Does the Combination of the MMSE and Clock Drawing Test (Mini-Clock) Improve the Detection of Mild Alzheimer's Disease and Mild Cognitive Impairment?

Abstract

There is currently a need to develop tools to identify patients with mild AD and mild cognitive impairment (MCI). We determined the validity and reliability of a brief, easily administered cognitive screening battery consisting of fusion of two well-known brief tests (Mini-Mental Status Examination [MMSE] and Clock Drawing Test [CDT]) (Mini-clock) to differentiate between patients with mild AD, MCI, and healthy control subjects. 66 consecutive patients with mild AD, 21 with MCI, and 66 healthy controls seen in a memory clinic setting were compared. Receiver operating characteristic (ROC) curve analysis was used to calculate the cut-off value permitting discrimination between mild AD, MCI, and healthy control subjects. Interrater and test-retest reliability were also assessed. Mean cognitive scores for patients with AD, MCI, and control subjects on all two individual tests were significantly different (for each, p < 0.001). The mean area under the ROC curve for Mini-clock was higher than that obtained with MMSE or CDT in differentiating mild AD from controls (0.973 vs. 0.952 and 0.881, respectively) and MCI from controls (0.855 vs. 0.821 and 0.779, respectively). Test-retest reliability for the Mini-clock was 0.99, meanwhile interrater reliability was 0.87. The mean time to complete the test for all subjects was 8 min and 50 s. The Mini-clock is highly sensitive and specific in the detection of mild AD and reasonably accurate when attempting to separate MCI from health controls. It has a high interrater and test-retest reliability, can be quickly administered, and does not require major training.

Clock Drawing Test and the diagnosis of amnestic mild cognitive impairment: Can more detailed scoring systems do the work?

“…However, such a comprehensive evaluation of cognitive state is available only to a small proportion of the patients in need, since such evaluations are provided mostly at specialized memory clinics. Therefore, determining an accurate screening method for MCI, which could serve as a preselection of the persons at higher risk, has been the subject of many research studies in the past decade (Cacho et al, 2010;Ehreke, Luppa, König, & RiedelHeller, 2010;Ladeira, Diniz, Nunes, & Forlenza, 2009;Nasreddine et al, 2005;Nishiwaki et al, 2004;Peters, 2009). There is no consensus regarding which test should be used, but several candidate instruments are available.…”

Testing Older Adults for Signs of Age-Related Cognitive Decline: Clock Drawing Test vs.Mini-Mental State Examination

“…MMSE asks questions that assess 5 areas of cognitive functioning (i.e., orientation, immediate memory, attention/concentration, delayed recall, language) (Shigemori, Ohgi, Okuyama, Shimura, & Schneider, 2010). The results of a few surveys indicate that the MSSE has become the most commonly used cognitive test by the health professionals such that approximately 9 out of 10 experts have reported using the test predominantly (Cacho et al, 2010). Farmer and his colleagues (1995) showed that in elderly people with baseline MMSE>23, education was a significant predictor of cognitive decline, not only in the elderly but also in younger participants.…”

“…MMSE is a commonly used screening tool for cognitive impairment in older adults. The test can be used to distinguish between older adults with and without neuropsychiatric disorders and as a follow up test to measure the progress of the disorder across time (Cacho et al, 2010). MMSE asks questions that assess 5 areas of cognitive functioning (i.e., orientation, immediate memory, attention/concentration, delayed recall, language) (Shigemori, Ohgi, Okuyama, Shimura, & Schneider, 2010).…”

Neuropsychological Status of Heroin Users Undergoing Methadone Maintenance in Harm Reduction Program and Therapeutic Community

“…The CDT has shown good sensitivity in discriminating mild cognitive impairment (sensitivity = 0.76; Cacho et al 2010) and Alzheimer's disease (sensitivity=0.81; Schramm et al 2002).…”