The Tree Drawing Test in Evolution: An Explorative Longitudinal Study in Alzheimer’s Disease

Abstract

Objective To study the evolution of the Tree Drawing Test (TDT) in a group of Alzheimer’s disease (AD) patients. Methods A total of 33 AD patients were consecutively evaluated by Mini Mental State Evaluation (MMSE) and TDT. The evolution of the TDT parameters, trunk-to-crown (TC) and space occupation (SO) index, were analyzed. Results The median age at first visit was 79 years. Globally, trees drawn by patients showed an evolution characterized by a progressive reduction of the crown compared to the trunk. TC index showed a significant linear growth change (2.52 points per year) while SO index did not significantly increase. No significant associations were found examining the relations between MMSE and TC and SO index. Conclusions TDT could represent a complementary technique to the main neuropsychological screening tests for orienting cognitive impairment diagnosis and an aid in following the evolution of cognitive impairment over time in AD patients.

“Build Your Village”—Conducting the Village Test on Cognitively Impaired Patients: A First Journey into Alzheimerland

“…In the last few years, it has been shown that other simple projective techniques, like the Tree Drawing Test (TDT), the Human Figure Drawing Test (HFDT), and The House Drawing Test, can be used in an attempt to discriminate patients suffering from AD from those with MCI and healthy subjects [ 3 , 4 , 6 , 7 , 8 ]. In particular, trees drawn by AD patients are significantly smaller compared to those drawn by MCI and healthy subjects, and they are poorly detailed, with a smaller crown compared to the trunk, while MCI patients draw trees intermediate in size between AD patients and healthy subjects.…”

“…Compared to our previous works related to the study of the TDT and the HFDT in AD patients, in this case, our patient sample was studied by means of an extensive battery of neuropsychological tests exploring specific cognitive functions and global cognitive functioning, instead of an analysis limited only to the assessment of global cognition through the MMSE [ 3 , 4 , 6 ]. Neuropsychological assessment clearly distinguishes AD and MCI patient groups from normal subjects, although the difference between MCI patients and controls is smaller, especially in constructional praxis.…”

“…Recently, a complementary method to the traditional conception of screening cognitively impaired patients was proposed, based on projective techniques currently used in the study of personality, especially in those cases where a neuropsychological screening evaluation is not clearly unambiguous [ 3 , 4 , 5 , 6 , 7 , 8 ]. In fact, personality can be used not only to determine and condition patients’ behavioral disorders, but also to represent the background on which individual cognitive functioning has organized and developed.…”

“…These latter types of tests are generally easier to perform with cognitively impaired patients, facilitating the unconscious expression of affection and personality. In this sense, we have previously described the use of two projective personality tests, such as the Tree Drawing Test (TDT) and the Human Figure Drawing Test (HFDT), to show the possibility of differentiating patients with AD from those with mild cognitive impairment (MCI) and healthy subjects [ 3 , 4 , 6 ].…”