Clock Drawing Test Scores Research Articles

Effects of age and education on clock-drawing performance by elderly adults in China

Objective: The Clock Drawing Test (CDT) is widely used as a cognitive screening tool. The purpose of this study was to investigate the influence of gender, age, and education on CDT scores in a sample of elderly, community-dwelling adults in China.Methods: The sample was derived from a cross-sectional survey, “The study on the early screening methods for senile dementia.” It included Chinese-speaking persons 65 years of age or older with normal cognitive functioning. All the participants underwent neuropsychological assessments, including the Mini-Mental State Examination (MMSE) and the CDT. The CDT was administered and scored using Shulman’s methodology. The effects of gender, age, and education on CDT performance were analyzed.Results: The sample contained 440 males and 445 females, ranging from 65 to 93 years of age, with a mean age of 74.94 ± 6.17 years old. The mean CDT and MMSE scores were 4.81 ± 0.54 and 28.79 ± 1.35, respectively. CDT performance was significantly different among age groups (χ2 = 22.85, p < .01) and educational levels (χ2 = 6.94, p = .03). However, there was no significant difference in CDT scores between males and females (t = 0.56, p = .57). The gender difference remained non-significant when the sample was divided according to age group and educational level.Conclusions: The study provides preliminary normative data on the CDT for the older population of China. CDT performance was significantly influenced by age and education, which must be taken into account when using the CDT as a cognitive screening tool in the Chinese population.

P1‐314: ANALYSIS OF THE STATUS OF FRAILTY AND CORRELATION WITH COGNITIVE FUNCTION IN HOSPITALIZED PATIENTS OVER 60 YEARS OLD

This study aimed to investigate the status of frailty in Hospitalized patients over 60 years old and to analyze the correlation between frailty and cognitive function. We enrolled 223 hospitalized patients over 60 years old who were surveyed by a suit of scales, including demographic data from November 2015 to May 2016. We used FRAIL to assess frailty dividing these patients into three groups as non-frailty, pre-frailty and frailty.The Mini Mental State Examination(MMSE), Clock Drawing Test (CDT)were used to assess cognitive function. the higher the score of MMSE or CDT, the better the cognitive function. we analyze the prevalence of frailty, the correlation between frailty and demography, total cognitive function and multiple cognitive domains. Among the Hospitalized patients over 60 years old, the prevalence of non-frailty group was 23.3%, pre-frailty group was 49.3%, frailty group was 27.4%. Frailty was closely related to age and education level (P<0.05). The scores of MMSE and CDT gradually decreased from non-frailty group, pre-frailty group to frailty group, and the differences between groups were significant (P<0.05). We analyze frailty with multiple cognitive domains. The scores of time orientation, place orientation, attention, calculation capacity, delayed memory and visual space gradually decreased from non-frailty group, pre-frailty group to frailty group, and the differences between groups were significant (P<0.05); The score of language gradually decrease, the differences between non-frailty and frailty were significant (P<0.05)；Compair to non-frailty the time orientation scores of pre-frailty group decreased, the difference was significant (P<0.05)；Comparing to pre-frailty group and frailty group, time orientation, place orientation and the visual space scores of the latter group decreased, the difference was significant (P<0.05).

Clock drawing test in mild cognitive impairment: Correlation with cerebral perfusion in single-photon emission computed tomography.

This study aimed to understand the relationship between the Clock Drawing Test (CDT) and decreased blood flow in mild cognitive impairment (MCI) patients, using single-photon emission computed tomography. We characterized regional cerebral blood flow (rCBF) and the correlation with clinical variables and future conversion to dementia in 94 amnestic MCI patients. Blood perfusion data was correlated with the CDT (quantitative and qualitative scores) in order to evaluate their relationship and usefulness in predicting conversion to dementia. MCI patients displayed reduced rCBF in brain areas including the caudate nucleus; the frontal, parietal, and temporal lobes; as well as the cerebral cortex and cerebellum. The decrease in rCBF was higher for patients who later developed dementia. At baseline, CDT scores of these patients correlated with hypoperfusion in cortical and subcortical areas typically affected in Alzheimer's disease (AD) median 3 years before developing dementia. CDT total score was significantly correlated with rCBF in the left temporal lobe and the putamen; the analysis of rCBF in Brodmann areas showed significant correlations between the several clock elements (face, numbers, and hands), underlying qualitative errors (stimulus-bound response and conceptual deficit), and rCBF, most significantly in the left inferior temporal gyrus, posterior entorhinal cortex, posterior cingulate cortex, left parahippocampal cortex, and left inferior prefrontal gyrus. This study showed that a quantitative score and a qualitative assessment of clock drawing (error analysis) corresponded to dysfunction in AD key areas at an early stage, supporting the CDT utility in the detection of prodromal AD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Diagnostic value of digital clock drawing test in comparison with CERAD neuropsychological battery total score for discrimination of patients in the early course of Alzheimer\u2019s disease from healthy individuals

The early detection of cognitive impairment or dementia is in the focus of current research as the amount of cognitively impaired individuals will rise intensely in the next decades due to aging population worldwide. Currently available diagnostic tools to detect mild cognitive impairment (MCI) or dementia are time-consuming, invasive or expensive and not suitable for wide application as required by the high number of people at risk. Thus, a fast, simple and sensitive test is urgently needed to enable an accurate detection of people with cognitive dysfunction and dementia in the earlier stages to initiate specific diagnostic and therapeutic interventions. We examined digital Clock Drawing Test (dCDT) kinematics for their clinical utility in differentiating patients with amnestic MCI (aMCI) or mild Alzheimer’s dementia (mAD) from healthy controls (HCs) and compared it with the diagnostic value of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) neuropsychological battery total score. Data of 381 participants (138 patients with aMCI, 106 patients with mAD and 137 HCs) was analyzed in the present study. All participants performed the clock drawing test (CDT) on a tablet computer and underwent the CERAD test battery and depression screening. CERAD total scores were calculated by subtest summation, excluding MMSE scores. All tablet variables (i.e. time in air, time on surface, total time, velocity, pressure, pressure/velocity relation, strokes per minute, time not painting, pen-up stroke length, pen-up/pen-down relation, and CDT score) during dCDT performance were entered in a forward stepwise logistic regression model to assess, which parameters best discriminated between aMCI or mAD and HC. Receiver operating characteristics (ROC) curves were constructed to visualize the specificity in relation to the sensitivity of dCDT variables against CERAD total scores in categorizing the diagnostic groups. dCDT variables provided a slightly better diagnostic accuracy of 81.5% for discrimination of aMCI from HCs than using CERAD total score (accuracy 77.5%). In aMCI patients with normal CDT scores, both dCDT (accuracy 78.0%) and CERAD total scores (accuracy 76.0%) were equally accurate in discriminating against HCs. Finally, in differentiating patients with mAD from healthy individuals, accuracy of both dCDT (93.0%) and CERAD total scores (92.3%) was excellent. Our findings suggest that dCDT is a suitable screening tool to identify early cognitive dysfunction. Its performance is comparable with the time-consuming established psychometric measure (CERAD test battery).

Effectiveness of acupuncture for vascular cognitive impairment no dementia: a randomized controlled trial

Objective: To evaluate the effectiveness of acupuncture in patients with vascular cognitive impairment no dementia (VCIND) in comparison with citicoline, an agent for cognitive disturbances associated with chronic cerebral disorders. Design: A randomized controlled multicenter trial. Setting: In three hospitals in Beijing, China. Subjects: A total of 216 patients with VCIND were recruited. Interventions: Patients with VCIND (mean age of 65.4 years) were randomized to receive acupuncture (two sessions per week) or oral citicoline (100 mg three times daily) over three months. Main measures: The primary outcome was the change from baseline to three months in cognitive symptom, measured by Alzheimer’s disease Assessment Scale, cognitive subscale (ADAS-cog). Secondary outcomes included changes from baseline to six months in ADAS-cog, executive function measured by the Clock Drawing Test (CDT), and functional disability measured by the Ability of Daily Living (ADL) scale at three and six months. Results: At three months, the acupuncture group had a greater decrease in mean ADAS-cog score (−2.33 ± 0.31) than the citicoline group (−1.38 ± 0.34) with a mean difference of −0.95 (95% CI, −1.84 to −0.07, P = 0.035). The mean change from baseline to six months in ADAS-cog also significantly favored acupuncture treatments (acupuncture change −2.61 vs citicoline −1.25, difference: −1.36 points; 95% CI, −2.20 to −0.51; P = 0.002). There was no difference between the two groups on CDT and ADL scores at either time point. Conclusion: Compared with citicoline, acupuncture has comparable and even superior efficacy with improved cognitive and daily living performance as a complementary and alternative medicine treatment for VCIND.

Napping characteristics and cognitive performance in older adults.

To determine the association of napping intention, frequency, and duration with cognition in a nationally-representative sample of US older adults. We performed a cross-sectional analysis of community-dwelling Medicare beneficiaries aged ≥65years from Rounds 3 or 4 (2013-2014) of the National Health and Aging Trends Study (N=2549). Participants reported past-month napping intention (intentional/unintentional), napping frequency (rarely/never [non-nappers], some days [infrequent nappers], most days/every day [frequent nappers]), and average nap duration (we categorized as ≤30minutes [short]; 31-60minutes [moderate]; and>60minutes [long]). Cognitive outcomes were performance on immediate and delayed word recall tests (IWR and DWR, respectively), the Clock Drawing Test (CDT), and self-rated memory (score: 1[excellent]-5[very poor]). After adjustment for potential confounders, unintentional nappers had poorer immediate word recall test performance than non-nappers (B=-0.23, P<0.01) and intentional nappers (B=-0.26, P<0.01). After further adjustment for daytime sleepiness, frequent nappers reported poorer self-rated memory than non-nappers (B=0.14, P<0.05). Compared with short nappers, long nappers had poorer IWR (B=-0.26, P<0.05) and CDT scores (B=-0.17, P<0.05). Except for the association of nap duration with IWR and CDT, these associations remained after excluding participants with dementia and/or proxy respondents. Among participants undiagnosed with dementia or proxies, moderate-duration naps were associated with better DWR than short naps (B=0.24, P<0.05). Neither napping intentionality nor frequency was associated with CDT performance. Among older adults, distinct aspects of napping are associated with cognitive performance. Prospective research, with objective measures of napping, is needed to elucidate the link between napping and cognitive trajectories.

The association between cognitive decline and short-term blood pressure variability in middle-aged patients with primary hypertension — a pilot study

Introduction. Hypertension (HTN) is a common cause of cognitive dysfunction. Current data emphasize a role of HTN in the development of unfavourable vascular remodelling and changes in cerebral microcirculation, leading to cognitive decline. In this study, we sought associations between circadian blood pressure variability (BPV) in a 24h blood pressure ambulatory monitoring (ABPM) and cognitive decline in middle-aged hypertensive patients. Material and methods. The study group comprised 42 patients with uncomplicated hypertension (24 females, 18 males; mean age: 59.1 ± 6.1 years). BPV was assessed by ABPM and expressed in standard deviation (24 MAP SD) and coefficient of variation (CV). Cognitive performance was evaluated using Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT) and Montreal Assessment Cognitive Scale (MoCA). Results. In the whole study group, MMSE and CDT scores were within the normal range, but the mean scores were lowered in the MoCA test. All of the neuropsychological test scores were comparable in groups with normal and abnormal (non-dipper) blood pressure patterns. Among the analyzed BPV indicators, CV was negatively correlated with CDT and MoCA scores. 24 MAP expressed in standard deviations was also negatively correlated with CDT scores. In the multivariate analysis, MoCA scores were inversely associated with CV after adjusting for age, gender, education and abnormal lipid profiles. Mean MoCA scores were significantly lower in men in comparison to women. Conclusions. In this pilot-based study, mild cognitive impairment in middle-aged patients with long-lasting uncomplicated hypertension may be associated with increased diurnal variability of blood pressure.

The effect of the onset of seizure on clock drawing test score of epilepsy patients

Background: Epilepsy is one of the causing factors of cognitive impairment which affects the patient’s quality of life. The most critical risk factor for cognitive impairment in epilepsy patients is the onset of seizure. Performing detection of cognitive impairment in those patients is crucial. Clock Drawing Test (CDT) is a validated instrument for the detection of cognitive impairment in epilepsy patients. Objective: This study was aimed to investigate the effect of the onset of seizure on CDT score in epilepsy patients. Methods: This study was a cross-sectional study involving 64 epilepsy patients of Mutiara Sukma Mental Hospital, West Nusa Tenggara, who met the inclusion but not exclusion criteria. The clinical and demographic characteristics data collected in this study were age, gender, type of seizure, etiology, length of education, duration of treatment, and antiepileptic drugs (AED). Cognitive function evaluation has been done by using the CDT instrument. Analysis of the effect of the beginning of seizure on CDT score was carried out by observing the influence of the clinical and demographic characteristics data. Results: There was a significant difference between the onset of seizure on CDT score (p 0.05). Conclusion: The onset of the seizure in epilepsy patients affect CDT score. This effect might be attributed to etiology and age of epilepsy patients.

Cognitive Impairment and Glycemic Control in Elderly Patients Under Health-Care Case Management.

We aim to test whether the association between glucose control and cognitive function still holds true in elderly patients with diabetes mellitus (DM) and Alzheimer disease (AD) under health-care case management. We enrolled 100 patients with DM (mean age: 74.6 years; male: 49%) and 102 patients with AD (mean age: 77.9 years; male: 41.2%) consecutively from the Diabetes Shared Care Program and the memory clinic. These patients were followed up every 3 months with scheduled examinations. Most patients with AD were at early stage and DM was a common comorbidity (n = 42). In the DM group, there were 76 patients with subjective cognitive decline and 19 patients with mild cognitive impairment, but none sought further consultation. After adjusting for age, sex, education, and comorbidity, higher levels of glycated hemoglobin (HbA1C) were not associated with lower Mini-Mental State Examination (MMSE) scores in the DM group (coefficient: 0.03; 95% confidence interval [CI]: -0.44 to 0.50) and lower MMSE scores were not associated with higher HbA1C in the AD group either (coefficient: -0.05; 95% CI: -0.11 to 0.01). When additionally accounting for the variability of HbA1C in the DM group, higher standard deviation of HbA1C was associated with poor clock drawing test scores, but not MMSE. The coexistence of AD-DM was common, but the association between hyperglycemia and cognitive impairment was not seen in patients under regular health monitoring.

Clock Drawing Test in acute stroke and its relationship with long-term functional and cognitive outcomes

Objective: The Clock Drawing Test (CDT) is commonly used as a screening tool for the assessment of dementia. The association between the CDT in acute stroke and long-term functional and cognitive outcomes in this population is unknown. The present prospective study is the first to examine if CDT scores in the acute stage after stroke are related to long-term outcomes and to compare the predictive ability of two scoring systems in a large sample of stroke patients. Method: A total of 340 patients admitted to an acute stroke unit were included in the present study. Separate stepwise multiple linear regression analyses were performed with eight independent variables (demographic/pre-stroke variables – age, sex, premorbid functioning; stroke-related variables – stroke severity, localization; cognitive variables – Orientation Test, CDT [2 scoring systems]), and four dependent variables administered one year post-stroke (Barthel Index, modified Rankin Scale, Reintegration to Normal Living index, Global Deterioration Scale). Results: Although both CDT scoring methods were related to all long-term outcome measures, the more comprehensive scoring system was the only baseline variable that significantly explained the variance in outcome measures in all four multiple regression models. Conclusion: Performance on the CDT in acute stroke is related to long-term outcomes including patients’ degree of independence in performing activities of daily living, the degree to which they achieved reintegration into daily occupations, and the degree of cognitive decline observed one-year post-stroke. Future studies are needed to clarify the nature of the relationship between different CDT scoring systems and post-stroke outcomes.

REM SLEEP DISORDERS IN LEWY BODY DISEASE—OR MAY THERE BE ANOTHER REASON?

In 2017 a 68 year old patient came together with his wife to our outpatient memory department to have his cognitive functions evaluated. The wife complained about a very annoying aggressive sleep behavior, e.g. boxing in the night. This aggressive sleep disorder had been present for about one year. On inspection the patient showed movement disorders like in Parkinson's disease. Patient history, medication and other exams were collected. Moreover neuropsychological tests were done. Apart from an arterial hypertension and a diabetes mellitus type II no further diseases were known. The medication consisted in pantoprazol, citalopram 40 mg once daily, metamizol, candesartan and magnesium. The neurological examination showed a slow moving patient without tremor or rigor and without really typical symptoms for Parkinson's disease. The cognitive testing disclosed deficits in memory and visual construction (for example: clock drawing test score 4, MMSE 23 points, MoCA 17 points). The MRI showed a slight reduction of brain volume and only a few microvascular lesions. The Beta-Cit-SPECT did not point in the direction of Parkinson's disease. In the face of these results Lewy body disease was assumed, where REM sleep disorders are typical. But due to the fact that drugs like selective serotonin reuptake inhibitors (SSRI) may also induce aggressive sleep behavior, the family was advised to first reduce citalopram, but of course slowly to avoid a SSRI discontinuation syndrome. Despite this citalopram the patient discontinued citalopram rapidly and with the end of the citalopram therapy the aggressive sleep disorder disappeared. It was concluded that the first and very evident reason for the REM sleep disorders, the probable Lewy body disease, was not the only reason and that a methodical workup of the patient is important. The Lewy body disease may have laid the ground for a higher susceptibility for REM sleep disorders and that the SSRI had initiated the symptoms.

Sonolysis in risk reduction of symptomatic and silent brain infarctions during coronary stenting (SONOREDUCE): Randomized, controlled trial

BackgroundSilent brain infarcts can be detected on magnetic resonance imaging (MRI) in ~22% of patients after coronary angioplasty and stenting (CS). The effect of periprocedural sonolysis on the risk of new brain infarcts during CS was examined. MethodsPatients undergoing elective CS were allocated randomly to a bilateral sonolysis group (70 patients, 58 men; mean age, 59.9 years) or a control group (74 patients, 45 men; mean age, 65.5 years). Neurologic examination, cognitive function tests, and brain MRI were performed prior to intervention and at 24 h after CS. Neurologic examination and cognitive function tests were repeated at 30 days after CS. ResultsNo significant differences were observed in the number of patients with new infarcts (25.7 vs. 18.9%, P = 0.423), the number of lesions (1.3 ± 1.0 vs. 2.9 ± 5.3, P = 0.493), lesion volume (0.16 ± 0.34 vs. 0.28 ± 0.60 mL, P = 0.143), and the number of patients with new ischemic lesions in the insonated MCA territories (18.6vs. 17.6%, P = 0.958) between the sonolysis group and the control group. There were no cases of stroke, transient ischemic attack, myocardial infarction, or death in the two groups. Intracranial bleeding was reported only in 1 patient in the control group (0 vs. 1.4%, P = 0.888). Clock-drawing test scores at 30 days were significantly higher in the sonolysis group than in the control group (median 3.0 vs. 2.5, P = 0.031). ConclusionsSonolysis does not reduce the risk of new brain infarcts after CS. The effect of sonolysis on number and volume of ischemic lesions and cognitive function should be assessed in further studies.

Normative data for the Clock Drawing Test for French-Quebec mid- and older aged healthy adults

Objective: The Clock Drawing Test (CDT) is frequently used to screen for cognitive impairment, however, normative data for Rouleau et al.’s scoring system are scarce. The present study aims to provide norms for Rouleau et al.’s scoring system that are tailored to Quebec French-speaking mid- and older aged healthy adults.Methods: Six researchers from various research centers across the Province of Quebec (Canada) sent anonymous data for 593 (391 women) healthy community-dwelling volunteers (age range: 43–93 years; education range: 5–23 years) who completed the CDT ‘drawing on command’ version. This command version (setting the clock hands to 11:10, without a pre-drawn circle) was administrated as part of a more extensive neuropsychological assessment, or along with cognitive screening instruments. Each drawn clock was scored according to the quantitative criteria set by Rouleau et al.’s scoring system.Results: CDT scores were significantly correlated with age (r(592) = −.132, p = .001) and years of education (r(592) = .116, p = .005), but not with sex (r(592) = .065, p = .112). Since data were skewed towards higher test scores, the percentiles method was used for analysis. Percentile ranks stratified by age and education are presented.Conclusion: These normative data for Rouleau et al.’s scoring system will contribute towards adequately screening for cognitive decline in Quebec French-speaking healthy adults, by also taking into account individual characteristics such as age and education.

Disrupted Spontaneous Neural Activity Related to Cognitive Impairment in Postpartum Women.

Purpose: Prior research has demonstrated that the postpartum period is associated with an increased risk of cognitive impairment. This study aims to investigate whether disrupted spontaneous neural activity exists in postpartum women without depression using resting-state functional magnetic resonance imaging (rs-fMRI) and to detect the relationship between these abnormalities and cognitive impairment.Materials and Methods: Postpartum women (n = 22) were compared with age- and education-matched nulliparous women (n = 23) using rs-fMRI. We calculated the amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) values to evaluate spontaneous neural activity and detect the relationship between rs-fMRI data and cognitive performance.Results: Relative to nulliparous women, postpartum women had significantly decreased ALFF and ReHo values primarily in the left posterior cingulate cortex (PCC) and prefrontal cortex and increased ALFF values in left cerebellar posterior lobe. We found a positive correlation between the ALFF and ReHo values in the PCC and the complex figure test (CFT)-delayed scores in postpartum women (r = 0.693, p = 0.001; r = 0.569, p = 0.011, respectively). Moreover, the clock-drawing test (CDT) scores showed positive correlations with the ALFF and ReHo values in the right superior frontal gyrus (SFG; r = 0.492, p = 0.033; r = 0.517, p = 0.023, respectively).Conclusion: Our combined ALFF and ReHo analyses revealed decreased spontaneous neural activity, mainly in the PCC and prefrontal cortex, which was correlated with specific impaired cognitive functioning in postpartum women. This study may elucidate the neurophysiological mechanisms underlying postpartum cognitive impairment and enhance our understanding of the neurobiological aspects of the postpartum period.

Cognitive impairment in Parkinson's disease, Alzheimer's dementia, and vascular dementia: the role of the clock-drawing test.

Cognitive impairment is present in several neurodegenerative disorders. The clock-drawing test (CDT) represents a useful screening instrument for assessing the evolution of cognitive decline. The aim of this study was to investigate the sensitivity of the CDT in monitoring and differentiating the evolution of cognitive decline in Alzheimer's dementia (AD), vascular dementia (VaD), and Parkinson's disease (PD). This study involved 139 patients, including 39 patients with PD and mild cognitive impairment, 16 demented PD patients, 21 VaD patients with mild cognitive impairment, 17 patients with VaD, 33 patients with mild cognitive impairment due to AD, and 13 patients with probable AD. All participants completed the CDT. The Mini-Mental State Examination was administered to establish patients' cognitive functioning. Comparisons of quantitative and qualitative CDT scores showed significant differences between the various diseases. Impairment of executive functioning seems to be more pronounced in PD and VaD than in AD. Patients with AD committed more errors related to a loss of semantic knowledge, indicating a severely reduced capacity in abstract and conceptual thinking. Results support the usefulness and sensitivity of the CDT in the detection of different dementia subtypes. Qualitative error analysis of the CDT may be helpful in differentiating PD, VaD, and AD, even in the early stages of each disease.

Comparative study on neuropsychological tests for typical Alzheimer's disease, frontal variant of Alzheimer's disease and behavioral variant of frontotemporal dementia

Objective To compare the neuropsychological features and other clinical and imaging characteristics among patients with typical Alzheimer's disease (TAD), frontal variant Alzheimer's disease (fvAD) and behavioral variant frontotemporal dementia (bvFTD). Methods Neuropsychological scales were used to evaluate the cognitive function and neuropsychiatric symptoms of nine patients with fvAD, 30 patients with bvFTD and 32 patients with typical AD (TAD). The apolipoprotein E (ApoE) e4 allele and brain imaging techniques, including the magnetic resonance imaging (MRI), 11C-Pittsburgh compound B positron emission tomography (PIB-PET), and 18F-deoxyglucose positron emission tomography (FDG-PET), were used for the differential diagnosis of fvAD and bvFTD. Results There were no significant differences in general cognitive function or daily activity in patients among the three groups.However, the cognitive subscale scores of Montreal Cognitive Assessment (MoCA) scale, including visual acuity and executive function, delayed recall, and orientation, were significantly different among the groups (Z=7.891, P=0.035; Z=7.412, P=0.031; Z=6.437, P=0.043, respectively). The clock drawing test (CDT) score of TAD group was higher than that in the bvFTD and fvAD groups (Z=8.673, P=0.020), while the neuropsychological questionnaire (NPI) scores of the bvFTD and fvAD groups were higher than those of the TAD group (Z=7.577, P=0.023). Meanwhile, the incidences of agitation, disinhibition and abnormal behavior of NPI in the bvFTD and fvAD groups were higher than those in the TAD group (χ2=11.139, P=0.004; χ2=6.481, P=0.039; χ2=6.812, P=0.033, respectively). The frequencies of the ApoE e4 allele were 44.4% in the fvAD group and 33.3% in the bvFTD group, which were not significant different from that in the TAD group (40.6%). Furthermore, patients in the fvAD group were associated with decreased regional cerebral glucose metabolism and amyloid deposition in the temporal-parietal cortex evaluated by FDG-PET and PIB-PET. Conclusions Neuropsychological evaluation is valuable for the differential diagnosis of TAD, fvAD and bvFTD.The frequencies of the ApoEe4 allele are similar among the three groups.FDG-PET and PIB-PET imaging plays an important role in the diagnosis of variant types of Alzheimer's disease. Key words: Alzheimer disease; Frontal lobe; Dementia; Neuropsychological tests; Apolipoprotein E4; Positron-emission tomography

Cognitive Functioning and Silent Neurological Manifestations in Behçet's Disease with Ocular Involvement.

Various reports have revealed a cognitive dysfunction in Behçet's disease (BD). In this study, we aimed to assess the silent neurological manifestations, behavioral and neuropsychiological impairments of Behçet's disease patients with ocular involvement. Thirty BD patients with ocular involvement in the nonactive phase of their illness were applied detailed neurological examination and magnetic resonance imagining (MRI). Neuropsychological tests were performed. Patients' neuropsychological performances were compared to those of healthy, demographically matched twenty subjects. Neurological manifestations of patients were headache (56.6%), pyramidal signs (13.3%), behavioral changes (3.3%) and sensory symptoms (3.3%). Four patients (13.3%) had white matter hyperintensities lesions on T2/FLAIR brain MRI. Fourteen patients (46%) had impaired cognitive performances on the following tasks: verbal memory (immediate memory p=0.000, maximal learning capacity p=0.009, number of repetitions p=0.000, total learning capacity p=0.001, recall p=0.033), nonverbal memory (immediate memory p=0.029, recall p=0.001), logical memory (immediate memory p=0.001, recall p=0.001), executive (frontal) functions (clock-drawing test p=0.000, Stroop test p=0.001, verbal fluency tests p=0.000). Patients' MMSE and clock drawing test scores were significantly lower than controls (p=0.03). Attention deficit was not detected. Behçet's disease patients showed higher scores on depression scales than healthy subjects but there was no statistically significant difference between anxiety scores. Neuropsychological deficits, involving mainly memory and executive functioning, subcortical MRI lesions, and non-structural headache may be present in Behçet's disease patients with ocular involvement without overt neurological manifestations.

The relevance of hippocampal subfield integrity and clock drawing test performance for the diagnosis of Alzheimer’s disease and mild cognitive impairment

Objectives: The clock drawing test (CDT) is one of the worldwide most used screening tests for Alzheimer’s disease (AD). MRI studies have identified temporo-parietal regions being involved in CDT impairment. However, the contributions of specific hippocampal subfields and adjacent extrahippocampal structures to CDT performance in AD and mild cognitive impairment (MCI) have not been investigated so far. It is unclear whether morphological alterations or CDT score, or a combination of both, are able to predict AD.Methods: 38 AD patients, 38 MCI individuals and 31 healthy controls underwent neuropsychological assessment and MRI at 3 Tesla. FreeSurfer 5.3 was used to perform hippocampal parcellation. We used a collection of statistical methods to better understand the relationship between CDT and hippocampal formation. We also tested the clinical feasibility of this relationship when predicting AD.Results: Impaired CDT performance in AD was associated with widespread atrophy of the cornu ammonis, presubiculum, and subiculum, whereas MCI subjects showed CDT-related alterations of the CA4-dentate gyrus and subiculum. CDT correlates in AD and MCI showed regional and quantitative overlap. Importantly, CDT score was the best predictor of AD.Conclusions: Our findings lend support for an involvement of different hippocampal subfields in impaired CDT performance in AD and MCI. CDT seems to be more efficient than subfield imaging for predicting AD.

Association of subclinical carotid atherosclerosis with immediate memory and other cognitive functions

To clarify whether carotid atherosclerosis and its risk factors are associated with cognitive decline. We evaluated 206 individuals who visited our center for health screening. We carried out physical examinations, blood tests, intima-media thickness (IMT) measurement by carotid ultrasonography, brain magnetic resonance imaging scanning and cognitive function assessments. A total of 30 individuals, who had significant cerebrovascular lesions detected in magnetic resonance imaging scans, were excluded. To detect early cognitive decline, we defined "cognitive impairment (CI)" when a patient satisfied at least one of three criteria. These were Mini-Mental State Examination score <24, clock-drawing test score <4 coexisting with forgetfulness and Wechsler Memory Scale-revised delayed recall score below the normal range for the duration of education (>16 years of education: ≥9, 10-15 years: ≥5, 0-9 years: ≥3). Among 176 individuals, 27 were placed in the CI group. IMT was significantly higher in the CI group as compared with the non-CI group (mean ± SD: 2.0 ± 1.0 vs 1.7 ± 0.7, P = 0018 by Student's t-test). Other atherosclerotic risk factors, such as blood pressure, low-density lipoprotein cholesterol, and hemoglobin A1c, were not significantly different between the two groups. In multivariate analysis, maximum IMT was associated with impaired immediate recall score on Wechsler Memory Scale-revised, independent of the presence of deep white matter hyperintensities on the magnetic resonance imaging scan. Subclinical carotid atherosclerosis, defined as thickened IMT, could be a marker for early stages of CI, especially for immediate memory recall. The impairment is presumably caused by inducing cerebral microvascular dysfunction in the frontal lobe. Geriatr Gerontol Int 2018; 18: 65-71.

Cortical signature of clock drawing performance in Alzheimer's disease and mild cognitive impairment

It is unclear whether clock drawing test (CDT) performance relies on a widely distributed cortical network, or whether this test predominantly taps into parietal cortex function. So far, associations between cortical integrity and CDT impairment in Alzheimer's disease (AD) and mild cognitive impairment (MCI) largely stem from cortical volume analyses. Given that volume is a product of thickness and surface area, investigation of the relationship between CDT and these two cortical measures might contribute to better understanding of this cognitive screening tool for AD. 38 patients with AD, 38 individuals with MCI and 31 healthy controls (HC) underwent CDT assessment and MRI at 3 Tesla. The surface-based analysis via Freesurfer enabled calculation of cortical thickness and surface area. CDT was scored according to the method proposed by Shulman and related to the two distinct cortical measurements. Higher CDT scores across the entire sample were associated with cortical thickness in bilateral temporal gyrus, the right supramarginal gyrus, and the bilateral parietal gyrus, respectively (p < 0.001 CWP corr.). Significant associations between CDT and cortical thickness reduction in the parietal lobe remained significant when analyses were restricted to AD individuals. There was no statistically significant association between CDT scores and surface area (p < 0.001 CWP corr.). In conclusion, CDT performance may be driven by cortical thickness alterations in regions previously identified as “AD vulnerable”, i.e. regions predominantly including temporal and parietal lobes. Our results suggest that cortical features of distinct evolutionary and genetic origin differently contribute to CDT performance.