Abstract
BackgroundMany scoring systems exist for clock drawing task variants. However, none of them are reliable in evaluating longitudinal changes of cognitive function. The purpose of this study is to create a simple yet optimal scoring procedure to evaluate cognitive decline using a clinic-based sample.MethodsClock-drawings from 121 participants (76 individuals with no dementia and later did not develop dementia after a mean 41.2-month follow-up, 45 individuals with no dementia became demented after a mean 42.3-month follow-up) were analyzed using t-test to determine a new and simplified CDT scoring system. The new scoring method was then compared with other commonly used systems.ResultsIn the converters, there were only 7 items that are significantly different between the initial visits and the second visits. We propose a new scoring system that includes the seven critical items: numbers are equally spaced (12–3–6–9) (p = 0.031), the other eight numbers are marked (p = 0.022), numbers are clockwise (p = 0.002), all numbers are correct (p = 0.030), distance between numbers is constant (p = 0.016), clock has two hands (p = 0.000), arrows are drawn (p = 0.003). Compared with other traditionally used scoring methods, this based change clock drawing test (BCCDT) has one of the most balanced sensitivities/specificities with a clinic-based sample.ConclusionsThe new CDT scoring system provides further evidence in support of a simple and reliable clock-drawing scoring system in follow-up studies to evaluate cognitive decline, which can be used in assessing the efficacy of medicine.
Highlights
Neuropsychological evaluations are an integral part of a complete geriatric evaluation used to diagnose dementia
The clock drawing test (CDT) requires different cognitive abilities including auditory and visual comprehension, concentration, visuospatial abilities, abstract conceptualization, and executive control [1]. Deficits in these areas reflect possible frontal and temporoparietal disturbances that are often exhibited in Alzheimer disease (AD) [2,3,4], and that may not be detected by commonly-used cognitive screening tests such as the Mini-Mental State Exam (MMSE) [5].Correlating highly with the MMSE [6] and other measures of global cognitive decline, the CDT serves as a simple and nonthreatening cognitive screen, rendering it a popular tool in both clinical and research practices [5],[7]
All of the MCI participants were diagnosed according to the following which take Mayo criteria [37] as reference: (1) cognitive complaints verified by an informant; (2) cognitive impairment lasting more than 3 months; (3) mini-mental state examination-Chinese version (C-MMSE) $ cut-off score for adjusted education: edu$9 yr, 26; 6#edu,9 yr, 22 [19]; (4) preserved basic ability of daily life (ADL)/minimal impairment in complex instrumental functions; (5) etiology unknown; (6) normal hearing and sight; (7) have not met the diagnostic criteria for dementia based on the criteria from the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA)
Summary
Neuropsychological evaluations are an integral part of a complete geriatric evaluation used to diagnose dementia. The CDT requires different cognitive abilities including auditory and visual comprehension, concentration, visuospatial abilities, abstract conceptualization, and executive control [1]. Deficits in these areas reflect possible frontal and temporoparietal disturbances that are often exhibited in Alzheimer disease (AD) [2,3,4], and that may not be detected by commonly-used cognitive screening tests such as the Mini-Mental State Exam (MMSE) [5].Correlating highly with the MMSE [6] and other measures of global cognitive decline, the CDT serves as a simple and nonthreatening cognitive screen, rendering it a popular tool in both clinical and research practices [5],[7]. The purpose of this study is to create a simple yet optimal scoring procedure to evaluate cognitive decline using a clinic-based sample
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