A comparison of five clock scoring methods using ROC (receiver operating characteristic) curve analysis.

OBJECTIVE: To compare the accuracy of five clock scoring methods for detecting dementia in English-speaking patients. DESIGN: A prospective cohort study. SETTING: A general geriatric outpatient clinic in southwest Sydney, Australia. PARTICIPANTS: A total of 127 consecutive new referrals to the clinic, of mean age 78.2 years. MEASUREMENTS: The clock drawing test was conducted at the beginning of each clinic appointment by a blinded observer. Each patient was then assessed by a geriatrician, who collected demographic data, administered the modified Barthel index, the geriatric depression scale, and the Folstein Mini-Mental State Examination, and categorised each patient as demented or not demented, according to DSM-4 criteria. Each clock was scored according to the methods of Mendez, Shulman, Sunderland, Watson and Wolf-Klein, and evaluated for reliability, and predictive accuracy, using receiver operating characteristic (ROC) curve analysis. RESULTS: The area under the ROC curve was largest for the Shulman (0.79, 95% CI 0.70-0.85) and Mendez (0.78, 95% CI 0.70-0.85) methods. Both predicted dementia more accurately than the Sunderland (area = 0.71) and Watson (area = 0.65) methods (p < 0.05). The inter-rater (0.81-0.93) and intra-rater (0.87-0.96) correlation coefficients were high for all five methods. CONCLUSIONS: While substantial differences among the clock scoring methods were evident in our sample, the accuracy of each was modest at best. Unless further studies in relevant settings suggest otherwise, we caution on the use of clock drawing alone to screen for dementia.

An enzymatic method (phospholipase B) for studies on cestode infection (Hymenolepis nana) and its suppression by chemotherapy.

The phospholipase B activity of the small intestine of mice infected with Hymenolepis nana has been studied to determine its value as a laboratory test for the presence of parasites and the chemotherapeutic effects of antitapeworm drugs. Mice infected with 500 H. nana eggs were examined on the 21st day of infection and the phospholipase B content of homogenates of small intestine was determined using lysolecithin (6.6 x 10(-3) M) as the substrate. Some of the infected animals were treated with niclosamide according to schedules and doses known to affect worm development. Presence or absence of parasites was verified by visual inspection of the intestinal content. The enzymatic and visual methods gave equivalent results in both infected-not treated and infected-treated groups. Special features of niclosamide action (relative refractoriness of the early parasitic forms, enhanced effect of multiple doses) have been confirmed. The enzymatic method is proposed as a procedure for laboratory testing in chemotherapeutic investigations.