Is the Clock Drawing Test Appropriate for Screening for Mild Cognitive Impairment? – Results of the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)

Ehreke, Lena; Luppa, Melanie; Luck, Tobias; Wiese, Birgitt; Weyerer, Siegfried; Eifflaender-Gorfer, Sandra; Weeg, Dagmar; Olbrich, Julia; Bussche, Hendrik van den; Bachmann, Cadja; Eisele, Marion; Maier, Wolfgang; Jessen, Frank; Wagner, Michael; Fuchs, Ângela; Pentzek, Michael; Angermeyer, Matthias C.; König, Hans‐Helmut; Riedel‐Heller, Steffi G.

doi:10.1159/000253484

Cited by 26 publications

(13 citation statements)

References 60 publications

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“…The positive predicted value was 95.0%, which represents the probability of cognitive dysfunction for positive test results, and the negative predictive value was 88.2%, which represents the probability of cognitive function being normal for negative test results; these values were based on a cutoff of 10 points. The CDT is believed to be useful in assessments and interventions based on its excellent ability to identify cognitive impairment 6 , 13 , 14 , 15 ) .…”

Section: Discussionmentioning

confidence: 99%

Clinical usefulness of the clock drawing test applying rasch analysis in predicting of cognitive impairment

Yoo

Lee

2016

J Phys Ther Sci

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[Purpose] This study examined the clinical usefulness of the clock drawing test applying Rasch analysis for predicting the level of cognitive impairment. [Subjects and Methods] A total of 187 stroke patients with cognitive impairment were enrolled in this study. The 187 patients were evaluated by the clock drawing test developed through Rasch analysis along with the mini-mental state examination of cognitive evaluation tool. An analysis of the variance was performed to examine the significance of the mini-mental state examination and the clock drawing test according to the general characteristics of the subjects. Receiver operating characteristic analysis was performed to determine the cutoff point for cognitive impairment and to calculate the sensitivity and specificity values. [Results] The results of comparison of the clock drawing test with the mini-mental state showed significant differences in according to gender, age, education, and affected side. A total CDT of 10.5, which was selected as the cutoff point to identify cognitive impairement, showed a sensitivity, specificity, Youden index, positive predictive, and negative predicive values of 86.4%, 91.5%, 0.8, 95%, and 88.2%. [Conclusion] The clock drawing test is believed to be useful in assessments and interventions based on its excellent ability to identify cognitive disorders.

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Section: Discussionmentioning

confidence: 99%

Clinical usefulness of the clock drawing test applying rasch analysis in predicting of cognitive impairment

Yoo

Lee

2016

J Phys Ther Sci

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“…Yet, these physicians often complain about the lack of suitable instruments and time to assess cognition. Alas, the CDT has proved to be difficult to assess in the primary care setting (Ehreke et al, 2009). In Italy, as in many other countries, the CDT and MMSE are commonly used in combination as "first line tests" for dementia evaluation by both neurologists and primary care physicians.…”

Section: Discussionmentioning

confidence: 99%

A Quick Test of Cognitive Speed: norm-referenced criteria for 121 Italian adults aged 45 to 90 years

Petrazzuoli

Palmqvist

Thulesius

et al. 2014

Int. Psychogeriatr.

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Background: A Quick Test of Cognitive Speed (AQT) is a brief test that can identify cognitive impairment. AQT has been validated in Arabic, English, Greek, Japanese, Norwegian, Spanish, and Swedish. The aim of this study was to develop Italian criterion-referenced norms for AQT. Methods: AQT consists of three test plates where the patient shall rapidly name (1) the color of 40 blue, red, yellow, or black squares (AQT color), (2) the form of 40 black figures (circles, squares, triangles, or rectangles; AQT form), (3) the color and form of 40 figures (consisting of previous colors and forms; AQT color-form). The AQT test was administered to 121 Italian cognitively healthy primary care patients (age range: 45-90 years). Their mean Mini-Mental State Examination (MMSE) score was 28.8 ± 0.9 points (range 26-30 points). AQT naming times in seconds were used for developing preliminary criterion cut-off times for different age groups. Results: Age was found to have a significant moderate positive correlation with AQT naming times color (r = 0.65, p < 0.001), form (r = 0.53, p < 0.001), color-form (r = 0.63, p < 0.001) and a moderate negative correlation with MMSE score (r = -0.44, p < 0.001) and AQT naming times differed significantly between younger (45-55 years old), older (56-70 years old), and the oldest (71-90 years old) participants. Years of education correlated positively but weakly with MMSE score (r = 0.27, p = 0.003) and negatively but weakly with AQT color (r = -0.16, p = ns), form (r = -0.24, p = 0.007), and color-form (r = -0.19, p = 0.005). We established preliminary cut-off times for the AQT test based on +1 and +2 standard deviations according to the approach in other languages and settings. Conclusions: This is the first Italian normative AQT study. Future studies of AQT - a test useful for dementia screening in primary care - will eventually refine cut-off times for normality balancing sensitivity and specificity in cognitive diagnostics.

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“…The CDT has a high sensitivity and specificity for the detection of Alzheimer’s dementia (AD) [10], but a poor sensitivity for the detection of amnestic MCI (aMCI) [11,12,13,14,15,16] that is assumed to reflect the prodromal stage of AD [17]. Cognitive processes involved in CD seem to be impaired quite late when AD has already manifested.…”

Section: Introductionmentioning

confidence: 99%

Clock Test Deficits Related to the Global Cognitive State in Alzheimer’s and Parkinson’s Disease

Saur

Maier²,

Milian³

et al. 2012

Dement Geriatr Cogn Disord

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Background/Aims: Clock drawing (CD) seems to be impaired quite early in the process of cognitive decline in Parkinson’s disease (PD). Methods: We assessed performance on the CD test (CDT), clock setting test (CST) and clock reading test (CRT) in 32 elderly healthy controls, 41 patients with PD, 23 patients with amnestic mild cognitive impairment (aMCI) and 40 patients with Alzheimer’s dementia (AD). Our focus was on comparing the performance of PD and aMCI/AD patients in relation to their global cognitive states (operationalized by the Mini Mental Status Examination). We also analyzed qualitative differences in errors of drawing, setting and reading clocks. Results: We found that performance in CDT, but not in the CST or CRT, was impaired earlier in PD than in aMCI/AD. Incorrect placement of the minute hand was the most prominent error in both patient groups. We found no specific influence of visuospatial dysfunction in PD on clock drawing. Conclusion: Our findings suggest that executive function related to retrieval of semantic memory about the minute hand is compromised early in PD.

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Is the Clock Drawing Test Appropriate for Screening for Mild Cognitive Impairment? – Results of the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)

Cited by 26 publications

References 60 publications

Clinical usefulness of the clock drawing test applying rasch analysis in predicting of cognitive impairment

Clinical usefulness of the clock drawing test applying rasch analysis in predicting of cognitive impairment

A Quick Test of Cognitive Speed: norm-referenced criteria for 121 Italian adults aged 45 to 90 years

Clock Test Deficits Related to the Global Cognitive State in Alzheimer’s and Parkinson’s Disease

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