Cognitive profile in mild cognitive impairment with Lewy bodies

INTRODUCTION@#This study aimed to elucidate the cognitive profile of patients with mild cognitive impairment with Lewy bodies (MCI-LB) and to compare it to that of patients with mild cognitive impairment due to Alzheimer's disease (MCI-AD).@*METHODS@#Subjects older than 60 years with probable MCI-LB (n = 60) or MCI-AD (n = 60) were recruited. All patients were tested with Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) to assess their global cognitive profile.@*RESULTS@#The MCI-AD and MCI-LB patients did not differ in total MMSE and MoCA scores. However, some sub-items in MMSE and MoCA were shown to be screening markers for differentiating MCI-LB from MCI-AD. In the visuoconstructive test, the total score and hands subitem score in the clock-drawing test were significantly lower in MCI-LB than in MCI-AD. As for the executive function, the 'animal fluency test', 'repeat digits backward test' and 'take paper by your right hand' in MMSE all showed lower scores in MCI-LB compared with MCI-AD. As for memory, 'velvet' and 'church' in MoCA and 'ball' and 'national flag' in MMSE had lower scores in MCI-AD than in MCI-LB.@*CONCLUSION@#This study presents the cognitive profile of patients with MCI-LB. In line with the literature on Dementia with Lewy bodies, our results showed lower performance on tests for visuoconstructive and executive function, whereas memory remained relatively spared in the early period.

Teste do Desenho do Relógio: dados normativos para idosos / Clock Drawing Test: standard data for older adults / Prueba de Diseño de Reloj: datos normativos para ancianos

Trata-se de um estudo quantitativo, retrospectivo, correlacional e de corte transversal, com objetivo de fornecer dados normativos do TDR para idosos, levando em consideração diferentes faixas etárias e níveis de escolaridade. Duzentos e trinta e cinco foram entrevistados individualmente, distribuídos em cinco grupos etários e quatro níveis de escolaridade. Os instrumentos foram Ficha de Dados Sociodemográficos, Miniexame do Estado Mental (MEEM), Escala de Depressão Geriátrica, versão reduzida (GDS-15), Tarefa de Fluência Verbal Semântica (TFVS) e o TDR. Utilizou-se estatísticas descritivas, correlação de Pearson e análise univariada (one-way ANOVA) com post hoc Scheffe. Os escores do TDR apresentaram associações significativas com os anos de idade, anos de escolaridade, MEEM, TFVS e GDS-15. Houve diferença de desempenho no TDR ao considerarem os grupos por idade. O estudo fornece valores normativos para o TDR em uma amostra de idosos do sul do Brasil que foram influenciados pela idade, escolaridade, sintomatologia depressiva e fluência verbal. (AU)

This was a quantitative, retrospective, correlational, cross-sectional study that aimed to provide normative CDT (Clock-Drawing Test) data for older adults, taking into account different age groups and educational levels. The sample included 235 older adults distributed among five age groups and four levels of education. The instruments were Sociodemographic Data Sheet, the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale reduced version (GDS-15), the Semantic Verbal Fluency Task (TFVS), and the CDT. Descriptive statistics, Pearson's correlation, and univariate analysis (one-way ANOVA) with Scheffe post hoc were used. The CDT scores showed significant associations with age, years of schooling, MMSE, TFVS, and GDS-15. There was a difference in performance in CDT when considering age groups. The present study was able to provide normative values ​​for CDT in a sample of older adults in southern Brazil that ​​were influenced by age, education, depressive symptoms, and verbal fluency. (AU)

Se trata de un estudio cuantitativo, retrospectivo, correlacional y transversal, con el objetivo de aportar datos normativos sobre el TDR para ancianos, teniendo en cuenta diferentes grupos de edad y niveles educativos. La muestra incluyó a 235 ancianos distribuidos en cinco grupos de edad y cuatro niveles de educación. Los instrumentos utilizados fueron Ficha de Datos Sociodemográficos, Mini Examen del Estado Mental (MMSE), Escala de Depresión Geriátrica, versión reducida (GDS-15), Tarea de Fluidez Verbal Semántica (TFVS) y TDR. Se emplearon estadísticas descriptivas, correlación de Pearson y análisis univariante (one-way ANOVA) con post hoc Scheffe. Los puntajes de TDR mostraron asociaciones significativas con la edad, años de escolaridad, MMSE, TFVS y GDS-15. Hubo diferencia en el desempeño en el TDR al considerar los grupos por edad. El presente estudio fue capaz de proporcionar valores normativos para TDR en una muestra de ancianos en el sur de Brasil influenciados por la edad, la escolaridad, los síntomas depresivos y la fluidez verbal. (AU)

Clock drawing test: comparison between the Pfizer and the Shulman systems / Teste do desenho do relógio: comparação dos sistemas de Pfizer e de Shulman

ABSTRACT Cognitive decline can be screened by the clock drawing test (CDT), which has several versions. Objective: This survey aimed to analyze the correlation between two simple methods for scoring the CDT. Methods: This cross-sectional study was nested in the Elo-Creati cohort from Passo Fundo, Brazil and comprised 404 subjects. Two raters underwent previous training and scored the subjects' CDT according to both the Pfizer and Shulman systems. The inter-observer and intra-observer concordance within each method was analyzed with the Spearman's rank correlation coefficient, as well as the concordance of the scores between the two methods. Age and scholarity were also correlated with the scores. Results: Most of the participants were women (93.8%) and Caucasian (84.6%), with a mean age of 66.9 (±7.8) years and a scholarity of 10.9 years (±5.6). There was significant inter-observer (Pfizer: r=0.739, p£0.001; Shulman: r=0.727, p£0.001) and intra-observer correlation (Pfizer: rater 1, r=0.628, p≤0.001; rater 2, r=0.821, p≤0.001; Shulman: rater 1, r=0.843, p≤0.001; rater 2: r=0.819; p≤0.001). Intra-observer correlation was also observed comparing Pfizer and Shulman methods (rater 1: r=0.744; p≤0.001; rater 2: r=0.702; p≤0.001). There was weak correlation of the scores with scholarity (Pfizer: r=0.283, p£0.001; Shulman: r=0.244, p£0.001) and age (Pfizer: r=-0.174, p£0.001; Shulman: r=-0.170, p£0.001). More participants were classified with decreased cognition through the Pfizer system (rater 1: 44.3 vs. 26.5%; rater 2: 42.1 vs. 16.3%; p≤0.001). Conclusions: For this population, our results suggest that the Pfizer system of scoring CDT is more suitable for screening cognitive decline.

RESUMO O déficit cognitivo pode ser triado pelo teste do desenho do relógio (TDR), que tem várias versões. Objetivo: Esta pesquisa visou avaliar a concordância entre dois métodos simples de TDR. Métodos: Estudo transversal, aninhado na coorte Elo-Creati de Passo Fundo, Brasil, que incluiu 404 sujeitos. Dois avaliadores previamente treinados analisaram o TDR dos participantes de acordo com os sistemas de Pfizer e de Shulman. A concordância inter e intraobservador foi analisada com o teste de coeficiente de correlação de postos de Spearman, assim como a concordância pela estatística kappa dos escores entre os métodos. Idade e escolaridade também foram correlacionados com os escores. Resultados: A maioria dos participantes era de mulheres (93,8%) e caucasianos (84,6%), com média de idade de 66,9±7,8 anos e de escolaridade de 10,9±5,6 anos. Houve significativa correlação interobservador (Pfizer: r=0,739, p£0,001; Shulman: r=0,727, p£0,001) e intraobservador (Pfizer: avaliador 1, r=0,628, p≤0,001; avaliador 2, r=0,821, p≤0,001; Shulman: avaliador 1, r=0,843, p≤0,001; avaliador 2: r=0,819; p≤0,001). Correlação intraobservador significativa também foi evidenciada comparando-se os sistemas de Pfizer e Shulman (avaliador 1: r=0,744; p≤0,001; avaliador 2: r=0,702; p≤0,001). Houve fraca correlação dos escores com escolaridade (Pfizer: r=0,283, p£0,001; Shulman: r=0,244, p£0,001) e idade (Pfizer: r=-0,174, p£0,001; Shulman: r=-0,170, p£0,001). Mais participantes foram classificados com declínio cognitivo com o sistema de Pfizer (avaliador 1: 44,3 vs. 26,5%; avaliador 2: 42,1 vs. 16,3%; p≤0,001). Conclusões: Nossos resultados sugerem que, para essa população, o sistema de Pfizer para avaliar o TDR é mais adequado para a triagem cognitiva.

Performance characteristics and diagnostic efficacy of the digital clock drawing test in patients with amnestic mild cognitive impairment / 中华行为医学与脑科学杂志

Objective:To explore the performance characteristics of the digital clock-drawing test(dCDT) for amnestic mild cognitive impairment(aMCI), and its diagnostic value for aMCI patients compared with the traditional clock-drawing test (tCDT).Methods:Total 81 middle-aged and elderly outpatients in Affiliated Hospital to Shanxi Medical University from November 2020 to May 2021 were selected, including 42 cognitively normal people (control group) and 39 aMCI patients (aMCI group). The dCDT developed by our team was used to collect drawing process parameters (such as stroke length, time and speed). The Cognitive Domain Indexs of Montreal Cognitive Assessment (MoCA) were calculated using the CDIS scoring method, and the correlation between dCDT parameters and MoCA indexs were analyzed.Logistic regression analysis was used to construct the predictive model, and the sensitivity and specificity of different methods for the diagnosis of aMCI patients were compared by the area under the ROC curve.Results:(1) The total time(51.25(38.80, 63.75)s vs 42.42(33.64, 51.91)s) and time in air(36.34(26.81, 47.25)s vs 28.47(22.37, 33.98)s) of the aMCI group were significantly higher than those of the control group, and the minute hand/hour hand ratio(1.23±0.35 vs 1.39±0.34), strokes per minute((31.31±10.44) vs (41.05±9.48))and tCDT score(3.0(3.0, 4.0), 4.0(3.0, 4.0))were significantly lower than those of the control group, and the differences were statistically significant (all P<0.05). Other dCDT parameters were not statistically significant between the two groups ( Z=-1.835--0.440, P>0.05). (2) Correlation analysis showed that the total time was negatively correlated with MoCA MIS( r=-0.224, P=0.049), LIS( r=-0.237, P=0.037)and AIS( r=-0.236, P=0.038); time in air was negatively correlated with MoCA MIS( r=-0.268, P=0.018), LIS( r=-0.271, P=0.016), AIS( r=-0.259, P=0.022)and OISA( r=-0.267, P=0.018); the minute hand/hour hand ratio was positively correlated with MoCA EIS( r=0.259, P=0.022)and VIS( r=0.309, P=0.006); the strokes per minute was positively correlated with MoCA MIS( r=0.376, P=0.001), EIS( r=0.290, P=0.010), VIS( r=0.294, P=0.009), AIS( r=0.238, P=0.036)and OISA( r=0.301, P=0.007). (3)dCDT model composed of the pre-second hand latency, the ratio of minute hand/hour hand, and the strokes per minute can correctly classify 77.8% of aMCI, with a sensitivity of 74.36% and a specificity of 80.95%.Its diagnostic power for aMCI was significantly higher than the tCDT scoring( Z=2.335, P=0.02). Conclusion:The cognitive impairment in aMCI can be detected by dCDT, and different dCDT parameters can reflect the impairment of different cognitive domains.Compared with tCDT scoring, dCDT can improve the diagnostic efficacy of aMCI patients.

Qualitative analysis and identification of pattern of errors in Clock Drawing Tests of community-dwelling older adults / Análise qualitativa e identificação de padrões de erros no Teste do Desenho do Relógio em idosos da comunidade

Abstract The Clock Drawing Test (CDT) is a frequently employed screening tool with different scoring systems. Quantitative and semi-quantitative scoring systems, such as Sunderland's et al. (1989), do not discriminate different error patterns. Thus, the same score can represent a number of different neuropsychological profiles. Therefore, the use of a scoring method that emphasizes qualitative aspects to determine specific error patterns is fundamental. Objective: To use a qualitative scale to analyze error patterns in the CDTs of older adults who scored 5 in a previous study. Methods: 49 CDTs with score of 5 were analyzed using the qualitative scale. Linear regression and hierarchical and non-hierarchical cluster analyses were performed. Results: The linear regression showed a significant association between the total score and all the error patterns of the qualitative scale. The hierarchical cluster yielded three groups. However, due to the heterogeneity observed among the groups, a non-hierarchical cluster analysis was performed to better understand the results. Three groups were determined with different neuropsychological profiles and patterns of errors. Conclusion: The qualitative scoring of the CDT is important when examining and analyzing specific neuropsychological domains in older adults, especially executive functions.

Resumo O Teste do Desenho do Relógio (TDR) está entre os instrumentos de rastreio mais utilizados e apresenta diversos métodos de correção e pontuação. Sistemas de pontuação quantitativos e semiquantitativos não discriminam diferentes padrões de erros, como é o caso do método de Sunderland et al. (1989). Dessa feita, uma mesma pontuação pode reunir diferentes perfis neuropsicológicos. Assim, o uso de métodos de correção com ênfase nos aspectos qualitativos, para verificar padrões mais específicos de erro, tornou-se fundamental. Objetivo: Analisar através de escala qualitativa os padrões de erros no TDR dos idosos cuja pontuação foi 5 em estudo anterior. Métodos: 49 TDR com pontuação 5 foram analisados pela escala qualitativa. Uma regressão linear e análises de cluster hierárquica e não-hierárquicas foram realizadas. Resultados: A regressão linear mostrou associação significativa entre o resultado total e todos os padrões de erro da escala qualitativa. O cluster hierárquico gerou três grupos. Entretanto devido a heterogeneidade observada entre os grupos, uma análise de cluster não hierárquico foi realizada para melhor entender os resultados. Três grupos foram formados com diferentes perfis neuropsicológicos e padrão de erros. Conclusão: A pontuação qualitativa do TDR é importante para examinar e analisar domínios neuropsicológicos específicos em idosos, principalmente funções executivas.

Usefulness of the Clock Drawing Test as a Cognitive Screening Instrument for Mild Cognitive Impairment and Mild Dementia: an Evaluation Using Three Scoring Systems

BACKGROUND AND PURPOSE: Although the clock drawing test (CDT) is a widely used cognitive screening instrument, there have been inconsistent findings regarding its utility with various scoring systems in patients with mild cognitive impairment (MCI) or dementia. The present study aimed to identify whether patients with MCI or dementia exhibited impairment on the CDT using three different scoring systems, and to determine which scoring system is more useful for detecting MCI and mild dementia. METHODS: Patients with amnestic mild cognitive impairment (aMCI), vascular mild cognitive impairment (VaMCI), mild Alzheimer's disease (AD), mild vascular dementia (VaD), and cognitively normal older adults (CN) were included. All participants were administered the CDT, the Korean-Mini Mental State Examination (K-MMSE), and the Clinical Dementia Rating scale. The CDT was scored using the 3-, 5-, and 15-point scoring systems. RESULTS: On all three scoring systems, all patient groups demonstrated significantly lower scores than the CN. However, while there were no significant differences among patients with aMCI, VaMCI, and AD, those with VaD exhibited the lowest scores. Area under the Receiver Operating Characteristic curves revealed that the three CDT scoring systems were comparable with the K-MMSE in differentiating aMCI, VaMCI, and VaD from CN. In differentiating AD from CN, however, the CDT using the 15-point scoring system demonstrated the most comparable discriminability with K-MMSE. CONCLUSIONS: The results demonstrated that the CDT is a useful cognitive screening tool that is comparable with the Mini-Mental State Examination, and that simple CDT scoring systems are sufficient for differentiating patients with MCI and mild dementia from CN.

Scoring systems for the Clock Drawing Test: A historical review / Sistemas de pontuação do Teste do Desenho do Relógio: Uma revisão histórica

ABSTRACT The Clock Drawing Test (CDT) is a simple neuropsychological screening instrument that is well accepted by patients and has solid psychometric properties. Several different CDT scoring methods have been developed, but no consensus has been reached regarding which scoring method is the most accurate. This article reviews the literature on these scoring systems and the changes they have undergone over the years. Historically, different types of scoring systems emerged. Initially, the focus was on screening for dementia, and the methods were both quantitative and semi-quantitative. Later, the need for an early diagnosis called for a scoring system that can detect subtle errors, especially those related to executive function. Therefore, qualitative analyses began to be used for both differential and early diagnoses of dementia. A widely used qualitative method was proposed by Rouleau et al. (1992). Tracing the historical path of these scoring methods is important for developing additional scoring systems and furthering dementia prevention research.

RESUMO O Teste do Desenho do Relógio (TDR) é um instrumento de rastreio neuropsicológico simples bem aceito pelos pacientes e com sólidas propriedades psicométricas. Em meio aos métodos de pontuação, não existe consenso com relação aos que tenham maior acurácia. Esse artigo tem como objetivo realizar uma revisão histórica sobre os sistemas de pontuação mais utilizados e as mudanças ocorridas com os mesmos ao longo dos anos. No decorrer do caminho histórico, diferentes tipos de sistemas de pontuação surgiram. Inicialmente, o foco era no rastreio de demência e os métodos utilizados eram quantitativos e semi-quantitativos. Contudo, em um segundo momento, a necessidade de diagnóstico precoce demandou o uso de um sistema de pontuação que pudesse especificar erros sutis especialmente aqueles relacionados a funções executivas. Assim, análise qualitativa começou a ser mais usada em ambos no diagnóstico diferencial e precoce de demência. Um método qualitativo amplamente utilizado é o de Rouleau et al. (1992). O caminho histórico é importante para o desenvolvimento dos sistemas de pontuação e também para as pesquisas de prevenção de demência.

Underdiagnosis of delirium on admission and prediction of patients who will develop delirium during their inpatient stay: a pilot study

<p><b>INTRODUCTION</b>The study aimed to determine the prevalence and documentation of delirium among the elderly and if the Clock Drawing Test (CDT) can be used to predict which patients had delirium on admission and those who may develop delirium during their stay in acute medical wards.</p><p><b>METHODS</b>A single researcher performed the Mini-Mental State Examination (MMSE) and CDT on admission and discharge of 57 elderly adults at the National University Hospital, Singapore. Delirium was defined as a ≥ 3-point improvement or ≥ 2-point decline in MMSE scores from admission to discharge, where a fall denotes development of delirium and a rise denotes resolution. The case notes of the same patients were reviewed for documentation of delirium. All inpatients from two acute medical wards were examined. One CDT score and a pair of MMSE scores were collected from each patient.</p><p><b>RESULTS</b>A total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years. The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score.</p><p><b>CONCLUSION</b>The prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital.</p>

Specific algorithm method of scoring the Clock Drawing Test applied in cognitively normal elderly / Método com algoritmo específico para pontuação do teste do desenho do relógio em idosos cognitivamente normais

ABSTRACT. The Clock Drawing Test (CDT) is an inexpensive, fast and easily administered measure of cognitive function, especially in the elderly. This instrument is a popular clinical tool widely used in screening for cognitive disorders and dementia. The CDT can be applied in different ways and scoring procedures also vary. OBJECTIVE: The aims of this study were to analyze the performance of elderly on the CDT and evaluate inter-rater reliability of the CDT scored by using a specific algorithm method adapted from Sunderland et al. (1989). METHODS: We analyzed the CDT of 100 cognitively normal elderly aged 60 years or older. The CDT ("free-drawn") and Mini-Mental State Examination (MMSE) were administered to all participants. Six independent examiners scored the CDT of 30 participants to evaluate inter-rater reliability. RESULTS AND CONCLUSION: A score of 5 on the proposed algorithm ("Numbers in reverse order or concentrated"), equivalent to 5 points on the original Sunderland scale, was the most frequent (53.5%). The CDT specific algorithm method used had high inter-rater reliability (p<0.01), and mean score ranged from 5.06 to 5.96. The high frequency of an overall score of 5 points may suggest the need to create more nuanced evaluation criteria, which are sensitive to differences in levels of impairment in visuoconstructive and executive abilities during aging.

RESUMO. O Teste do Desenho do Relógio (TDR) é uma barata e rápida medida de função cognitiva, de fácil aplicação, especialmente em idosos. Este instrumento é uma ferramenta clínica muito conhecida, amplamente utilizada no rastreamento de transtornos cognitivos e demência. O TDR pode ser aplicado de diferentes formas e a sua pontuação também varia. OBJETIVO: Os objetivos deste estudo foram analisar o desempenho dos idosos no TDR e avaliar a confiabilidade inter-examinadores do TDR pontuado por um método com algoritmo específico, adaptado a partir dos critérios estabelecidos por Sunderland et al. (1989). MÉTODOS: Analisamos o TDR de 100 idosos cognitivamente saudáveis com 60 anos de idade ou mais. O TDR ("desenho livre") e o Mini-Exame do Estado Mental (MEEM) foram administrados em todos os participantes. Seis avaliadores independentes pontuaram 30 TDR para avaliar a confiabilidade inter-examinadores. RESULTADOS E CONCLUSÃO: A pontuação 5 do algoritmo proposto ("Os números em ordem inversa ou concentrados") equivalente a 5 pontos na escala original de Sunderland foi a mais frequente (53,5%). O método com algoritmo específico do TDR utilizado teve alta confiabilidade entre avaliadores (p<0,01), e a média da pontuação variou entre 5,06 e 5,96. A alta frequência de 5 pontos na pontuação geral pode sugerir a necessidade da elaboração de critérios de avaliação mais sutis, que sejam sensíveis às diferenças entre indícios de comprometimento nas habilidades visuoconstrutivas e executivas durante o envelhecimento.

The use of the Clock Drawing Test in bipolar disorder with or without dementia of Alzheimer’s type / O uso do Teste do Desenho do Relógio em pacientes com transtorno bipolar com e sem demência do tipo Alzheimer

There is limited data regarding the cognitive profile from screening tests of older adults with bipolar disorder (BD) with dementia. Objective To investigate the Clock Drawing Test (CDT) among older adults with BD with and without Alzheimer’s disease (AD). Method 209 older adults (79 with BD without dementia and 70 controls; 60 with AD, being 27 with BD) were included to evaluate the performance of three CDT scoring scales, beyond the Mini-Mental State Examination (MMSE) and verbal fluency (VFT). Results Patients with BD without dementia presented with lower scores in MMSE, VF and one CDT scoring scale than controls. Patients with BD and AD presented with lower scores in VF and CDT scoring scales than patients with only AD. All CDT scales presented similar sensitivity and specificity for BD and non-BD groups. Conclusion Elderly subjects with BD showed greater impairment in CDT in both groups of normal cognition and AD. .

Há dados limitados sobre o perfil cognitivo de idosos com transtorno bipolar (TAB) e demência. Previamente, testes de rastreio cognitivo comuns foram pouco estudados. Objetivo Investigar o Teste do Desenho do Relógio (CDT) entre idosos com TAB com e sem doença de Alzheimer (DA). Método Foram incluídos 209 idosos (79 pacientes com TAB sem demência e 70 controles; 60 indivíduos com DA leve, sendo 27 com TAB) para avaliar três escalas de pontuação do TDR, além do Mini-Mental State Examination (MMSE) e fluência verbal (FV). Resultados Pacientes com TAB sem demência apresentaram menores escores no MMSE, FV e uma escala de TDR que controles. Pacientes com TAB e DA apresentaram escores mais baixos na FV e em todos os TDR comparados aos apenas com DA. As escalas de CDT apresentaram sensibilidade e especificidade semelhantes para os grupos com e sem TAB. Conclusão Idosos com TAB apresentaram maior comprometimento no TDR em ambos grupos com cognição normal e DA. .

Qualitative analysis of the Clock Drawing Test by educational level and cognitive profile / Análise qualitativa do Teste do Desenho do Relógio por faixas de escolaridade e perfil cognitivo

The use of a qualitative scale for the Clock Drawing Test (CDT) may add information about the pattern of errors committed. Objective: To translate and adapt the Modified Qualitative Error Analysis of Rouleau into Brazilian Portuguese and to examine the pattern of errors according to educational level and cognitive profile. Method: 180 adults (47-82 years) completed the CDT. Participants were stratified into age and educational levels and separated between those with and without changes in cognitive screening tests (Mini-Mental State Examination, Verbal Fluency). Results: No significant differences were found in CDT scores among age groups. Among participants without cognitive impairment, those with lower education often presented graphic difficulties, conceptual deficits and spatial deficits. Participants with cognitive deficits, demonstrated more frequently conceptual and spatial errors. Conclusion: The qualitative analysis of the CDT may contribute to the identification of cognitive changes. Education level has to be taken into consideration during the analysis. .

O uso de uma escala qualitativa para o Teste do Desenho do Relógio (TDR) pode trazer informações adicionais sobre o perfil dos erros cometidos. Objetivo: Realizar a tradução e a adaptação da Análise Qualitativa de Erros de Rouleau Modificada para o português e analisar o padrão de erros por faixas de escolaridade e perfil cognitivo. Método: 180 adultos (47-82 anos) completaram o TDR. Os participantes foram estratificados em faixas etárias, faixas de escolaridade e separados entre aqueles com e sem alterações cognitivas em testes de rastreio (Mini-Exame do Estado Mental, Fluência Verbal). Resultados: Não foram encontradas diferenças no perfil de erros no TDR entre as faixas de idade. Dentre os participantes com cognição preservada, aqueles com menor escolaridade apresentaram com maior frequência dificuldades gráficas, déficits conceituais e déficit espacial. Entre os participantes com alterações cognitivas, foram frequentes as dificuldades conceituais e espaciais. Conclusão: A análise qualitativa do TDR pode contribuir para identificar alterações cognitivas. A escolaridade deve ser levada em consideração durante sua análise. .

Application of Clock Drawing Test in Differentiating Mild Cognitive Impairment from Alzheimer's Disease / 中国康复理论与实践

@#Objective To investigate the potential of the Clock Drawing Test (CTD) in differentiating the mild cognitive impairment (MCI) and Alzheimer's disease (AD). Methods Cognitive impaired patients admitted to the outpatient and inpatient of neurological department of our hospital from October 2011 to October 2013 were reviewed. There were 65 cases with MCI and 63 cases with AD. The scores of CDT were compared between them, and the sensitivity and specificity were evaluated with Receiver Operating Characteristic Curve. Results The MCI group and AD group matched in age, gender and education. The scores of Chinese version of the Mini-Mental State Examination and CDT were significantly defferent between the two groups. The sensitivity of 3-point CDT was 54.0% and the specificity was 80.9% in differentiating MCI and AD. Conclusion CDT is helpful to differentiate MCI from AD only in a set of assessment.

Application of Clock Drawing Test in Differentiating Mild Cognitive Impairment from Alzheimer's Disease / 中国康复理论与实践

Objective To investigate the potential of the Clock Drawing Test (CTD) in differentiating the mild cognitive impairment (MCI) and Alzheimer's disease (AD). Methods Cognitive impaired patients admitted to the outpatient and inpatient of neurological depart-ment of our hospital from October 2011 to October 2013 were reviewed. There were 65 cases with MCI and 63 cases with AD. The scores of CDT were compared between them, and the sensitivity and specificity were evaluated with Receiver Operating Characteristic Curve. Re-sults The MCI group and AD group matched in age, gender and education. The scores of Chinese version of the Mini-Mental State Examina-tion and CDT were significantly defferent between the two groups. The sensitivity of 3-point CDT was 54.0%and the specificity was 80.9%in differentiating MCI and AD. Conclusion CDT is helpful to differentiate MCI from AD only in a set of assessment.

Mapping the clockworks: what does the Clock Drawing Test assess in normal and pathological aging? / Mapeando as engrenagens: o que o Teste do Desenho do Relogio avalia no envelhecimento normal e patologico?

The Clock Drawing Test (CDT) is a cognitive screening tool used in clinical and research settings. Despite its role on the assessment of global cognitive functioning, the specific cognitive components required for test performance are still unclear. We aim to assess the role of executive functioning, global cognitive status, visuospatial abilities, and semantic knowledge on Shulman’s CDT performance. Fifty-three mild cognitive impairment, 60 Alzheimer’s dementia, and 57 normal elderly controls performed the CDT, the Frontal Assessment Battery, the Mini-Mental State Examination, the Stick Design Test, and a naming test (TN-LIN). An ordinal regression assessed specific neuropsychological influences on CDT performance. All the cognitive variables were related to the CDT, accounting for 53% of variance. The strongest association was between the CDT and executive functions, followed by global cognitive status, visuospatial processing, and semantic knowledge. Our result confirms the multidimensional nature of the test and the major role of executive functions on performance.

O Teste do Desenho do Relógio (TDR) é um instrumento de rastreio cognitivo amplamente usado em contextos clínicos e de pesquisa. Embora seu papel na avaliação do funcionamento cognitivo global seja reconhecido, os componentes específicos necessários à sua realização não são claros. Objetivo: avaliar a influência das funções executivas, estado cognitivo global, processamento visioespacial e conhecimento semântico no TDR. Realizaram o TDR, a Bateria de Avaliação Frontal, o Mini-Exame do Estado Mental, a Construção com Palitos, e um teste de nomeação (TN-LIN) 53 pacientes com comprometimento cognitivo leve, 60 com Alzheimer e 57 idosos normais.. A influência de variáveis neuropsicológicas específicas no TDR foi avaliada através de regressão ordinal. Todas as variáveis se relacionaram com o teste, respondendo por aproximadamente 53% da variância. A associação mais forte foi entre o TDR e as funções executivas, seguidas pela cognição geral, processamento visioespacial e conhecimento semântico. Nossos resultados confirmam a natureza multidimensional da tarefa e o papel das funções executivas em sua realização.

Clinical observation on changes of cognitive function in patients with cerebral microbleeds / 中华行为医学与脑科学杂志

Objective To investigate the relationship between the cerebral microbleeds (CMBs) and changes of cognitive function,and the possible mechanism of cognitive impairment caused by CMBs.Methods Sixty-eight micro-hemorrhage patients on susceptibility weighted imagine (SWI) sequences composed positive group,and sixty-eight patients selected without micro-hemorrhage in the SWI sequence and meeting the selection criteria as control group.At the same time,both two groups were assessed by MoCA and CDT scale inspection.Results CDT scores of CMBs group (2.00±0.88) were significantly lower than those of control group (3.76±0.53),and there was significantly different in the two groups (t=-3.27,P=0.00).At the same time,MoCA total scores and executive functions,naming,calculation,language,abstraction,recall scores of CMBs group were significantly lower than those of control group,and all of the groups were significantly different (t=-5.48,P=0.00; t=-4.36,P=0.00; t=-2.35,P=0.01 ; t=-2.49,P=0.02; t=-4.09,P=0.00; t=-4.63,P=0.00).CDT scores,MoCA total scores,executive functions,language,abstraction,memory scores between CMBs groups and control group were significantly different at all levels (P＜0.05).Executive functions,languages and calculated inter-group of mild CMBs,moderate CMBs,severe CMBs were significantly different (P＜0.05).The number of CMBs was negative correlation with total scores,executive function,language,and abstract (r=-0.675,P=0.000; r=-0.689,P=0.000; r=-0.536,P=0.000; r=-0.636,P=0.000).Conclusion The existence of CMBs and the number of CMBs are closely related to cognitive dysfunction.The more of CMBs,the more of obvious cognitive impairment.

Validity of Dementia Screening Test 'Korean Version of the Mini-Cog'

OBJECTIVE: The Mini-Cog, a composite of three word recall and clock drawing, was developed by Soo Borson as a brief test for discriminating demented from non-demented persons in a community sample. This study was conducted to prove the diagnostic validity of the Korean version of Mini-cog. METHODS: All 41 who met the criteria for probable dementia based on informant interviews and 88 with no history of cognitive decline were included. Sensitivity and, specificity of the Mini-Cog were compared with those of the Mini-Mental State Examination in the Korean version of the CERAD assessment packet (MMSE-KC), clock drawing test (CDT) and three word recall. RESULTS: The Mini-Cog had the higher sensitivity (86.11%) than MMSE-KC and fair specificity (72.09%). Cut off points of Mini-Cog was 2/3. AUC of Mini-Cog was 0.819 (p<0.001). The Mini-Cog required minimal training to administer and no test forms of scoring modifications. CONCLUSION: It suggests that the Mini-Cog might be readily incorporated into general practice and senior care setting as a routine cognitive measure.

Usefulness of clock drawing test in Filipino patients with schizophrenia

OBJECTIVES: To compare the Clock Drawing Test (CDT) performance of Filipino patients with schizophrenia and normal subjects in detecting cognitive impairment and to determine the correlation of symptom severity using Brief Psychiatric Rating Scale (BPRS) and Positive and Negative Syndrome Scale (PANSS) with the CDT performance among schizophrenic subjects.METHODOLOGY: A descriptive cross-sectional study using convenient sampling. Stable and compliant schizophrenic subjects were recruited at the psychiatry OPD of our institution from July to November 2004. Normal subjects were recruited from the community who were age,sex, and education matched. CDT and MMSE were administered to all the subjects and the scores of the two groups were compared using the two-tailed Student t-test. Symptom severity using BPRS and PANSS were correlated with CDT and Mini Mental Status Exam (MMSE) in schizophrenic subjects using the Pearson;s correlation coefficient.RESULTS: A total of 66 subjects, 33 schizophrenic and 33 normal subjects were included in the study. Schizophrenic subjects performed poorly on CDT and MMSE compared to the normal subjects. The difference between the mean scores was statistically significant. The examination errors on the clock drawing test was more apparent among schizophrenic subjects. There were positive correlations between CDT and MMSE, and BPRS and PANSS. Negative correlations were observed between the cognitive performance and the symptom severity of schizophrenia.CONCLUSION: Schizophrenic subjects performed poorly on CDT compared to the normal subjects, thus it is useful in detecting cognitive impairment. Likewise, CDT performance correlates well with symptom severity. Its availability and simplicity makes it very useful in detecting cognitive impairment in our clinical practice.

Correlation exploration between executive function and white matter lesions in patients with vascular dementia / 中华行为医学与脑科学杂志

Objective To explore the correlation between executive function and white matter lesions (WML) and the diagnostic value by clock drawing test(CDT) in patients with vascular dementia (VaD). Methods Twenty-seven VaD patients and twenty-five normal control subjects were evaluated with CDT to assess the executive function. CDT was scored according the four point method. Age-related white matter change rating scale (ARWMCrs) was used qualitatively to measure and locate the WML by cranial MRI scanning. Results 1. The scores of CDT in normal cognition health and VaD were ( 3.88 ± 0. 33 ) and ( 1.74 ± 0. 98 ). The difference between two groups was statistically significant (P＜0. 01 ). The humerous part and the point part were the earliest to decline in the VaD Patients. The scores of WML were (5.12 ± 4. 19) and ( 11.19± 3.09), respectively. There was significant difference between two groups(P ＜ 0. 01 ). The scores of CDT had significant positive correlation with MMSE scores and negative correlation with WML scores (P ＜ 0. 01 ). Conclusion The executive functional impairment in patients with VaD could be associated with the degree of WML.

Limitations in differentiating vascular dementia from Alzheimer's disease with brief cognitive tests / Limitações em diferenciar demência vascular de doença de Alzheimer através de testes cognitivos breves

OBJECTIVE: To investigate the diagnostic value of brief cognitive tests in differentiating vascular dementia (VaD) from Alzheimer's disease (AD). METHOD: Fifteen patients with mild VaD, 15 patients with mild probable AD and 30 healthy controls, matched for age, education and dementia severity, were submitted to the following cognitive tests: clock drawing (free drawing and copy), category and letter fluency, delayed recall test of figures and the EXIT 25 battery. RESULTS: VaD patients performed worse than AD patients in category fluency (p=0.014), letter fluency (p=0.043) and CLOX 2 (p=0.023), while AD cases performed worse than VaD patients in delayed recall (p=0.013). However, ROC curves for these tests displayed low sensitivity and specificity for the differential diagnosis between VaD and AD. CONCLUSION: Although the performance of VaD and AD patients was significantly different in some cognitive tests, the value of such instruments in differentiating VaD from AD proved to be very limited.

OBJETIVO: Investigar o valor diagnóstico de testes cognitivos breves na diferenciação de demência vascular (DV) e doença de Alzheimer (DA). MÉTODO: Quinze pacientes com DV, 15 com DA provável e 30 controles saudáveis, pareados em relação à idade, escolaridade e gravidade da demência, foram submetidos aos seguintes testes: desenho do relógio espontâneo e cópia, fluência verbal semântica e fonêmica, teste de evocação de memória de figuras e a bateria EXIT25. RESULTADOS: Pacientes com DV apresentaram pior desempenho na fluência verbal semântica (p=0,014), fonêmica (p=0,043), e no CLOX 2 (p=0,023). O grupo com DA obteve pior desempenho no teste de evocação tardia (p=0,013). As curvas ROC aplicadas a esses testes mostraram baixa sensibilidade e especificidade para o diagnóstico diferencial entre DV e DA. CONCLUSÃO: Embora o desempenho dos pacientes tenha sido diferente em alguns testes, o valor desses instrumentos para o diagnóstico diferencial entre DV e DA parece ser muito limitado.

Cognitive Function in Patients with First Lacunar Infarct / 中国康复理论与实践

@#Objective To evaluate the cognitive impairment and the related factors in patients after first lacunar infarct （LI）. Methods96 patients with LI and 40 controls were assessed with mini-mental state examination（MMSE）, digit span test （DST）, verbal fluency test （VFT）and clock drawing test （CDT）. ResultsThe scores of MMSE, DST, VFT and CDT were significantly lower in LI group than in control group (P＜0.05). Cognitive impairment occurred in 37 (38.5%) patients with LI after first stroke. The scores of MMSE, DST, VFT and CDT were lower in the patients with multiple infarcts than with single infarct (P＜0.05), and lower in patients with infarcts affecting the frontal lobe, thalamus and basal ganglia than affecting other area (P＜0.05). The scores of MMSE were lower in the patients with prior vascular risk factors than without risk factors (P＜0.05). ConclusionLacunar infarction usually leads to cognitive impairment. Cognitive function is associated with multiple infarcts, lesions affecting the frontal lobe, thalamus and basal ganglia and those with prior vascular risk factors.