Clock drawing and neuroanatomical correlates: A systematic review

Abstract

Objective The popular clock drawing test (CDT) is easy to administer, acceptable to patients, and has excellent psychometric properties. Although it has been used primarily as a cognitive screening test, many studies have attempted to establish the CDT's ability to localize specific brain lesions or pathology. This systematic review aimed to summarize the evidence on the neuroanatomical correlates of the CDT. Methods Using PRISMA guidelines, the authors systematically reviewed the evidence on neuroanatomical correlates of clock drawing by a systematic search in six databases (Pubmed, CINHL, PsychINFO, HealthStar, Embase, and Web of Science) until January 2018. Studies were included if they reported CDT correlations with anatomical brain lesions documented by neuroimaging. Results Forty‐five papers met inclusion criteria. Thirty‐one studies identified distinct areas of neuroanatomical correlates of CDT utilizing different scoring methods and imaging techniques. Nine articles reported on the degree of white matter hyperintensities that correlated with lower scores on CDT and the severity of cognitive deficits. Five articles focused on postacute cerebrovascular accidents correlated with CDT performance. A variety of different anatomical lesions, located in all areas of the brain, were associated with abnormalities on the CDT. Conclusions The CDT, regardless of scoring method and population studied, was not associated with any consistent, specific brain localization. This systematic review supports the use of the CDT as a cognitive screening test rather than a method of localizing brain lesions.

Diagnostic performance and neural basis of the combination of free‐ and pre‐drawn Clock Drawing Test

“…Group 3 (impaired in the pre‐drawn CDT) was associated with GM volume reduction in the right middle and inferior temporal gyri. These results are consistent with a previous review that suggested the involvement of various brain regions in CDT, among which the bilateral temporal lobes have been implicated in many papers 18 …”

“…Group 3 was suggested to be related to GM volume reduction in the right temporal gyrus. A previous systematic review reported the involvement of various brain regions in the performance of pre‐drawn CDT 18 . Some papers have highlighted the neurological correlation between CDT failure and the right inferior temporal gyrus, right superior temporal gyrus, and fusiform gyrus 13,15,16 .…”

“…Age is suggested to have a negative correlation with the functions of the occipital and parietal lobes, which could contribute to poor CDT performance 17 . However, a systematic review demonstrated that specific brain regions were not detected as neural correlates of CDT, and various brain regions were involved in CDT performance 18 . Since the different scoring and administration systems of CDT could detect different areas of brain damage, 13,19,20 the combination of different administration systems of CDT could detect broader brain damage.…”

Understated Cognitive Impairment Assessed with the Clock-Drawing Test in Community-Dwelling Individuals Aged ≥50 Years

“…However, this type of association was expected because according to the literature data, the presence of white matter hyperintensities is associated with lower CDT scores. 43 It may be that the low prevalence of severe WMLs in our study population prevented us from observing an association. Conversely, we confirmed that impaired CDT performance is associated with a higher Scheltens score, a hallmark of hippocampal atrophy 44 usually associated with poor episodic memory, especially in Alzheimer's disease.…”

Non-Cognitive Characteristics of Older Adults With Mild Cognitive Impairment And Errors On The Clock Drawing Test

“…Grip strength is also reported to be associated with cognition (9). Moreover, although the association between white matter lesions (WMLs) on magnetic resonance images (MRI) and cognitive decline is well established (10), and these lesions are reported to be associated with lower CDT scores (11), it is not known whether CDT errors are associated with WMLs.…”