The influence of education on performance of adults on the Clock Drawing Test

Diagnostic accuracy of cognitive screening tools validated for older adults in Iran: a systematic review and meta-analysis

BACKGROUND

This systematic review aims to comprehensively assess the diagnostic accuracy of cognitive screening tools validated for older adults in Iran, providing evidence-based recommendations for clinicians and researchers.

METHODS

A comprehensive search in March 2023 across Web of Science, PubMed, Scopus, ScienceDirect, SID, IranMedex, and IranDoc, enhanced by hand-searching references and Google Scholar, identified cross-sectional studies on cognitive screening in Iranian seniors. We assessed diagnostic accuracy, cognitive domains, and test strengths and weaknesses. A bivariate random-effects meta-analysis provided summary estimates and 95% confidence intervals, illustrated in forest plots.

RESULTS

Our review, derived from an initial screening of 38 articles, focused on 17 studies involving 14 cognitive screening tools and participant counts from 60 to 350, mostly from specialized clinics. The MMSE was the only tool examined in at least three studies, prompting a meta-analysis revealing its sensitivity at 0.89 and specificity at 0.77 for dementia detection, albeit amidst significant heterogeneity (I^2 > 80%). ACE-III demonstrated the highest diagnostic accuracy for MCI and dementia, while MoCA's performance was deemed adequate for MCI and excellent for dementia. High bias risk in studies limits interpretation.

CONCLUSION

This review identifies key cognitive tools for dementia and MCI in Iranian older adults, tailored to educational levels for use in primary and specialized care. It emphasizes the need for further validation to enhance diagnostic precision across diverse settings, within a concise framework prioritizing brevity and accuracy for clinical applicability.

Clock Drawing Test Performance of Young Adults Based on a One-Shot Case Study

OBJECTIVE

The clock drawing test (CDT) is being used regularly by medical professionals in a variety of settings to aid in assessing cognitive functioning in adults of all ages. As our technological environment has changed significantly, because of the inception of this measure, the use of and exposure to the analog clock have diminished. We investigated whether young adults, who have grown up in a mainly digital world, can draw and tell time on an analog clock.

METHOD

Participants aged 18-30 years (N = 80, Mage = 24.2, SD = 3.93), who self-identified as having normal cognition, completed the CDT, as well as setting hands on a pre-drawn clock and identifying analog clock times.

RESULTS

About 25% of participants received a CDT score below the expected range. There was a moderate, positive correlation between analog clock hand setting and time identification in the group who scored below the expected range on the CDT only (rs(16) = 0.472, p = .048). Most participants reported not wearing an analog watch.

CONCLUSIONS

Based on these findings, the CDT should be used with caution to screen cognitive functioning in young adults (i.e., aged 18-30 years). Consideration of an alternative approach to screening cognition and modifying cognitive assessments in which the CDT is embedded is recommended for this population. These findings warrant further investigation into CDT performance in the young adult population.

Modified Brief Cognitive Screening Battery - Indonesian Version: cross-cultural adaptation and normative data based on demographic factors in North Sumatra, Indonesia

Introduction

Key component of early detection of dementia is a brief and culturally appropriate cognitive screening tool. This study aimed to perform a cultural adaptation of the Brief Cognitive Screening Battery (BCSB) and to obtain normative data from the older adult population.

Methods

Cross-cultural adaptation process to develop BCSB-INA was performed. This was followed by a feasibility study from community dwelling older adults from several urban and rural areas in North Sumatra, Indonesia.

Results

The BCSB-INA was generally well understood and showed not much discrepancy in translation from the original version. There were differences in semantic and phonemic fluency and CDT based on years of education, but no difference was found on other domain, including the delayed recall of the FMT. The battery was more influenced by age than education.

Discussion

The BCSB-INA is culturally appropriate and feasible to be used in population with heterogenous educational background in Indonesia.

[Discriminant validity and inter-rater concordance of two scoring systems for the clock test]

OBJECTIVE

To compare the discriminant validity and inter-rater reliability of the two scoring systems for the Clock test that are most used in Spain.

METHODOLOGY

Two collections of clock drawings obtained in a clinical context (116 cases; 56.8% women, mean age 73.1±7.7 years) and in a cohort of volunteers (2039 drawings of 579 subjects; 59.5% women, mean age 78.3±3.8 years) have been assessed. All subjects were classified as cognitively normal (CN) or cognitively impaired (CI) after extensive clinical and neuropsychological evaluation. Expert raters have evaluated these drawings independently and without knowledge of the diagnosis using the Sunderland and Solomon systems standardized in Spanish by Cacho (range 0 to 10) and del Ser (range 0 to 7) respectively. The discriminant validity of each method was calculated in the two samples using the area under the ROC curve (aROC), and the inter-rater reliability was calculated in the clinical sample, that was assessed by the two evaluators, using the intraclass correlation coefficient (ICC) and the kappa coefficient.

RESULTS

There are no significant differences in the discriminant validity of the Sunderland and Solomon systems in any of the samples (clinical: aROC 0.73 [CI95%: 0.64-0.81] and 0.77 [CI95%: 0.69-0.85] respectively, P=.19; volunteers: aROC 0.69 [CI95%: 0.67-0.71] and 0.72 [CI95%: 0.69-0.73] respectively, P=.08). The cut-off points ≤8 and ≤5 correctly classify 71% and 73% of the clinical sample and 82% and 84% of the volunteer sample, respectively. Both systems have good agreement in the clinical sample (Sunderland: ICC 0.90 [CI95%: 0.81-0.93], kappa 0.76 [CI95%: 0.70-0.83]; Solomon: 0.92 [CI95%: 0.88-0.95] and 0.77 [CI95%: 0.71-0.83] respectively), somewhat higher in the second, although the differences are not significant.

CONCLUSIONS

The discriminant validity and inter-observer reliability of these two Clock Test correction systems are similar. Solomon's method, shorter and simpler, may be more advisable in pragmatic terms.

The Clock-Drawing Test as a Useful Screening Assessment of Preoperative Cognitive Impairment with Readmission After Transcatheter Aortic Valve Implantation

Background

Transcatheter aortic valve implantation (TAVI) has recently become more common as a treatment for severe, symptomatic aortic stenosis (AS). Cognitive impairment (CI) is strongly associated with the prognosis of TAVI patients. However, some cognitive assessments currently in use are difficult to perform routinely in the clinical setting. To easier CI evaluation, we investigated whether CI using the clock-drawing test (CDT), one part of the Mini-Cog, affects the postoperative prognosis of TAVI patients with AS.

Methods

The present study enrolled 52 patients (median age, 85 years; 28.8% male) who underwent TAVI and were discharged between 2019 and 2021. The outcome was readmission for all causes within one year of discharge and patients were grouped according to whether they were readmitted or not. Cognitive function was assessed using the Mini-Cog which combines verbal playback and CDT.

Results

Of the 52, 11 patients (21.2%) comprised readmission group, including 4 (36.4%) each for fracture and infection, and 1 (9.1%) each for heart failure, subdural hematoma, and pneumothorax. Median Mini-Cog score was lower in the readmission group than in the non-readmission group (4 vs. 5; P < 0.05). The frequency of Mini-Cog score < 3 (indicative of CI) and CDT failure were significantly higher in the readmission group than in the non-readmission group, respectively (46% vs. 7%, P < 0.01) (46% vs. 12%, P < 0.05). Both of Mini-Cog score < 3 and CDT failure were independently associated with readmission. The areas under the curve showed CDT was an indicator of readmission with similar accuracy to the Mini-Cog score < 3. Kaplan-Meier curves showed significant differences in readmission after 1 year between the 2 Mini-Cog groups with scores of < 3 or ≥ 3 points and CDT failure and success.

Conclusion

The CDT may be a very easy and simple screening assessment of preoperative CI with readmission within one year after TAVI.

Examination of the validity of the 'Papadum test': an alternative to the clock drawing test for people with low levels of education

Objectives: The clock drawing test (CDT) is a widely used cognitive screening test. However, CDT performance is affected by education. This study examined an alternative, the Papadum test, designed for people with low levels of education/literacy. The association between education and test performance, correlation between CDT and Papadum test, and diagnostic accuracy of both CDT and Papadum tests were examined. Method: 89 healthy literate adults and 59 literate adults (all Bengali speaking) with a diagnosis of mild-moderate dementia from hospitals in Kolkata, India undertook the CDT and the Papadum test. Results: Education had a significant association with the CDT but not with the Papadum test. Across the whole sample there was a significant correlation between CDT and Papadum, but not within separate groups of healthy controls and patients. Diagnostic accuracy for the Papadum test was similar to that for CDT. Conclusions: Results highlight the strong influence that education has on CDT performance indicating that it is not suitable for those with low levels of literacy. The Papadum test could provide a viable alternative as a screening tool to the CDT for use with people who are illiterate or have low levels of education. Further validation studies are required.

More than a third of middle-aged adults (50-65) have understated executive dysfunction

OBJECTIVES

Understated executive dysfunction (UED) is predictive of cognitive decline and death. We aimed to assess the prevalence of UED, assessed with the clock-drawing test (CDT) and the Frontal Assessment Battery (FAB) in middle-aged adults and to investigate associated characteristics.

METHODS

Cross-sectional analysis of data on 516 community-dwellers aged 50-65, lacking cognitive complaints, who were included prospectively (2010-2017) after a multidimensional geriatric assessment at a "healthy ageing" outpatient clinic. Age- and educational-level-adjusted logistic models were used to assess factors associated with UED.

RESULTS

The CDT and FAB were impaired in 27.7% and 14.7% of the participants (median age: 59.7 years). The prevalence [95% confidence interval (CI)] of UED was 36.2% [32.2-40.5%]. After adjustment for age and education, participants with UED were more likely to be obese (odds ratio [95%CI] = 1.89 [1.12-3.19], P = 0.02), and to have a metabolic syndrome (1.98 [1.06-3.72], P = 0.03).

CONCLUSION

More than one third of middle-aged adults without cognitive complaints have UED, which was linked to obesity and metabolic syndrome. Cognitive screening tests targeting executive functions might be useful for early detection of UED and the initiation of multidomain interventions improving cognitive performance.

Formal language assessment in low-educated persons with aphasia: can the lesion effect be distinguished from the education effect?

ABSTRACT Background: Language tests are important in the assessment and follow up of people with aphasia (PWA). However, language assessment in the low literacy population is still a challenge. Objective: To investigate whether a formal evaluation of aphasia is able to distinguish the neurological effect from the effect of low educational level in people with post-stroke aphasia. Methods: The sample consisted of a group of 30 aphasic subjects (AG) and a control group (CG) of 36 individuals, both with an educational level of 1-4 years. The Brazilian Montreal-Toulouse Language Assessment battery was applied to all subjects. Results: There were statistically significant differences between the groups in 19 out of the 20 tasks analyzed. Conclusions: These results suggest that formal evaluation procedures are able to detect language disorders resulting from stroke, even in subjects with low educational level.

Language skills differences between adults without formal education and low formal education

BACKGROUND

The influence of education on cognition has been extensively researched, particularly in countries with high levels of illiteracy. However, the impact of low education in all cognitive functions appears to differ. Regarding to language, the effects of education on many linguistic tasks-supported by different processing-remain unclear. The primary objective of this study was to determine whether oral language task performance differs among individuals with no formal and low-educated subjects, as measured by the Brazilian Montreal-Toulouse Language Assessment Battery (MTL-BR). This is the only language battery available for use in Brazil, but lacks normative data for illiterate individuals. The secondary objective was to gather data for use as clinical parameters in assessing persons with aphasia (PWA) not exposed to a formal education.

METHODS

A total of 30 healthy illiterate individuals aged 34-60 years were assessed. All participants underwent the MTL-BR Battery, excluding its written communication tasks. The data obtained in the present study were compared against results of a previous investigation of individuals with 1-4 years of education evaluated using the same MTL-BR instrument.

RESULTS

Statistically significant differences in performance were found between non-formal education and the low-educated (2-4 years) groups on the tasks Auditory Comprehension, Repetition, Orthographic/Phonological Fluency, Number dictation, Reading of numbers and also on simple numerical calculations.

CONCLUSION

The study results showed that individuals with no formal education/illiterate had worse performance than low-education individuals on some of the language tasks of the MTL-Br Battery, suggesting that each year of education impacts cognitive-language performance. Also, data were obtained which can serve as a guide for PWA not exposed to a formal education.

Assessment of the diagnostic accuracy and discriminative validity of the Clock Drawing and Mini-Cog tests in detecting cognitive impairment

INTRODUCTION AND OBJECTIVES

The Mini-Cog is a very brief, widely used cognitive test that includes a memory task and a simplified assessment of the Clock Drawing Test (CDT). There is not a formal evaluation of the Mini-Cog test in Spanish. This study aims to analyse the diagnostic usefulness of the Mini-Cog and CDT for detecting cognitive impairment (CI).

METHODS

We performed a cross-sectional study, systematically including all patients who consulted at our neurology clinic over a 6-month period. We assessed diagnostic usefulness for detecting CI (defined according to the National Institute on Aging-Alzheimer's Association criteria for mild cognitive impairment and dementia) according to the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios were calculated for each cut-off point.

RESULTS

The study included 581 individuals (315 with CI); 55.1% were women and 27.7% had not completed primary studies. The Mini-Cog showed greater diagnostic usefulness than the CDT (AUC±sensitivity: 0.88±0.01 vs 0.84±0.01; P<.01). Both instruments were less useful for screening in individuals with a low education level (0.74±0.05 vs 0.75±0.05, respectively). A cut-off point of 2/3 in the Mini-Cog achieved a sensitivity of 0.90 (95%CI, 0.87-0.93) and a specificity of 0.71 (95%CI, 0.65-0.76); a cut-off point of 5/6 in the CDT achieved a sensitivity of 0.77 (95%CI, 0.72-0.81) and a specificity of 0.80 (95%CI, 0.75-0.85).

CONCLUSION

In our neurology clinic, the Mini-Cog showed acceptable diagnostic usefulness for detecting CI, greater than that of the CDT; neither test is an appropriate instrument for individuals with a low level of education.

Translations and cultural adaptations of the Montreal Cognitive Assessment: a systematic and qualitative review

This study provides a systematic review of linguistically and culturally adapted versions of the original Montreal Cognitive Assessment (MoCA) full version. Adapted versions were identified through a systematic review in 3 databases and on the MoCA website. Overall, 86 culturally different versions of MoCA are available: 74 versions on the MoCA website (25 of them have a corresponding paper concerning the translation process found with the systematic review) and 12 additional versions identified only with the search in biomedical databases. Culturally different adapted versions of the MoCA were unevenly distributed across different geographic areas. The quality of the process of cultural adaptation of MoCA differs considerably among different available versions as well as the number of items adapted in the various language versions. The potential availability of many culturally adapted and translated versions of the MoCA increases the chance of offering a linguistically and culturally sensitive screening for cognitive impairment to diverse populations; further studies are needed to identify if MoCA can be considered a truly cross-cultural fair test.

Assessment of the diagnostic accuracy and discriminative validity of the Clock Drawing and Mini-Cog tests in detecting cognitive impairment

INTRODUCTION AND OBJECTIVES

The Mini-Cog is a very brief, widely used cognitive test that includes a memory task and a simplified assessment of the Clock Drawing Test (CDT). There is not a formal evaluation of the Mini-Cog test in Spanish. This study aims to analyse the diagnostic usefulness of the Mini-Cog and CDT for detecting cognitive impairment (CI).

METHODS

We performed a cross-sectional study, systematically including all patients who consulted at our neurology clinic over a 6-month period. We assessed diagnostic usefulness for detecting CI (defined according to the National Institute on Aging-Alzheimer's Association criteria for mild cognitive impairment and dementia) according to the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios were calculated for each cut-off point.

RESULTS

The study included 581 individuals (315 with CI); 55.1% were women and 27.7% had not completed primary studies. The Mini-Cog showed greater diagnostic usefulness than the CDT (AUC ± sensitivity: 0.88 ± 0.01 vs 0.84 ± 0.01; P < .01). Both instruments were less useful for screening in individuals with a low education level (0.74 ± 0.05 vs 0.75 ± 0.05, respectively). A cut-off point of 2/3 in the Mini-Cog achieved a sensitivity of 0.90 (95% CI, 0.87-0.93) and a specificity of 0.71 (95% CI, 0.65-0.76); a cut-off point of 5/6 in the CDT achieved a sensitivity of 0.77 (95% CI, 0.72-0.81) and a specificity of 0.80 (95% CI, 0.75-0.85).

CONCLUSION

In our neurology clinic, the Mini-Cog showed acceptable diagnostic usefulness for detecting CI, greater than that of the CDT; neither test is an appropriate instrument for individuals with a low level of education.

Driving Performance and Its Correlation with Neuropsychological Tests in Senior Drivers with Cognitive Impairment in Japan

BACKGROUND

With the rapid aging of the population, the issue of driving by dementia patients has been causing increasing concern worldwide.

OBJECTIVE

To investigate the driving difficulties faced by senior drivers with cognitive impairment and identify the specific neuropsychological tests that can reflect specific domains of driving maneuvers.

METHODS

Senior drivers with cognitive impairment were investigated. Neuropsychological tests and a questionnaire on demographic and driving characteristics were administered. Driving simulator tests were used to quantify participants' driving errors in various domains of driving.

RESULTS

Of the 47 participants, 23 current drivers, though they had better cognitive functions than 24 retired drivers, were found to have impaired driving performance in the domains of Reaction, Starting and stopping, Signaling, and Overall (wayfinding and accidents). The parameters of Reaction were significantly related to the diagnosis, and the scores of MMSE, TMT-A, and TMT-B. As regards details of the driving errors, "Sudden braking" was associated with the scores of MMSE (ρ= -0.707, p < 0.01), BDT (ρ= -0.560, p < 0.05), and ADAS (ρ= 0.758, p < 0.01), "Forgetting to use turn signals" with the TMT-B score (ρ= 0.608, p < 0.05), "Centerline crossings" with the scores of MMSE (ρ= -0.582, p < 0.05) and ADAS (ρ= 0.538, p < 0.05), and "Going the wrong way" was correlated with the score of CDT (ρ= -0.624, p < 0.01).

CONCLUSION

Different neuropsychological factors serve as predictors of different specific driving maneuvers segmented from driving performance.

Patient Competency Rating Scale-Brazilian Revised Version (PCRS-R-BR): Normative and Psychometric Data in 154 Healthy Individuals

Background Patient Competency Rating Scale (PCRS-R-BR) is a clinical tool to evaluate the degree of competence in cognitive skills perceived by patients with brain injuries. However, no studies have investigated the influence of sociodemographic variables on self-report and self-awareness of healthy individuals.Aim This study aimed to (1) present normative data from the PCRS-R-BR in a healthy adult Brazilian sample; and (2) investigate psychometric properties of the scaleMethod One hundred and fifty-four adults that were divided in three age groups and two education groups and their informants completed the PCRS-R-BR.Results Score on the PCRS-R-BR Patient's Form differed as a function of age with younger adults reporting less competency than older individuals. An education effect was found on Attention/Working memory Factor on the Informant's PCRS-R-BR with informants of higher education adults reporting better competency than lower education individuals. A gender effect was observed on the Informant's Form. The Informant's Form scores of informants of women were higher than the scores provided by the informants of men. PCRS-R-BR showed adequate consistency coefficients and six factors.Conclusion PCRS-R-BR scores showed acceptable validity evidence and provides information regarding how age and gender effects may influence ratings in a Brazilian sample.

Qualitative and quantitative aspects of the F-A-S fluency test in people with aphasia

Verbal fluency tests are widely used in neuropsychological assessment. The quantitative and qualitative analysis of the performance of aphasic individuals on the phonemic verbal fluency (PVF) test can contribute to a better understanding of cognitive changes in this group of patients.

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

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.

Can a combination of two neuropsychological tests screen for mild neurocognitive disorder better than each test alone? A cross-sectional study

Background

Early symptoms of dementia may not be apparent and are sometimes even concealed during short office visits initiated for other complaints. The aim of the study is to find out if the combined use of VF/CDT, VF/BNT, or CDT/BNT could improve the accuracy of detecting mild NCD in an outpatient setting, compared with either test used alone.

Participants

Community-dwelling older adults, attending the outpatient Geriatrics Clinic at Ain Shams University hospitals between June 1, 2017 and January 31, 2018. All participants received a comprehensive geriatric assessment (CGA) which included the mini-mental state examination test. Participants with a score of less than 24 and fulfil DSM5 criteria for mild neurocognitive disorder (NCD) are considered cognitively impaired otherwise are considered normal. Then participants were further examined by the Arabic versions of CDT, BNT, and VF animal category.

Results

We recruited 143 male and female participants mean age 67.17 ± 5.41, females are 56.6%, and 48.9% of all participants have mild NCD according to DSM5 criteria. AUC for individual neurocognitive tests in illiterates is 0.893 for clock drawing test, 0.907 for verbal fluency animal category, and 0.904 for Boston naming test, while AUC for neurocognitive test combinations in illiterates is 0.932 for VF + CDT, 0.917 for VF + BNT, and 0.932 for BNT + CDT. On the other hand, AUC for individual neurocognitive tests in educated participants is 0.925 for clock drawing test, 0.921 for verbal fluency animal category, and 0.907 for Boston naming test, whereas AUC for neurocognitive test combinations in educated participants is 0.958 for VF + CDT, 0.963 for VF + BNT, and 0.953 for BNT + CDT.

Conclusion

From the current study, we can conclude that any of the studied combinations have better diagnostic accuracy (although small) than individual test in both literate and illiterate older adults.

The clock drawing test as a cognitive screening tool for assessment of hypertension-mediated brain damage

INTRODUCTION

Hypertension (HTN) is the most frequent cause of subcortical vascular brain injury (VBI) and its cognitive consequences. The aims were to show the usefulness of the Clock Drawing Test (CDT) to detect cognitive impairment in hypertensive patients and to compare it with the Mini-Mental Test (MMSE).

METHODS

A subset of hypertensive patients of the Heart-Brain Study in Argentina was included. Demographic characteristics, vascular risk factors, blood pressure (BP) and schooling level were recorded. The MMSE and CDT tests were used for neurocognitive assessment and Hospital Anxiety Depression scale (HAD) for mood disorder evaluation.

RESULTS

1414 hypertensive patients (age 59.7±13.8 years, female (62.3%). The prevalence of cognitive impairment was 20.7% (using MMSE) and 36.1% (using CDT). Among hypertensive patients with normal MMSE (>24) 29.3% had cognitive impairment (abnormal CDT). The CDT was associated with level of education but not with age or mood status.

CONCLUSIONS

The CDT is a useful screening tool to detect hypertension-mediated brain damage earlier (especially in midlife) and is more sensitive than MMSE.

Influence of age and schooling in written discourse of healthy adults

BACKGROUND

Discourse production is a very complex cognitive task that requires the integration of several linguistic cognitive skills. Socio-demographic factors such as schooling can impact on cognitive tasks. This study investigated the impact of age and schooling in some macrolinguistic and microlinguistic aspects in the written discourse of healthy adults.

METHODS

Individuals with no previous history of language, hearing, neurological, or psychiatric disorders were asked to write a story based on a figure that showed a "bank robbery." A total of 463 graphic narrative were analyzed. The schooling was stratified into the following three bands: 5 to 8 years, 9 to 11 years and 12 or more, and the age ranged from 19 to 75 years.

RESULTS

Individuals with high schooling (12 years or more) produced discourses with more information units, more coherent, and cohesive. The oldest group (60 to 75 years) needed more time to finish the written production.

CONCLUSION

The schooling influences some micro and macrolinguistic aspects in the written discourse production. A higher educational level provided a greater number of words as well as a higher number of information units, and the discourses produced are more coherent and cohesive. The age influenced only the time of discourse production.

Usefulness of clock-drawing test in Indian older adults with diabetes mellitus

BACKGROUND

Clock-drawing test (CDT) is a simple, quick, and bedside cognitive screening test which measures different cognitive domains but has some limitations. The aim of this study was to examine the usefulness of CDT for Indian older adult based on a part of an ICMR-funded research project, New Delhi, India.

MATERIALS AND METHODS

Sample comprised seventy participants (38 controls and 32 cases) aged 60 years and above included according to the inclusion/exclusion criteria in a consecutive series. Participants, who gave written informed consent, residing permanently in the area of Chowk, Lucknow, constituted the study sample. Semistructured sociodemographic details and medical history pro forma, socioeconomic status scale, General Health Questionnaire-12 (GHQ-12), CDT, and Hindi cognitive screening test (HCST) were administered. Biochemical investigations were carried out, and blood glucose level (fasting ≤100 mg/dl and postprandial ≤140 mg/dl) was considered for having diabetes mellitus (DM). The participants were categorized into two groups: (1) case: participants with DM only and (2) control: participants without discernible abnormality of physical illness and GHQ negative. Data were analyzed using percentages, t-test, the Chi-square test, sensitivity, and specificity.

RESULTS

About 71.05% participants in control and 81.25% in the case group have cognitive impairment on CDT. Significantly higher illiterates (P < 0.05) were found to be significantly more cognitively impaired on HCST. CDT has a high level of sensitivity (0.71) and low specificity (0.23) when compared with HCST.

CONCLUSION

CDT had screening bias to Indian older adults as a higher number of literates (almost double) and illiterates (four times) were found to be cognitively impaired compared to on HCST. Usefulness of CDT to screen Indian older adults for cognitive impairment is debatable.

Formal language assessment in low-educated healthy subjects

Although many studies have shown the influence of education on cognition, the impact of low education on the various cognitive functions appears to differ. The hypothesis of the present study is that, with regards to language, the use of parameters derived from populations with 5-8 years of education leads to false-positive results.

OBJECTIVE

to determine the influence of low education on the language tasks assessed by the MTL-Brazil Battery.

METHODS

30 healthy adults with 2-4 years of education were submitted to the MTL-Br Battery, comprising 22 subtests. The data were submitted to descriptive statistical analysis for each subtest and Z-scores were then calculated based on the parameters of a population with 5-8 years of education. All participants would be considered impaired if the Battery had been applied according to published normative criteria for a population with 5-8 years of education.

RESULTS

Separate analysis revealed that published scores for 17 out of the 22 Battery tasks were inappropriate for a population with 2-4 years of education.

CONCLUSION

Education was found to effect performance for each of the language abilities differently. In addition, the study results can be applied to language assessments of individuals with 1-4 years of education using the MTL-Br battery, since this is the only language test for adults available in Brazil, and for which there are no normative data for low-educated subjects.