Age and Graphomotor Decision Making Assessed with the Digital Clock Drawing Test: The Framingham Heart Study

Piers, Ryan J.; Devlin, Kathryn N.; Ning, Boting; Liu, Yulin; Wasserman, Burton S.; Massaro, Joseph M.; Lamar, Melissa; Price, Catherine C.; Swenson, Rod; Davis, Randall; Penney, Dana L.; Au, Rhoda; Libon, David J.

doi:10.3233/jad-170444

Cited by 46 publications

(43 citation statements)

References 30 publications

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“…Starting in 2011, using the academic version of proprietary software developed and patented by researchers at MIT and Lahey Hospital and Medical Center (U.S. patent number US 2008/9243933A1), FHS substituted use of a regular ballpoint pen with a digital pen for the Clock Drawing Test. The MIT/Lahey-owned software transforms the data captured by the digital pen into more than 1000 analyzable features that have been combined to reveal decision-making latencies and graphomotor characteristics that may serve as measures of underlying cognitive processes (Piers et al, under review; Souillard-Mandar et al, 2016; Cohen et al, 2014; Libon, Penney, et al, 2014), taking the BPA approach to a level of precision that hand scored BPA efforts cannot. For example, preliminary exploration of metrics obtained using the digital Clock Drawing Test (dCDT) suggests that information processing speed is not a single, all-encompassing construct (Piers, Devlin, et al, 2016).…”

Section: Bpa In the Current Decade (2010–2020)mentioning

confidence: 99%

“…Clinically relevant higher-order decision latencies include, but are not limited to: (1) the latency after drawing the clock face, (2) the latency before drawing the first hand, (3) the latency before drawing the second hand, and (4) the latency between drawing the numbers. The dCDT provides a rigorous, psychometrically objective assessment of the constructs underlying clock drawing behavior (Piers et al, under review). …”

Section: Bpa In the Current Decade (2010–2020)mentioning

confidence: 99%

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How technology is reshaping cognitive assessment: Lessons from the Framingham Heart Study.

Piers

Devine

2017

Neuropsychology

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Objective This article elucidates how the Boston Process Approach (BPA) can amplify the role of neuropsychology in the study of preclinical and clinical dementia, particularly Alzheimer’s disease (AD), and how advancements in technology expand BPA capacity objectively and exponentially. Method The BPA is based on a conceptualization of cognition as being comprised of multiple processes, the nature of which could not possibly be captured by a single score on a test or battery of tests. Identification of these processes is only possible with careful observation of an individual during the entire testing process to determine how, when, and why a person fails, which helps to reveal the integrity of the cognitive processes underlying the behavior. Results BPA use within the Framingham Heart Study is described, including how digital technology has been incorporated to enhance the sensitivity of BPA to detect insidious onset changes even earlier than had been previously possible. The digital technology movement will dramatically alter the means by which cognitive function is assessed going forward. Conclusions Technological advances will catalyze groundbreaking discoveries for effective treatments of neurodegenerative cognitive disorders, such as AD, and inform novel strategies for dementia prevention and sustained lifelong cognitive health.

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Section: Bpa In the Current Decade (2010–2020)mentioning

confidence: 99%

Section: Bpa In the Current Decade (2010–2020)mentioning

confidence: 99%

How technology is reshaping cognitive assessment: Lessons from the Framingham Heart Study.

Piers

Devine

2017

Neuropsychology

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“…Total time to completion is the time in seconds to draw all the elements of the clock, from the start of the first stroke to the completion of the final stroke. Total time to draw the face of a clock, put in all the numbers, and set the hands for 10 after 11 requires multiple cognitive domains, 1–4 increases with age, 12 and positively associates with increased prefrontal oxygen–hemoglobin recruitment 18. The copy condition requires less time and is a metric measuring executive and visuocon-struction measures.…”

Section: Methodsmentioning

confidence: 99%

“…The copy condition requires less time and is a metric measuring executive and visuocon-struction measures. 1–4,12…”

Section: Methodsmentioning

confidence: 99%

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Clock Drawing Performance Slows for Older Adults After Total Knee Replacement Surgery

Hizel

Warner

Wiggins

et al. 2019

Anesthesia &Amp; Analgesia

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BACKGROUND Clock drawing is a neurocognitive screening tool used in preoperative settings. This study examined hypothesized changes in clock drawing to command and copy test conditions 3 weeks and 3 months after total knee arthroplasty (TKA) with general anesthesia. METHODS Participants included 67 surgery and 66 nonsurgery individuals >60 years who completed the digital clock drawing test before TKA (or a pseudosurgery date), and 3 weeks and 3 months postsurgery. Generalized linear mixed models assessed digital clock drawing test latency (ie, total time to completion, seconds between digit placement) and graphomotor output (ie, total number of strokes, clock size). Reliable change analyses examined the percent of participants showing change beyond differences found in nonsurgery peers. RESULTS After adjusting for age, education, and baseline cognition, both digital clock drawing test latency measures were significantly different for surgery and nonsurgery groups, where the surgery group performed slower on both command and copy test conditions. Reliable change analyses 3 weeks after surgery found that total time to completion was slower among 25% of command and 21% of copy constructions in the surgery group. At 3 months, 18% of surgery participants were slower than nonsurgery peers. Neither graphomotor measure significantly changed over time. CONCLUSIONS Clock drawing construction slowed for nearly one-quarter of patients after TKA surgery, whereas nonsurgery peers showed the expected practice effect, ie, speed increased from baseline to follow-up time points. Future research should investigate the neurobiological basis for these changes after TKA.

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Reaction time and response inhibition in autosomal dominant Alzheimer’s disease

Medina

Woo

Rodríguez-Agudelo

et al. 2021

Brain and Cognition

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Age and Graphomotor Decision Making Assessed with the Digital Clock Drawing Test: The Framingham Heart Study

Abstract: Longer age-related decision making latencies may reflect a greater need for working memory and increased self-monitoring in older subjects. These latency measures have potential to serve as neurocognitive biomarkers of Alzheimer's disease and other insidious neurodegenerative disorders.

Cited by 46 publications

References 30 publications

How technology is reshaping cognitive assessment: Lessons from the Framingham Heart Study.

How technology is reshaping cognitive assessment: Lessons from the Framingham Heart Study.

Clock Drawing Performance Slows for Older Adults After Total Knee Replacement Surgery

Reaction time and response inhibition in autosomal dominant Alzheimer’s disease

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