바로가기메뉴

본문 바로가기 주메뉴 바로가기

logo

The Clock Drawing Test as a General Cognitive Function Screening Tool for Dementia: Quantitative and Qualitative Analyses

Abstract

The present study investigates the usefulness of the Clock Drawing Test(CDT) as a tool for the detection of cognitive impairment by examining the association between CDT performance and, the general cognitive function and each cognitive function evaluated by a neuropsychological battery(SNSB-D). Also, this study examines the efficiency of the CDT for differentiating control, mild cognitive impairment(MCI) and Alzheimer's disease(AD). The results of the quantitative analysis of CDT showed significant mean differences across three groups. In the results of the quality analysis of CDT, errors in all types except for size seem to be different in groups and errors in AD groups appear to be a more frequent than in other groups. We found that the CDT score was significantly correlated with the SNSB-D score. The discriminate accuracy of CDT was relatively low in differentiating the MCI from control group, but somewhat better in differentiating the AD from control group and in differentiating the AD from MCI group. This study showed CDT performance reflects general cognitive function and is a useful tool for assessing cognitive impairment. However, CDT is less adequate at differentiating MCI from control group, so if the CDT is used for MCI, there should be special consideration of this finding, with reference to the quantitative analysis of CDT or other screening tests.

keywords
Clock Drawing Test, Mild cognitive impairment, Dementia, Screening test, 시계 그리기 검사, 경도인지장애, 치매, 선별 검사

Reference

1.

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorder(4th ed.). Washington DC: American Psychiatric Press.

2.

Bassuk, S. S., & Murphy, J. M. (2003). Characteristics of the Modified Mini-Mental State Exam among elderly persons. Journal of Clinical Epidemiology, 56(7), 622-628.

3.

Beinhoff, U., Hilbert, V., Bittner, D., Gron, G., & Riepe, M. W. (2005). Screening for cognitive impairment: A triangle for outpatient care. Dementia and Geriatric Cognitive Disorders, 20(5), 278-285.

4.

Binetti, G., Magni, E., Padovani, A., Cappa, S. F., Bianchetti, A., & Trabucchi, M. (1996). Executive dysfunction in early Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 60, 91-93.

5.

Borson, S., Brush, M., & Gil, E. (1999). The clock drawing test: Utility for dementia detection in multiethnic elders. The Journals of Gerontology, 54(11), 534-540.

6.

Braekhus, A., Laake, K., & Engdal, K. (1995). A low, ‘normal’ score on the Mini Mental State Examination predicts development of dementia after three years. Journal of the American Geriatrics Society, 43(6), 656-661.

7.

Brodaty, H., & Moore, C. M., (1997). The clock drawing test for dementia of the Alzheimer’s type: A comparison of three scoring methods in a memory disorders clinic. International Journal of Geriatric Psychiatry, 12(6), 619-627.

8.

Cacho, J., Garcia-Garcia, R., Fernandez-Calvo, B., Gamazo, S., Rodriguez-Peres, R., Almeida, A., & Contador, I. (2005). Improvement pattern in the Clock Drawing Test in early Alzheimer’s disease. European Neurology, 53(3), 140-145.

9.

Chiu, Y. C., Li, C. L., Lin, K. N., Chiu, Y. F., & Liu, H. C. (2008). Sensitivity and specificity of the clock drawing test, incorporating Rouleau scoring system, as a screening instrument for questionable and mild dementia: Scale development. International Journal of Nursing Studies, 45(1), 75-84.

10.

Collie, A., & Maru, P. (2000). The neuropsychology of preclinical Alzheimer's disease and mild cognitive impairment. Neuroscience and Biobehavioral Reviews, 24(3), 365-374.

11.

Cummings, J., & Benson, D. F. (1992). Dementia a clinical approach(2nd ed.). Boston: Butterworths-Heinemann.

12.

Connor, D. J., Seward, J. D., Bauer, J. A., Golden, K. S., & Salmon, D. P. (2005). Performance of three clock scoring systems across Different ranges of dementia severity. Alzheimer Disease & Associated Disorders, 19 (3), 119-127.

13.

Flicker, C., Ferris, S. H., & Reisberg, B. (1991). Mild cognitive impairment in the elderly: Predictors of dementia. Neurology, 41, 1006 -1009.

14.

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). “Mini-Mental State Examination”: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189 -198.

15.

Freedman, M., Leach, L., Kaplan, E., Winocur, G., Schulman, K. I., & Delis, D. C., (1994). Clock drawing: A neuropsychological analysis. New York: Oxford University Press.

16.

Gauthier, S., Reisberg, B., Zaudig, M., Petersen, R. C., Ritchie, K., Broich, K., Belleville, S., Brodaty, H., Bennett, D., Chertkow, H., Cummings, J. L., de Leon, M., Feldman, H., Ganguli, M., Hampel, H., Scheltens, P., Tierney, M. C., Whitehouse, P., & Winblad, B. (2006). Mild cognitive impairment. Lancet, 367, 1262-1270.

17.

Harvan, J. R., & Cotter, V. (2006). An evaluation of dementia screening in the primary care setting. Journal of the American Academy of Nurse Practitioners, 18, 351-360.

18.

Hendriksen, C., Meier, D., Klitzing, W., Krebs, M., Ermini-Fünfschilling, D., & Stähelin, H. B. (1993). Early dementia and the clock drawing test. Poster presentation XVth Congress of the international Association of Gerontology, Budapest (Hungary).

19.

Kang, Y. S., Ha, J. Y., Kim, S. H., Lee, H. L., Park, W. M., & Lee, S. H. (1997). The usefulness of Clock Drawing Test as screening for dementia. The Journal of the Korean Academy of Family Medicine, 18(8), 785-792.

20.

Kang, Y. W., & Na, D. L. (2003). Seoul Neuropsychological Screening Battery(SNSB). InCheon: Human Brain Research & Consulting Co.

21.

Kim, H. Y. (2002). The normative study of the Clock Drawing Test in Korean elderly population. Unpublished master's thesis, Seoul National University, Seoul.

22.

Kitabayashi, Y., Ueda, H., Narumoto, J., Nakamura, K., Kita. H., & Fukui, K. (2001). Qualitative analyses of clock drawings in Alzheimer's disease and vascular dementia. Psychiatry and Clinical Neurosciences, 55(5), 485-491.

23.

Kuslansky, G., Buschke, H., Katz, M., Sliwinski, M., Lipton, R. B. (2002). Screening for Alzheimer's disease: The memory impairment screen versus the conventional three-word memory test. Journal of the American Geriatrics Society, 50(6), 1086-1091.

24.

Levey, A., Lah, J., Goldstein, F., Steenland, K., & Bliwise, D. (2006). Mild cognitive impairment: An opportunity to identify patients at high risk for progression to Alzheimer's disease. Clinical Therapeutics, 28 (7), 991-1001.

25.

Lezak M. D. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford University Press.

26.

Libon, D. J., Malamut, B. L., Swenson, R., Sands, L. P., & Cloud, B. S. (1996). Further analyses of clock drawing among demented and nondemented older subjects. Archives of Clinical Neuropsyology, 11(3), 193-205.

27.

Mashta, O. (2007). Number of people in UK with dementia will more than double by 2050. British Medical Journal, 334(7591), 447.

28.

Mendez, M. F., Ala, T., & Underwood, K. L. (1992). Development of scoring criteria for the clock drawing task in Alzheimer’s disease. Journal of the American Geriatrics Society, 40(11), 1095-1099.

29.

Mendez, M. F., & Cummings, J. L. (2003). Dementia: A clinical approach. Philadelphia: Elsevier.

30.

McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadian, E. M. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology, 34(7), 939-944.

31.

Ministry of Health & Welfare (2008). Nationwide study on the prevalence of dementia In Korean elders. Ministry of Health & Welfare.

32.

Morris, J. C. (1993). The clinical dementia rating(CDR): Current version and scoring rules. Neurology, 43(11), 2412-2414.

33.

Nøkleby, K., Boland, E., Bergersen, H., Schanke, A., Farner, L., Wagle, J., & Wyller, T. B. (2008). Screening for cognitive deficits after stroke: A comparison of three screening tools. Clinical Rehabilitation, 22, 1095-1104.

34.

Nunes, P. V., Diniz, B. S., Radanovic, M., Abreu, I. D., Borelli, D. T., Yassuda, M. S., & Forlenza, O. V. (2008). CAMCOG as a screening tool for diagnosis of mild cognitive impairment and dementia in a Brazilian clinical sample of moderate to high education. International Journal of Geriatric Psychiatry, 23(11), 1127-1133.

35.

Petersen, R. C., Doody, R., Kurz, A., Mohs, R. C., Morris, J. C., Rabins, P. V., Ritchie, K., Rossor, M., Thal, L., & Winblad, B. (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 58(12), 1985-1992.

36.

Peterson, R. C., Smith, G. E., & Waring, S. C. (1999). Mild cognitive impairment: Clinical characterization and outcome. Archives of Neurology, 56(3), 303-308.

37.

Peters, R., & Pinto, E. (2008). Predictive value of the Clock Drawing Test: A review of the literature. Dementia and Geriatric Cognitive Disorders, 26(4), 351-355.

38.

Pinto, E., & Peters, R. (2009). Literature review of the Clock Drawing Test as a tool for cognitive screening. Dementia and Geriatric Cognitive Disorders, 27(3), 201-213.

39.

Powlishta, K. K., Dras, V., & Stanford, A. (2002). The Clock Drawing Test is a poor screening for very mild dementia. Neurology, 59(6), 898-903.

40.

Rouleau, I., Salmon, D. P., Butters, N., Kennedy, C., & McGuire, K. (1992). Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease. Brain and Cognition, 18(1), 70-87.

41.

Royall, D. R., Cordes, J. A., & Polk, M. (1998). CLOX: An executive clock drawing task. Journal of Neurology, Neurosurgery, and Psychiatry, 64(5), 588-594.

42.

Schramm, U., Berger, G., Muller, R., Kratzsch, T., Peters, J., & Frölich, L. (2002). Psychometric properties of Clock Drawing Test and MMSE or Short Performance Test in dementia screening in a memory clinic population. International Journal of Geriatric Psychiatry, 17(3), 254-260.

43.

Shankle, W. R., Romney, A. K., Hara J., Fortier, D., Dick, M. B., Chen, J. M., Chan, T., & Sun, X. (2005). Methods to improve the detection of mild cognitive impairment. Proceedings of the National Academy of Sciences, 102(13), 4919-4924.

44.

Shulman, K. I. (2000). Clock-drawing: Is this the ideal cognitive screening test?. International Journal of Geriatric Psychiatry, 15 (6), 548-561.

45.

Spreen, O., & Strauss, E. (1998). A compendium of neuropsychological tests. administration, norms, and commentary(2nd ed.). New York: Oxford University Press.

46.

Thomann, P. A., Toro, P., Dos Santos, V., Essig, M., & Schröder, J. (2008). Clock drawing performance and brain morphology in mild cognitive impairment and Alzheimer's disease. Brain and Cognition, 67 (1), 88-93.

47.

Tuokko, H., Hadjistavropoulos, T., Miller, A., & Beattie, B. L. (1992). The clock test: A sensitive measure to differentiate normal elderly from those with Alzheimer disease. Journal of the American Geriatrics Society, 40 (6), 579-584.

48.

Umidi, S., Trimarchi, P., Corsi, M., Luzzati, C., & Annoni, G. (2009). Clock Drawing Test(CDT) in the screening of mild cognitive impairment(MCI). Archives of Gerontology and Geriatrics, 49, 227-229.

49.

Wimo, A., Winblad, B., & Grafstrom, M. (1999). The social consequences for families with Alzheimer's disease patients: Potential impact of new drug treatment. International Journal of Geriatric Psychiatry, 14(5), 338- 347.

logo