW women (β = -0.203, P = 0.004, and β = -0.139, P = 0.02, respectively) and, for IADL, in AA women and men (β = -0.156, P = 0.03, and β = -0.24, P < 0.001, respectively). CONCLUSION While African American women reported the highest difficulty with ADLs and IADLs among all race/sex groups, CLOX1 scores were correlated with ADL for AA men only. CLOX1 may have limitations to identify functional disability for older AA women. [Word Count = 234].
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Affiliation(s)
- Stephanie L Garrett
- Emory University School of Medicine, Division of General Medicine and Geriatrics, Atlanta, GA, USA.
| | | | | | | | | | - Richard M Allman
- The George Washington School of Medicine and Health Sciences, Washington, DC, USA
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Milman LH, Faroqi-Shah Y, Corcoran CD, Damele DM. Interpreting Mini-Mental State Examination Performance in Highly Proficient Bilingual Spanish-English and Asian Indian-English Speakers: Demographic Adjustments, Item Analyses, and Supplemental Measures. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:847-856. [PMID: 29486488 DOI: 10.1044/2017_jslhr-l-17-0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 11/14/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE Performance on the Mini-Mental State Examination (MMSE), among the most widely used global screens of adult cognitive status, is affected by demographic variables including age, education, and ethnicity. This study extends prior research by examining the specific effects of bilingualism on MMSE performance. METHOD Sixty independent community-dwelling monolingual and bilingual adults were recruited from eastern and western regions of the United States in this cross-sectional group study. Independent sample t tests were used to compare 2 bilingual groups (Spanish-English and Asian Indian-English) with matched monolingual speakers on the MMSE, demographically adjusted MMSE scores, MMSE item scores, and a nonverbal cognitive measure. Regression analyses were also performed to determine whether language proficiency predicted MMSE performance in both groups of bilingual speakers. RESULTS Group differences were evident on the MMSE, on demographically adjusted MMSE scores, and on a small subset of individual MMSE items. Scores on a standardized screen of language proficiency predicted a significant proportion of the variance in the MMSE scores of both bilingual groups. CONCLUSIONS Bilingual speakers demonstrated distinct performance profiles on the MMSE. Results suggest that supplementing the MMSE with a language screen, administering a nonverbal measure, and/or evaluating item-based patterns of performance may assist with test interpretation for this population.
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Affiliation(s)
- Lisa H Milman
- Department of Communicative Disorders & Deaf Education, Utah State University, Logan
| | - Yasmeen Faroqi-Shah
- Department of Hearing & Speech Sciences, University of Maryland, College Park
| | - Chris D Corcoran
- Department of Mathematics & Statistics, Utah State University, Logan
| | - Deanna M Damele
- Department of Communicative Disorders & Deaf Education, Utah State University, Logan
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Spenciere B, Alves H, Charchat-Fichman H. Scoring systems for the Clock Drawing Test: A historical review. Dement Neuropsychol 2017; 11:6-14. [PMID: 29213488 PMCID: PMC5619209 DOI: 10.1590/1980-57642016dn11-010003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Clock Drawing Test (CDT) is a simple neuropsychological screening instrument
that is well accepted by patients and has solid psychometric properties. Several
different CDT scoring methods have been developed, but no consensus has been
reached regarding which scoring method is the most accurate. This article
reviews the literature on these scoring systems and the changes they have
undergone over the years. Historically, different types of scoring systems
emerged. Initially, the focus was on screening for dementia, and the methods
were both quantitative and semi-quantitative. Later, the need for an early
diagnosis called for a scoring system that can detect subtle errors, especially
those related to executive function. Therefore, qualitative analyses began to be
used for both differential and early diagnoses of dementia. A widely used
qualitative method was proposed by Rouleau et al. (1992). Tracing the historical
path of these scoring methods is important for developing additional scoring
systems and furthering dementia prevention research.
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Affiliation(s)
- Bárbara Spenciere
- BsC, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ - Brazil
| | - Heloisa Alves
- PhD, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ - Brazil
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Siciliano M, Santangelo G, D’Iorio A, Basile G, Piscopo F, Grossi D, Trojano L. Rouleau version of the Clock Drawing Test: age- and education-adjusted normative data from a wide Italian sample. Clin Neuropsychol 2016; 30:1501-1516. [DOI: 10.1080/13854046.2016.1241893] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Beber BC, Kochhann R, Matias B, Chaves MLF. The Clock Drawing Test: Performance differences between the free-drawn and incomplete-copy versions in patients with MCI and dementia. Dement Neuropsychol 2016; 10:227-231. [PMID: 29213459 PMCID: PMC5642419 DOI: 10.1590/s1980-5764-2016dn1003009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 06/15/2016] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The Clock Drawing Test (CDT) is a brief cognitive screening tool for dementia. Several different presentation formats and scoring methods for the CDT are available in the literature. OBJECTIVE In this study we aimed to compare performance on the free-drawn and "incomplete-copy" versions of the CDT using the same short scoring method in Mild Cognitive Impairment (MCI) and dementia patients, and healthy elderly participants. METHODS 90 participants (controlled for age, sex and education) subdivided into control group (n=20), MCI group (n=30) and dementia group (n=40) (Alzheimer's disease - AD=20; Vascular Dementia - VD=20) were recruited for this study. The participants performed the two CDT versions at different times and a blinded neuropsychologist scored the CDTs using the same scoring system. RESULTS The scores on the free-drawn version were significantly lower than the incomplete-copy version for all groups. The dementia group had significantly lower scores on the incomplete-copy version of the CDT than the control group. MCI patients did not differ significantly from the dementia or control groups. Performance on the free-drawn copy differed significantly among all groups. CONCLUSION The free-drawn CDT version is more cognitively demanding and sensitive for detecting mild/early cognitive impairment. Further evaluation of the diagnostic value (accuracy) of the free-drawn CDT in Brazilian MCI patients is needed.
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Affiliation(s)
- Bárbara Costa Beber
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre
(HCPA), RS, Brazil
| | - Renata Kochhann
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre
(HCPA), RS, Brazil
- Graduate Program in Psychology, Human Cognition, Pontifícia Universidade
Católica do Rio Grande do Sul (PUCRS), RS, Brazil
| | - Bruna Matias
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre
(HCPA), RS, Brazil
| | - Márcia Lorena Fagundes Chaves
- Dementia Clinic, Neurology Service, Hospital de Clínicas de Porto Alegre
(HCPA), RS, Brazil
- Department of Internal Medicine, Faculty of Medicine, Universidade
Federal do Rio Grande do Sul (UFRGS), RS, Brazil
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A Short Battery for Predicting Rehabilitation Success After Hip Fracture Surgery in the Elderly. TOPICS IN GERIATRIC REHABILITATION 2016. [DOI: 10.1097/tgr.0000000000000101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mendes-Santos LC, Mograbi D, Spenciere B, Charchat-Fichman H. Specific algorithm method of scoring the Clock Drawing Test applied in cognitively normal elderly. Dement Neuropsychol 2015; 9:128-135. [PMID: 29213954 PMCID: PMC5619351 DOI: 10.1590/1980-57642015dn92000007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Clock Drawing Test (CDT) is an inexpensive, fast and easily administered measure of cognitive function, especially in the elderly. This instrument is a popular clinical tool widely used in screening for cognitive disorders and dementia. The CDT can be applied in different ways and scoring procedures also vary. Objective The aims of this study were to analyze the performance of elderly on the CDT and evaluate inter-rater reliability of the CDT scored by using a specific algorithm method adapted from Sunderland et al. (1989). Methods We analyzed the CDT of 100 cognitively normal elderly aged 60 years or older. The CDT ("free-drawn") and Mini-Mental State Examination (MMSE) were administered to all participants. Six independent examiners scored the CDT of 30 participants to evaluate inter-rater reliability. Results and Conclusion A score of 5 on the proposed algorithm ("Numbers in reverse order or concentrated"), equivalent to 5 points on the original Sunderland scale, was the most frequent (53.5%). The CDT specific algorithm method used had high inter-rater reliability (p<0.01), and mean score ranged from 5.06 to 5.96. The high frequency of an overall score of 5 points may suggest the need to create more nuanced evaluation criteria, which are sensitive to differences in levels of impairment in visuoconstructive and executive abilities during aging.
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Affiliation(s)
| | - Daniel Mograbi
- PhD, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ, Brazil.,Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Bárbara Spenciere
- BsC, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ, Brazil
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El Hachioui H, Visch-Brink EG, Lingsma HF, van de Sandt-Koenderman MWME, Dippel DWJ, Koudstaal PJ, Middelkoop HAM. Nonlinguistic cognitive impairment in poststroke aphasia: a prospective study. Neurorehabil Neural Repair 2013; 28:273-81. [PMID: 24213963 DOI: 10.1177/1545968313508467] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Information on cognitive impairment in aphasic patients is limited. Our aim was to investigate the prevalence and course of nonlinguistic cognitive impairments in the first year after stroke and their association with aphasia and functional outcome. METHODS We included 147 patients with acute aphasia. At 3 months and 1 year, we assessed cognition with a nonlinguistic cognitive examination including abstract reasoning, visual memory, visual perception and construction, and executive functioning. We assessed language with a verbal communication rating (Aphasia Severity Rating Scale), the ScreeLing (a linguistic-level screening test), and the Token Test. We evaluated functional outcome with the modified Rankin scale and registered the use of antidepressants. RESULTS In total, 107 (88%) patients had impairments in at least one nonlinguistic cognitive domain at 3 months and 91 (80%) at 1 year. The most frequently observed impairment concerned visual memory (83% at 3 months; 78% at 1 year) and the least frequent visual perception and construction (19% at 3 months; 14% at 1 year). There was improvement on all cognitive domains including language, except for abstract reasoning. Patients with persisting aphasia had lower cognitive domain scores, worse functional outcome, and were more often depressed than patients who had recovered from aphasia. CONCLUSIONS Standard nonlinguistic cognitive examination is recommended in aphasic stroke patients. Nonlinguistic cognitive impairments are common and associated with poor functional outcome and depression, especially in patients with persisting aphasia.
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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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Santana I, Duro D, Freitas S, Alves L, Simões MR. The Clock Drawing Test: Portuguese norms, by age and education, for three different scoring systems. Arch Clin Neuropsychol 2013; 28:375-87. [PMID: 23518874 DOI: 10.1093/arclin/act016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Clock Drawing Test has been systematically used to assess visuospatial deficits related to the parietal lobes, but we now acknowledge its much more complex relation with other cognitive abilities. Despite its common use in clinical and investigational practices, no study has developed normative data for the Portuguese population. We present the distribution of clock drawing scores using three scoring systems in a representative community sample of cognitively healthy subjects. We found that the systems were well correlated with each other and with cognitive screening tests widely used and had good psychometric properties. Normative data for the three scoring systems were developed considering age and education. These results allow a more rigorous interpretation of the test performance in clinical context and are especially relevant for epidemiological research.
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Affiliation(s)
- Isabel Santana
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
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Menon C, Hall J, Hobson V, Johnson L, O’Bryant SE. Normative performance on the executive clock drawing task in a multi-ethnic bilingual cohort: a project FRONTIER study. Int J Geriatr Psychiatry 2012; 27:959-66. [PMID: 22052628 PMCID: PMC4142441 DOI: 10.1002/gps.2810] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 09/12/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND The executive clock drawing task (CLOX) test is a neuropsychological measure intended to aid in the assessment and detection of dementia in older populations. Few studies have provided normative data for this measure, with even less research available regarding the impact of sociodemographic factors on test scores. This study presents normative data for the CLOX in a sample of English and Spanish-speaking Hispanic and non-Hispanic Whites. METHODS The total sample included 445 cognitively healthy older adults seen as part of an ongoing study of rural cognitive aging, project FRONTIER. Unlike previous studies, criteria for "normality" (i.e., unimpaired) for CLOX1 and CLOX2 were based not merely on global impairment, but also on domain-specific impairment of executive functioning on the Executive Interview 25-item Examination and/or Trail Making Test B, or visuospatial/constructional impairment on the Line Orientation and Figure Copy subtests of the Repeatable Battery for the Assessment of Neuropsychological Status, respectively. RESULTS Hierarchical regression analyses revealed that CLOX1 scores require adjustment by Age across ethnicities, whereas Education and Gender are necessary stratification markers for CLOX1 performance only in non-Hispanic Whites. None of the demographic variables were valid predictors of CLOX2 performance, negating the need for such adjustments. CONCLUSION In addition to being the first study to provide separate normative data for CLOX performance in Hispanic and non-Hispanic White samples, the current study offers a novel approach to defining "normal" by cognitive domain. We also highlight the need to directly examine the impact of sociodemographic factors before applying normative corrections based on factors that have negligible impact on test scores.
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Affiliation(s)
- Chloe Menon
- Department of Psychology, Texas Tech University, Lubbock, TX, U.S.A
| | - James Hall
- Institute of Aging and Alzheimer's Disease Research, University of North Texas Health Sciences Center, Fort Worth, TX, U.S.A
- Department of Psychiatry and Neuroscience, University of North Texas Health Sciences Center, Fort Worth, TX, U.S.A
| | - Valerie Hobson
- Department of Psychology, Texas Tech University, Lubbock, TX, U.S.A
| | - Leigh Johnson
- Laura W. Bush Institute for Women’s Health, Texas Tech University Health Sciences Center, Amarillo, TX, U.S.A
- Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, U.S.A
| | - Sid E. O’Bryant
- F. Marie Hall Institute for Rural & Community Health, Texas Tech University Health Science Center, Lubbock, TX, U.S.A
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX, U.S.A
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