Abstract
To evaluate the predictability of progression of cognitive impairment to dementia using qualitative clock drawing test (CDT) scores, we administered both the CDT using Cahn et al.’s qualitative scoring system and the Mini-Mental State Examination (MMSE) to assess cognitive function in non-demented older individuals attending a memory clinic at a university hospital. Patients visiting the clinic for assessment of cognitive function between January 2015 and December 2019 were enrolled, and only those who were diagnosed as not having dementia at the time of initial assessment completed a follow-up assessment at 1 y (n = 163). To examine any association of qualitative CDT score with progression to dementia, multiple logistic regression analysis was conducted with the change in diagnosis from non-dementia to dementia at 1 y as the dependent variable. A total of 26 participants (16.0%) were diagnosed as having converted to dementia. Multiple logistic regression analysis revealed that both the qualitative CDT score using Cahn et al.’s scoring system and the existence of conceptual deficits were significantly associated with progression to dementia at 1 y after initial assessment of cognitive function, irrespective of the MMSE score, among non-demented older individuals. The CDT may be a useful predictor of progression to dementia in primary care settings.
Highlights
As populations age rapidly worldwide, there is considerable clinical interest in accurately diagnosing dementia before it develops, and predicting the subsequent development of dementia among individuals with mild cognitive impairment (MCI)
We revealed that low scores on the clock drawing test (CDT) using Cahn et al.’s scoring system showed a significant association with progression to dementia at 1 y in non-demented participants, and the association was independent of the Mini-Mental State Examination (MMSE) score
We found that conceptual deficits on the CDT alone accounted for progression to dementia in non-demented participants
Summary
As populations age rapidly worldwide, there is considerable clinical interest in accurately diagnosing dementia before it develops, and predicting the subsequent development of dementia among individuals with mild cognitive impairment (MCI). Identifying dementia before or in the early stage has significance because this can help to maximize the effects of anti-dementia medications, and because it could mitigate the impact of actual diagnosis by allowing patients and their families to anticipate and prepare for later difficulties [1]. Several clinical markers for dementia have been established These include the biomarkers amyloid beta or tau protein in the cerebrospinal fluid (CSF) and amyloid and tau findings on positron emission tomography (PET) neuroimaging [3]. These markers are not always available to use in primary care settings because of the high cost involved and the need for specialized equipment or invasive procedures
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