Abstract
BackgroundThis study examined the use of the Folstein Mini Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) in predicting retrospective reports of driving problems among the elderly. The utility of existing scoring systems for the CDT was also examined.MethodsArchival chart records of 325 patients of a geriatric outpatient clinic were reviewed, of which 162 had CDT results (including original clock drawings). T-test, correlation, and regression procedures were used to analyze the data.ResultsBoth CDT and MMSE scores were significantly worse among non-drivers than individuals who were currently or recently driving. Among current or recent drivers, scores on both instruments correlated significantly with the total number of reported accidents or near misses, although the magnitude of the respective correlations was small. Only MMSE scores, however, significantly predicted whether or not any accidents or near misses were reported at all. Neither MMSE nor CDT scores predicted unique variance in the regressions.ConclusionsThe overall results suggest that both the MMSE and CDT have limited utility as potential indicators of driving problems in the elderly. The demonstrated predictive power for these instruments appears to be redundant, such that both appear to assess general cognitive function versus more specific abilities. Furthermore, the lack of robust prediction suggests that neither are sufficient to serve as stand-alone instruments on which to solely base decisions of driving capacity. Rather, individuals who evidence impairment should be provided a more thorough and comprehensive assessment than can be obtained through screening tools.
Highlights
This study examined the use of the Folstein Mini Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) in predicting retrospective reports of driving problems among the elderly
Results on assessment instruments purported to assess attention, reaction time, and visuospatial abilities are often used to inform clinical judgment about driving capacity in such settings. Two such screening instruments typically used to gauge general cognitive function, and inform questions pertaining to driving capacity are the Folstein Mini Mental Status Exam (MMSE) [3] and the Clock Drawing Test (CDT)
This study explored the relations of patient scores on the CDT and MMSE to patient or family reports of driving problems
Summary
This study examined the use of the Folstein Mini Mental Status Exam (MMSE) and the Clock Drawing Test (CDT) in predicting retrospective reports of driving problems among the elderly. Specific concerns pertaining to judgments of driving capacity are befalling upon the medical profession in primary care settings [1] To aid in this task, a number of brief assessment screens are often employed to identify cognitive problems that may be indicative of a range of pragmatic concerns, including (page number not for citation purposes). Results on assessment instruments purported to assess attention, reaction time, and visuospatial abilities are often used to inform clinical judgment about driving capacity in such settings Two such screening instruments typically used to gauge general cognitive function, and inform questions pertaining to driving capacity are the Folstein Mini Mental Status Exam (MMSE) [3] and the Clock Drawing Test (CDT). Directions for completing the CDT involve asking a patient to draw the face of a clock, including the numbers, and to place the hands to designate a certain time, such as "ten minutes after eleven." different scoring templates for the CDT exist, most often code for features such relative size, spacing and placement of numbers or hands, disorganization, perseveration, completeness, and other potential errors that are hypothesized to indicate cognitive impairment [6,7,8]
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