Clock Drawing Test Research Articles

The clock drawing test (CDT) in the digital era: Underperformance of generation Z adults

Background and objectivesThe clock drawing test (CDT) is a widely recognized neurocognitive test for executive and visuospatial functions. However, no normative data exist for Generation Z young adults (born on or after 1997). The widespread use of digital displays among this generation may impair performance on the analog CDT. MethodsYoung Generation Z adults with at least 12 years of education, who were evaluated at the Israel Defense Forces (IDF) outpatient neurology clinic between 2021 and 2022, completed a CDT using the Manos-Wu method and drew a digital clock. Patients with possible cognitive impairment were excluded. ResultsThree hundred Generation Z patients were recruited, with a mean age of 19.7 ± 1.2 years. 171 (57.0 %) were female. Mean CDT score was 8.1 ± 2.5 out of 10 (Manos & Wu). A lower CDT score was associated with younger age (p = 0.031). No association was found with chief complaint, presence of ADHD diagnosis, gender, or postsecondary education. Digital clock drawing (4/4 digits) was successful in 100 % of patients. DiscussionGeneration Z adults demonstrate lower CDT scores than previously reported for older generations. The CDT may require revision to maintain its specificity for this population. Developing an alternative, digital-based tool for cognitive screening in young generations could be advisable.

The Concurrent Association of Magnesium and Calcium Deficiencies with Cognitive Function in Older Hospitalized Adults

Background/Objectives: Hypomagnesemia and hypocalcemia are common conditions among older adults that may contribute to cognitive decline. However, most of the existing research has focused primarily on dietary intake rather than the actual serum levels of these nutrients or examined them separately. This study aims to investigate the relationship between hypomagnesemia, hypocalcemia, and the concurrent presence of both deficiencies in relation to cognitive performance among seniors. Methods: A total of 1220 hospitalized patients aged 60 and older were included in the analysis. The participants were categorized into four groups: those with normal serum levels of magnesium and calcium, those with hypomagnesemia, those with hypocalcemia, and those with both serum magnesium and calcium deficiencies. To evaluate the potential influence of age, sex, common comorbidities, and disturbances in magnesium and calcium levels on cognitive performance, two general linear models were employed, using the Mini-Mental State Examination (MMSE) and Clock-Drawing Test (CDT) as dependent variables. Results: After adjusting for age, sex, body mass index, and comorbidities, the mean values for the MMSE and CDT were 23.33 (95%CI: 22.89–23.79) and 5.56 (95%CI: 5.29–5.83) for the group with normomagnesemia and normocalcemia, 22.59 (95%CI: 21.94–23.24) and 5.16 (95%CI: 4.77–5.54) for the group with hypomagnesemia, 19.53 (95%CI: 18.36–20.70) and 4.52 (95%CI: 3.83–5.21) for the group with hypocalcemia, and 21.14 (95%CI 19.99–22.29) and 4.28 (95%CI 3.61–4.95) for the group with both hypomagnesemia and hypocalcemia, respectively. Magnesium and calcium deficiencies contributed to MMSE and CDT variance in the general linear models. Conclusions: Our findings indicate that in addition to age, body mass index, and chronic heart failure, both hypomagnesemia and hypocalcemia are associated with reduced cognitive performance.

Attention Score Enhancement Model Through Pairwise Image Comparison

This study proposes the Pairwise Attention Enhancement (PAE) model to address the limitations of the Vision Transformer (ViT). While the ViT effectively models global relationships between image patches, it encounters challenges in medical image analysis where fine-grained local features are crucial. Although the ViT excels at capturing global interactions within the entire image, it may potentially underperform due to its inadequate representation of local features such as color, texture, and edges. The proposed PAE model enhances local features by calculating cosine similarity between the attention maps of training and reference images and integrating attention maps in regions with high similarity. This approach complements the ViT’s global capture capability, allowing for a more accurate reflection of subtle visual differences. Experiments using Clock Drawing Test data demonstrated that the PAE model achieved a precision of 0.9383, recall of 0.8916, F1-Score of 0.9133, and accuracy of 92.69%, showing a 12% improvement over API-Net and a 1% improvement over the ViT. This study suggests that the PAE model can enhance performance in computer vision fields where local features are crucial by overcoming the limitations of the ViT.

Attention as the dimension that deteriorates first in patients with cognitive impairment after myocardial infarction

Abstract Background Previous publications by our team indicated a high prevalence (approximately 35%) of cognitive impairment (CI) in patients after myocardial infarction (MI). Moreover, we observed that the presence of peri-infarction deficits was not always associated with their occurrence after 6 months of follow-up and vice versa. This was the basis for distinguishing 4 groups of patients: a) group 1 – CI present peri-infarction and after 6 months; b) group 2 – CI present only peri-infarction; c) group 3 – CI present only after 6 months; d) group 4 – no CI during the study. Purpose The aim of the current study is to analyse the type of CI in patients after MI with a focus on its changes within the 4 groups mentioned. Methods The study included 326 patients hospitalised for MI treated by percutaneous coronary intervention. Cognitive function was assessed twice using the Mini–Mental State Examination (MMSE) and the Clock Drawing Test (CDT)-Shulman version during the first hospitalisation (on day 2-3 after MI) and 6 months later. In addition, the occurrence of sleep, aggression and mood disorders was assessed. The constructed research model was analysed with artificial intelligence algorithms. Results Persistent CI (group1) was found in 8.9%, peri-infarct CI (group 2) in 16.3%, and only after 6 months (group 3) in 7.7% of study participants (as assessed by MMSE). Analysis of the cognitive domains showed that in those who improve (group 2) or worsen cognitive function (group 3), analogous changes in attention function occurred, respectively improving in 81% and worsening in 100% of subjects in a given group. It was observed that there is a group of patients with a CI on the MMSE who perform CDT correctly, 12% peri-infarct and 11% at 6-month follow-up, respectively. Patients with a normal CDT score but CIs found in the MMSE have impaired attentional function regardless of the time of assessment. Conclusion CIs can occur both immediately after MI and during subsequent follow-up. However, after 6 months of intensive anti-atherosclerotic treatment (post-MI), cognitive functions improve in some patients, and deteriorate in others. At the same time, the cognitive function that undergoes similar changes in these groups is attention. The uniform type of impaired cognitive function and the lack of specific differences between the 4 groups allow us to assume a uniform etiology of cognitive deficits. Patients with normal CDT and disorders present in MMSE show deficits in attention functions. Performing CDT and using the MMSE component assessing attention function could prove sufficient for the initial assessment of cognitive functions in the population of patients after MI. The results require confirmation in a larger patient population.

Pre- and Post-Operative Cognitive Assessment in Patients Undergoing Surgical Aortic Valve Replacement: Insights from the PEARL Project

Background: Aortic valve stenosis (AVS) is a common valvular heart disease affecting millions of people worldwide. It leads to significant neurocognitive and neuropsychological impairments, impacting patients’ quality of life. Objective: The objective of this article is to identify and discuss the potential neurocognitive effects on patients with aortic stenosis before and after undergoing surgical aortic valve replacement (SAVR). Method: Our study involved the assessment of 64 patients undergoing aortic valve replacement (SAVR) using a neurocognitive evaluation comprising a battery of 11 different cognitive tests. These tests were designed to analyze the patients’ overall cognitive functioning, executive abilities, short- and long-term memory, and attentional performance. The tests were administered to patients before the aortic valve surgery (T0) and after the surgery (T1). From a statistical perspective, numerical variables are presented as means (±standard deviation) and medians (IQR), while categorical variables are presented as counts and percentages. Normality was assessed using the Shapiro–Wilk test. T0 and T1 scores were compared with the Wilcoxon signed rank test, with p < 0.05 considered significant. Analyses were performed using SAS version 9.4. Results: Conducted as part of a fully financed Italian Ministry of Health project (RF-2016-02361069), the study found that most patients showed normal cognitive functioning at baseline. Cognitive assessments showed that executive functions, attention, language, and semantic knowledge were within the normal range for the majority of participants. After SAVR, cognitive outcomes remained stable or improved, particularly in executive functions and language. Notably, verbal episodic memory demonstrated significant improvement, with the percentage of patients scoring within the normal range on the BSRT increasing from 73.4% at T0 to 92.2% at T1 (p < 0.0001). However, visuospatial and visuoconstructive abilities showed stability or slight decline, while attentional skills remained relatively stable. The Clock Drawing Test indicated the maintenance of cognitive functions. Conclusions: The findings of our study indicate a global stability in cognitive status among patients after undergoing SAVR, with significant improvement noted in verbal episodic memory. While other cognitive domains did not demonstrate statistically significant changes, these insights are valuable for understanding the cognitive effects of SAVR and can guide future research and clinical practice in selecting the most effective surgical and rehabilitative options for patients. Monitoring cognitive outcomes in patients undergoing aortic valve replacement surgery remains crucial.

Machine learning-based screening for outpatients with dementia using drawing features from the clock drawing test.

Background and Objectives: In geriatrics and dementia care, early diagnosis is crucial. We developed a dementia screening model using drawing features from clock drawing tests (CDT) and investigated the features contributing to the discrimination of dementia and its screening performance. Methods: This study included 129 older adults attending a dementia outpatient clinic. We obtained information on the diagnosis of dementia and CDT data from medical records and quantified 12 types of drawing features according to the Freedman scoring system. Based on the dementia diagnosis information, participants were assigned to two groups: 58 in the dementia diagnosis group and 71 in the non-diagnosis group. Using Boruta, an iterative feature selection algorithm, and a support vector machine, a machine learning method, we analyzed the drawing features contributing to dementia discrimination and evaluated discrimination performance. Results: Five types of drawing features were selected as contributors to discrimination, including "numbers in the correct position," "minute target number indicated," and "hand in correct proportion." These features exhibited a discriminating sensitivity of 0.74 ± 0.16 and specificity of 0.74 ± 0.18 for detecting dementia. Conclusion: This study demonstrated a method for identifying individuals likely to be diagnosed with dementia among patients attending a dementia outpatient clinic using drawing features. The knowledge of drawing features contributing to dementia differentiation may assist healthcare practitioners in clinical reasoning and provide novel insights for clinical practice. In the future, we plan to develop a primary screening for dementia based on machine learning using CDT.

Using Deep Learning Neural Networks to Improve Dementia Detection: Automating Coding of the Clock-Drawing Test.

Alzheimer's disease and related dementias (ADRD) is a growing public health concern. The clock-drawing test (CDT), where subjects draw a clock, typically with hands showing 11:10, has been widely used for ADRD-screening. A limitation of including CDT in large-scale studies is that the CDT requires manual coding, which could result in biases if coders interpret and implement coding rules differently. This study created and evaluated an intelligent CDT Clock Scoring system built with Deep Learning Neural Networks (DLNN) to automatically code CDT images. We used a large, publicly available repository of CDT images from the 2011-2019 National Health and Aging Trends Study (NHATS) and compared three advanced DLNN methods - ResNet101, EfficientNet and Vision Transformers (ViT) in coding CDT into binary and ordinal (0 to 5) scores. We extended beyond the traditional nominal classification approach (which does not recognize order) by introducing structured ordering into the coding system and compared DLNN-coded CDT images with manual coding. Results suggest that ViT outperforms ResNet101 and EfficientNet, as well as manual coding. The ordinal coding system has the ability to allow researchers to minimize either under- or over-estimation errors. Starting in 2022, our developed ViT-coding system has been used in NHATS' annual CDT-coding.

Effect of tDCS combined with virtual reality for post-stroke cognitive impairment: a randomized controlled trial study protocol

BackgroundPost-stroke cognitive impairment (PSCI) not only increases patient mortality and disability, but also adversely affects motor function and the ability to perform routine daily activities. Current therapeutic approaches for, PSCI lack specificity, primarily relying on and medication and traditional cognitive therapy supplemented by a limited array of tools. Both transcranial direct current stimulation (tDCS) and virtual reality (VR) training have demonstrated efficacy in improving cognitive performance among PSCI patients. Previous findings across various conditions suggest that implementing a therapeutic protocol combining tDCS and VR (tDCS - VR) may yield superior in isolation. Despite this, to our knowledge, no clinical investigation combining tDCS and VR for PSCI rehabilitation has been conducted. Thus, the purpose of this study is to explore the effects of tDCS - VR on PSCI rehabilitation.MethodsThis 4-week, single-center randomized clinical trial protocol will recruit 200 patients who were randomly assigned to one of four groups: Group A (tDCS + VR), Group B (tDCS + sham VR), Group C (sham tDCS + VR), Group D (sham tDCS + sham VR). All four groups will receive conventional cognitive rehabilitation training. The primary outcome measurement utilizes the Mini-Mental State Examination (MMSE). Secondary outcome measures include the Montreal Cognitive Assessment, Frontal Assessment Battery, Clock Drawing Test, Digital Span Test, Logic Memory Test, and Modified Barthel Index. Additionally, S-YYZ-01 apparatus for diagnosis and treating language disorders assesses subjects’ speech function. Pre- and post-four-week intervention assessments are conducted for all outcome measures. Functional near-infrared spectroscopy (fNIRS) is employed to observe changes in oxygenated hemoglobin (HbO), deoxy-hemoglobin (HbR), and total hemoglobin (HbT) in the cerebral cortex.DiscussionOur hypothesis posits that the tDCS - VR therapy, in opposed to individual tDCS or VR interventions, could enhance cognitive function, speech ability and daily living skills in PSCI patients while concurrently augmenting frontal cortical activity. This randomized study aims to provide a robust theoretical foundation supported by scientific evidence for the practical implementation of the tDCS - VR combination as a secure and efficient PSCI rehabilitation approach.Trial registrationChictr.org.cn Identifier: ChiCTR2300070580. Registered on 17th April 2023.

Normative data for tests of visuo-spatial, visuo-constructional skills, and visual memory for Spanish-speaking adults in the United States.

The Rey-Osterrieth Complex Figure Test (ROCFT) and the Clock Drawing Test (CDT) are commonly used in clinical practice. The ROCFT measures constructional praxis, visual perception, and visuospatial learning and memory, and the CDT assesses for visuospatial, constructional, and executive difficulties. Several neurological disorders are associated with visuospatial and visuo-constructional impairments, yet reliable normative data accounting for sociodemographic and acculturative variables are scarce for Hispanics living in the U.S. To generate normative data for the ROCFT and CDT in a Spanish-speaking adult population living in the U.S. The sample consisted of 245 cognitively healthy adults recruited from several states in the U.S. Each participant was administered the ROCFT and CDT as part of a larger cognitive battery. The ROCFT and CDT were normed using a Bayesian approach. Age, age2, education, sex, acculturation, and language proficiency were included as predictors in the analyses. ROCFT performance was associated with education and age, particularly as they interacted with Spanish language proficiency and time spent in the U.S. Education was significantly associated with recall abilities and a lower memory recall on the ROCFT. Age was found to vary depending on a person's bilingual abilities. Sex did not emerge as a predictor of performance, and it did not interact significantly with other variables. This is the first study to include acculturation and language proficiency variables in the creation of norms for the assessment of visuo-constructional abilities. This study will have a large impact on the practice of neuropsychology in the U.S.

Hospital stays and probable dementia as predictors of relocation to long-term care facilities.

This study aims to investigate the relocation of older adults in the US from community living to long-term care facilities (LTCFs). Specifically, it examines the predictive roles of possible and probable dementia and hospital stays in this complex health care transition. Utilizing data from the National Health and Aging Trends Study, a longitudinal cohort study (2011-2019), we employed a panel data approach, which consists of multiple observations over time for the same participants, allowing us to account for both cross-sectional variations (differences between participants) and time-series variations (changes in the same participant over time). The analysis involved longitudinal logistic regression models. Using the AD8 dementia screening interview, clock drawing test, immediate and delayed word recall test, orientation, and history of dementia diagnosis, we placed participants into categories of having no dementia, possible dementia, and probable dementia. A survey asked about hospital stays in the past year. Relocation to LTCFs was examined based on the changes to the living location. The proportion of individuals transitioning to LTCFs tripled between 2011 and 2019, emphasizing the need to understand and manage this health care transition. Hospital stays significantly increased the probability of moving to LTCFs, especially nursing homes. Probable dementia demonstrated a 3-fold increase, aligning with the rising prevalence of Alzheimer disease. Difficulty walking and climbing stairs significantly increased relocation probabilities. The study findings emphasize complexity in late-life relocations influenced by dementia and hospital stays. Screening for cognitive function among community-dwelling older adults, particularly those with a history of hospital stays and mobility difficulties, can inform interventions and policies. Implications extend to health care policy, geriatric care, and the imperative for targeted interventions considering demographic variations. Future research should explore additional variables and address limitations to refine our understanding of the relocation process.

Creating a Guidance Template for NCHDs to Evaluate Cognition in Geriatric Medicine Clinics

Abstract Background Non-Consultant hospital doctors (NCHDs), when rotating through geriatric medicine, often take a comprehensive cognitive history for the first time. Graduate clinical exams often overlook this complex assessment, and knowledge of cognitive disorders amongst NCHDs is often limited. We aimed to create a template to guide NCHDs in taking this history, including investigations and management options. Methods We developed a 9-question survey, administered to a sample of representative NCHDs and specialist nurses who have rotated through our department, to gauge their confidence in assessing cognition. We examined their understanding of cognitive assessments and if a template would be useful. With consultants, we subsequently drafted an agreed guidance template for use at clinics. Results We included 35 respondents who rotated through geriatric medicine clinics this year; 8 registrars, 18 SHOs, 5 interns, 1 ANP. 10(31.25%) felt very confident completing a cognitive history, 17(53.13%) felt just somewhat confident and 5(15.65%) did not feel confident. Regarding investigating a new cognitive impairment (CI) n=10 (31.25%) felt very confident, 12(37.5%) felt somewhat confident and 10(31.25%) did not feel confident. Management of CI - 12(37.5%) felt very confident, 11(34.38%) felt somewhat confident and n=9 (28.13%) did not feel confident. MMSE, MOCA, clock drawing test, Addenbrooks and RUDAS were listed as cognitive assessments. Regarding investigations, CT/MRI Brain were mentioned in all but just n=12 mentioned a PET scan. Services listed included Occupational Therapy (20), Social Work (6), Dublin Alzheimer’s Society (6), psychology (6). Almost all 96.87% (31) felt a guide would be helpful and 100% of participants said that they would use it. Conclusion We identified gaps in confidence and knowledge amongst NCHDs regarding assessment of cognition. Consequently, we designed a guidance template to ensure rotating junior staff are more confident and informed during cognitive assessments at clinics in our department.

Memory problems in elderly people with traumatic brain injury

AbstractThe aim of this study is to assess the effectiveness of various therapy methods in elderly individuals with traumatic brain injury (TBI), taking into account the degree of memory loss and the severity of the injury. The study was conducted in 2022 in Moscow, Russia, and Sofia, Bulgaria, involving six clinics. A total of 200 elderly patients with TBI participated in the study, with a mean age of 72 years. Patients were categorized into groups based on the degree of memory loss and severity of the injury. Standardized tests, including the Mini‐Mental State Examination (MMSE), Clock Drawing Test, Digit Symbol Substitution Test, and Free, and Cued Selective Reminding Test, were used to assess cognitive functions. The Progressive Learning Test evaluated patients' ability to memorize and reproduce information over time. Groups receiving physical therapy and cognitive rehabilitation showed statistically significant improvement in cognitive functions compared to other therapy methods. Specifically, the mean score of the MMSE in these groups increased by 7 points (p < .001). Patients with more severe memory loss demonstrated more pronounced improvement in cognitive functions following the integrated therapy approach. The mean MMSE score increased by 10 points (p < .001), whereas in patients with milder memory loss, the growth was less significant (mean increase of 5 points, p < .05). Groups receiving physical therapy and cognitive rehabilitation consistently demonstrated significantly better results compared to speech therapy and psychological support throughout the study period.

TEGEST as promising tool for assessing the risk of perioperative neurocognitive disorders

BackgroundPerioperative neurocognitive disorders are often neglected and undiagnosed. There are known risk factors for these disorders (e.g., higher levels of frailty, cognitive decline before surgery). However, these factors are usually not assessed in the daily clinical setting. One of the main reasons for this lack of examination is the absence of a suitable cognitive function test that can be used in acute clinical settings. The primary aim of this study was to determine correlations between preoperative and postoperative scores on three cognitive tests (the Mini Mental State Exam (MMSE), the Clock Drawing Test (CDT) and the Test of Gestures (TEGEST).MethodsThis was a prospective, monocentric, observational study that included one cohort of patients aged 65 years and older. Patients underwent acute or elective surgical operations. Preanaesthesia tests were administered. After the operation, the patients completed the same tests between the 2nd postoperative day and discharge. Preoperative and postoperative cognitive test scores were assessed.ResultsThis study included 164 patients. The arithmetic mean age was 74.5 years. The strongest correlations were observed between MMSE scores and TEGEST scores (r = 0.830 before and 0.786 after surgery, P < 0.001). To compare the MMSE and the TEGEST, the MMSE was divided into 2 categories—normal and impaired—and good agreement was found among 76.2% of the participants (ϰ = 0.515). If the TEGEST scoring system was changed so that scores of 4–6 indicated normal cognition and scores of 0–3 indicated cognitive impairment, the level of agreement would be 90.8%, ϰ = 0.817. Only 5.5% of the patients had impaired MMSE scores and normal TEGEST scores, whereas 3.7% of the respondents normal MMSE scores and impaired TEGEST scores.ConclusionAccording to our results, the TEGEST is a suitable option for assessing cognitive functioning before surgery among patients who are at risk of developing perioperative neurocognitive disorders. This study revealed that it is necessary to change the rating scale for the TEGEST so that scores of 4–6 indicate normal cognition and scores of 0–3 indicate cognitive impairment. In clinical practice, the use of the TEGEST may help to identify patients at risk of perioperative neurocognitive disorders.

Normative Scores on the Clock Drawing Test Among Older Adults from a Large Population Survey in Norway: The HUNT Study.

The Clock Drawing Test (CDT) is used to screen for Alzheimer's disease and other dementia disorders. Normative scores on the version from the Montreal Cognitive Assessment (MoCA) do not exist in the Nordic countries. To examine the normative scores of the CDT among adults aged 70 years and older. We included 4,023 cognitively healthy persons aged 70-97 years from a population survey in Norway. They were examined with the CDT, which has a total score between zero and three. A multiple multinominal regression model was applied with a CDT score as the dependent categorical variable and estimated the probabilities of scoring a particular score, stratified by age, sex, and education. These probabilities correspond to an expected proportion of the normative population scoring at, or below a given percentile. None scored zero, 2.1% scored one, 14.9% scored two, and 83% scored three. Higher age, female sex and fewer years of schooling were associated with poorer performance. Scores of zero and one deviated from the normative score regardless of age, sex and education. A score of two was within the norm for a female older than 81 and a male older than 85. The majority (83%) of people 70 years and older had a score of three on the CDT. Lower age, male sex, and higher education were associated with a better performance. Scores of zero and one were below the normative score. Except for the very old, a score of two was also well below the normative score.

Can volumetric magnetic resonance imaging evaluations be helpful in the follow-up of cognitive functions in cognitively normal Parkinson's disease patients?

In this study, besides the evaluation of gray and white matter changes in cognitively normal Parkinson's disease (PD-CN) patients with volumetric magnetic resonance imaging (MRI) parameters, it was tried to show that some neuropsychological tests may be impaired in PD-CN patients. Twenty-six PD-CN patients and 26 healthy elderly (HC) participants were included in the current study. Global cognitive status was assessed using the mini-mental state examination (MMSE), and the Montreal cognitive assessment scale (MoCA). Attention and executive functions were evaluated using the Wechsler memory scale-revised (WMS-R) digit span test and trail making test (TMT) part A and part B, the Stroop test, semantic and phonemic fluency tests, and clock drawing test. Magnetic resonance imaging (MRI) was acquired according to the Alzheimer's disease neuroimaging initiative (ADNI) protocol. There were no significant differences among groups regarding age, sex, handedness, and years of education. In the comparison of the PD-CN group and the HC group, there was a statistical decrease in the total animal scores, lexical fluency, TMT part A and TMT part B scores in the PD-CN group. Subcortical gray matter volumes (GMV) were significantly lower in PD-CN patients. The PD-CN group had a significantly reduced total volume of right putamen and left angular gyrus compared to that in the HC group. We observed that putamen and angular gyrus volumes were lower in PD-CN patients. On the other hand, TMT part B may be a useful pretest in detecting the conversion of mild cognitive impairment in PD. Significant MRI volumetric measurements and neuropsychological test batteries can be helpful in the clinical follow-up in PD-CN patients.

A Digital Clock Drawing Test on Tablet for the Diagnosis of Neurocognitive Disorders in Older Adults.

The diagnosis of neurocognitive diseases is an important health issue for patients, families and healthcare professionals. The need to develop rapid, high-performance screening tools would improve access to care. The Clock Drawing Test (CDT) is widely used and validated with the older adults, and its digital version is becoming increasingly widespread. We propose to confirm its validity in a population of old patients hospitalized in a geriatric unit, and secondly to verify its performance in comparison with the reference diagnosis made by a specialized team in a memory consultation. CDTs were collected from older hospitalized patients, both in paper form and digitally on a touchscreen tablet. The results show good agreement between the paper and digital versions (kappa coefficient = 0.81). Sensitivity and specificity of the digital CDT were 0.84 and 0.59 respectively for the diagnosis of major cognitive disorders. The corresponding values were 0.72 and 0.59 for the diagnosis of mild neurocognitive disorders. User questionnaires indicate that older participants find the digital tablet easy to use. However, they prefer to use paper, even if they are open to learning how to use the tablet.

Pattern of cognitive changes and content of cerebral neurotrophic factor in patients with chronic cerebral ischemia

Objective. To study the pattern of cognitive changes and the content of cerebral neurotrophic factor (BDNF) in the blood serum of patients with chronic cerebral ischemia (CICI).Materials and methods. We examined 128 people who were divided into two groups: the main group – 82 patients (38 men and 44 women) aged 60–74 years with CICI, the control group – 46 people comparable to the patients of the main group by gender and age, but without clinical manifestations of CICM. Cognitive functions were assessed using the Mini-Mental Status Scale (MSMS) and the Battery of Tests for the Assessment of Frontal Dysfunction (FMS). Attention (Schulte test), speech fluency (speech fluency subtest BTLD, verbal association test), memory (memory subtest KSHOPS; 5 words test) and visuospatial functions (clock drawing test) were studied. The content of BDNF in the blood serum of patients was determined by the enzyme immunoassay method.Results. The pattern of cognitive impairment in CIGM was characterized by changes in the domains of executive brain functions and complex attention. The content of BDNF in the blood serum of patients with CICI was significantly lower than that of the control group; in men is lower compared to female patients. Significant correlations were revealed between the severity of cognitive disorders and the level of BDNF in the blood serum.

Cognitive Impairment in Liver Tranplant Recipients: A Cross-Sectional Study.

The proportion of older transplant recipients has increased. Cognitive impairment is not rare after kidney transplant, but data on this issue in liver transplant recipients are scarse. In this cross-sectional study, we evaluated all liver transplant recipients from a single center in Brazil from July 2018 to June 2020 in terms of cognitive performance to determine the prevalence of neurocognitive disorder. We compared liver transplant recipients with neurocognitive disorder with liver transplant recipients without neurocognitive disorder. We also compared those with an alcoholic cause of liver transplant with other patients. The presence of depressive symptoms was assessed. We performed correlations of clinical data with cognitive scores. In a sample of 100 recipients with median age of 62 years (interquartile range, 56.2-69 y), neurocognitive disorder was present in 21% of the group. Patients with cognitive impairment were older (68 y [61-72] vs 61 y [52-68]; P = .019) and had a trend to higher proportion of persistent kidney injury (33.3% vs 13.9%; P = .055) versus patients without cognitive impairment. Recipients with alcoholic cause of liver transplant exhibited worse cognitive performance in the Mini-Mental State Examination (score of 26 [23.7-28.2] vs 28 [26-29]; P = .024) and the Alzheimer Disease Assessment Scale-cognitive (score of 10.4 [8.6-14.2] vs 8 [6.3-10]; P = .008) than other patients. Weak negative correlations were shown in cognitive performance scores versus recipient age (Semantic Verbal Fluency test, r = -0.334 [P = .001]; Clock Drawing test, r = -0.209 [P = .037]; Alzheimer Disease Assessment Scale-cognitive, r = -0.323 [P = .001]). Neurocognitive disorder was common in liver transplant recipients, in part due to increased age. This study also suggested a role for alcoholic cause of liver transplant and persistent kidney injury in the development of cognitive impairment.

Prognosis of Dementia Using Early Fusion Approach with Digital Clock Drawing and Trail-Making Tests

Prognosis of Dementia Using Early Fusion Approach with Digital Clock Drawing and Trail-Making Tests

Developing a fair and interpretable representation of the clock drawing test for mitigating low education and racial bias

The clock drawing test (CDT) is a neuropsychological assessment tool to screen an individual’s cognitive ability. In this study, we developed a Fair and Interpretable Representation of Clock drawing test (FaIRClocks) to evaluate and mitigate classification bias against people with less than 8 years of education, while screening their cognitive function using an array of neuropsychological measures. In this study, we represented clock drawings by a priorly published 10-dimensional deep learning feature set trained on publicly available data from the National Health and Aging Trends Study (NHATS). These embeddings were further fine-tuned with clocks from a preoperative cognitive screening program at the University of Florida to predict three cognitive scores: the Mini-Mental State Examination (MMSE) total score, an attention composite z-score (ATT-C), and a memory composite z-score (MEM-C). ATT-C and MEM-C scores were developed by averaging z-scores based on normative references. The cognitive screening classifiers were initially tested to see their relative performance in patients with low years of education (< = 8 years) versus patients with higher education (> 8 years) and race. Results indicated that the initial unweighted classifiers confounded lower education with cognitive compromise resulting in a 100% type I error rate for this group. Thereby, the samples were re-weighted using multiple fairness metrics to achieve sensitivity/specificity and positive/negative predictive value (PPV/NPV) balance across groups. In summary, we report the FaIRClocks model, with promise to help identify and mitigate bias against people with less than 8 years of education during preoperative cognitive screening.