The Human Figure Drawing test as a screen for dementia in the elderly: A community-based study

Abstract

The Human Figure Drawing (HFD) test is a non-verbal test, mainly based on visuo-spatial and constructional abilities. In screening for dementia, the HFD test can be hypothesised as a good complement to Mini-Mental State Examination (MMSE), which is inherently limited by its verbal nature. In order to test this hypothesis, both MMSE and HFD tests were administered to 461 individuals recruited from a community-based study of the elderly (the Kungsholmen project). According to the Third Revised Diagnostic and Statistical Manual of Mental Disorders, 95 subjects were affected by dementia and 366 were non-demented. We calculated the sensitivity and specificity of MMSE, the HFD test, and the combination of the two. Results showed that MMSE mean scores were significantly reduced between the non-demented group and groups with different severities of dementia. The mean scores of a short version of 29 HFD body details (HFD29) and seven HFD essential body details (HFDess) showed similar, but weaker trends than MMSE. However, the sensitivity increased by 4.2% when HFD29 and HFDess were added to MMSE, compared to the MMSE test alone. This increase partially derived from the portion of questionable and mild demented subjects. Unfortunately, a high drop-out rate was present in the HFD test. We conclude that the use of HFD test has limitations in this well-educated population, due to a high number of refusals and only a small improvement in detecting mild demented cases. The application of this test in lower educated populations requires further investigation.