Three Times of the Clock Drawing Test Rated with BaJa Scoring in Patients with Early Alzheimer‘s Disease


Authors: A. Bartoš 1,2,3;  M. Janoušek 1,3;  R. Petroušová 1;  M. Hohinová 3
Authors‘ workplace: Neurologická klinika 3. LF UK a FN Královské Vinohrady, Praha 1;  Národní ústav duševního zdraví, Klecany 2;  AD Centrum, Praha 3
Published in: Cesk Slov Neurol N 2016; 79/112(4): 406-412
Category: Original Paper

Overview

Aim:
The Clock Drawing Test (CDT) is a popular screening test to detect of dementia. The aim of the present research was to determine the role of the test in diagnosing early stages of Alzheimer‘s disease (AD).

Patients and methods:
The Mini-Mental State Examination (MMSE) and the CDT with three times 11:10, 23:20 and 5:40 were examined in 77 cognitively normal seniors (NOS) and in 77 patients diagnosed with early AD according to NIA-AA criteria. All CDTs were scored according to the instructions in the Addenbrooke´s and Montreal cognitive tests (ACE, MoCA), Shulman´s system and by our newly developed BaJa system with five dichotomous questions and 0–5 scale.

Results:
MMSE and CDT scores with any of the three times (11:10, 23:20, 5:40) assessed by any system were significantly lower for the early AD patients than for the NOS group (p < 0.01). The 23:20 was significantly more difficult than 11:10 for all participants (p = 0.003). A comparison of patients and NOS for three times of the CDT showed a cut-off score for BaJa ≤ 4 points, sensitivity 54–65%, specificity of 59–75% and the area under the receiver operating curve (AUC) around 0.7. The MMSE cut-off score ≤ 27 points was associated with higher sensitivity of 86%, specificity 96% and AUC 0.96. There were no differences between the four CDT scoring systems with respect to AUCs.

Conclusion:
Although the CDT with 23:20 is more difficult than the other times, the CDT in general is not useful for early detection of AD due to its low sensitivity and specificity, regardless of what time or scoring system is used.

Key words:
Clock Drawing Test – Mini-Mental State Examination – mild cognitive impairment –Alzheimer‘s disease – dementia screening – test – diagnosis

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Bartoš A, Raisová M. Testy a dotazníky pro vyšetřování kognitivních funkcí, nálady a soběstačnosti. Praha: Mladá fronta 2015.

2. Preiss M. Test hodin. Neuropsychologická screeningová zkouška. Čes a Slov Psychiat 1998;94(6):330– 5.

3. Sunderland T, Hill JL, Mel­low AM, et al. Clock draw­ing in Alzheimer’s disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37(8):725– 9.

4. Ismail Z, Rajji TK, Shulman KI. Brief cognitive screen­ing instruments: an update. Int J Geriatr Psychiatry 2010;25(2):111– 20. doi: 10.1002/ gps.2306.

5. Res­sner P, Res­snerová E. Test hodin, přehledná informace a zhodnocení škál dle Shulmana, Sunderlanda a Hendriksena. Neurol pro Praxi 2002;6:316– 22.

6. Shulman KI. Clock-drawing: is it the ideal cognitive screen­ing test? Int J Geriatr Psychiatry 2000;15(6):548– 61.

7. Shulman KI, Gold DP, Cohen CA, et al. Clock-draw­ing and dementia in the com­munity: a longitudinal study. Int J Geriatr Psychiatry 1993;8:487– 96.

8. Babins L, Slater ME, Whitehead V, et al. Can an 18--point clock-draw­ing scor­ing system predict dementia in elderly individuals with mild cognitive impairment? J Clin Exp Neuropsychol 2008;30(2):173– 86. doi: 10.1080/ 13803390701336411.

9. Cohen MJ, Ricci CA, Kibby MY, et al. Developmental progres­sion of clock face draw­ing in children. Child Neuropsychol 2000;6(1):64– 76.

10. Mainland BJ, Amodeo S, Shulman KI. Multiple clock draw­ing scor­ing systems: simpler is better. Int J Geriatr Psychiatry 2014;29(2):127– 36. doi: 10.1002/ gps.3992.

11. Pinto E, Peters R. Literature review of Clock draw­ing test as a tool for cognitive screening. Dement Geriatr Cogn Disord 2009;27:201– 13. doi: 10.1159/ 000203344.

12. Lonie JA, Tierney KM, Ebmeier KP. Screen­ing for mild cognitive impairment: a systematic review. Int J Geriatr Psychiatry 2009;24(9):902– 15. doi: 10.1002/ gps.2208.

13. Ehreke L, Luppa M, König HH, et al. Is the Clock Draw­ing Test a screen­ing tool for dia­gnosis of mild cognitive impairment? A systematic rewiev. Int Psychogeriatr 2010;22(1):56– 63. doi: 10.1017/ S1041610209990676.

14. Nasreddine ZS, Phil­lips NA, Bédirian V, et al. The Montreal Cognitive As­ses­sment, MoCA: a brief screen­ing tool for mild cognitive impairment. J Am Geriatr Soc 2005;53(4):695– 9.

15. Bartoš A, Orlíková H, Raisová M, et al. Česká tréninková verze Montrealského kognitivního testu (MoCA-CZ1) k časné detekci Alzheimerovy nemoci. Cesk Slov Neurol N 2014;77/ 110(5):587– 95.

16. Orlíková H, Bartoš A, Raisová M, et al. Montrealský kognitivní test (MoCA) k záchytu mírné kognitivní poruchy a časné Alzheimerovy nemoci. Psychiatrie 2014;18(1):18– 25.

17. Mioshi E, Dawson K, Mitchell J, et al. The Addenbrooke‘s Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 2006;21(11):1078– 85.

18. García-Cabal­lero A, Recimil MJ, García-Lado I, et al. ACE clock scoring: a comparison with eight standard cor­rection methods in a population of low educational level. J Geriatr Psychiatry Neurol 2006;19(4):216– 9.

19. Bartoš A, Raisová M, Kopeček M. Novelizace české verze Addenbrookského kognitivního testu (ACE-CZ). Cesk Slov Neurol N 2011;74/ 107(6):681– 4.

20. Bartoš, A, Raisová M, Kopeček M. Důvody a průběh novelizace české verze Addenbrookského kognitivního testu (ACE-CZ). Cesk Slov Neurol N 2011;74/ 107(6):1– 5.

21. Hum­melová-Fanfrdlová Z, Rektorová I, Sheardová K, et al. Česká adaptace Addenbrookského kognitivního testu (Addenbrooke’s Cognitive Examination). Cesk Psychol 2009;4:376– 88.

22. Vyhnálek M, Bartoš A, Dostál V, et al. Dia­gnostikujeme a léčíme demence správně a včas? Výsledky průzkumu ve světle nových doporučení. Psychiatr Prax 2012;13(1):19– 24.

23. Sheardová K, Hort J, Rektorová I, et al. Dementia dia­g­nosis and treatment in Czech neurological and psychiatric practices. Cesk Slov Neurol N 2012;75/108(2):208– 11.

24. Price CC, Cun­ningham H, Coronado N, et al. Clock draw­ing in the Montreal cognitive as­ses­sment: recom­mendations for dementia as­ses­sent. Dement Geriatr Cogn Disord 2011;31:179–87.

25. Powlishta KK, Von Dras DD, Stanford A, et al. The clock draw­ing test is a poor screen for very mild dementia. Neurology 2002;59(6):898– 903.

26. Lee H, Swanwick GR, Coen RF, et al. Use of the clock draw­ing task in the dia­gnosis of mild and very mild Alzheimer’s disease. Int Psychogeriatr 1996;8(3):469–76.

27. Ehreke L, Luck T, Luppa M, et al. Clock draw­ing test –  screen­ing utility for mild cognitive impairment accord­ing to dif­ferent scor­ing systems: results of the Leipzig Longitudinal Study of the Aged (LEILA 75+). Int Psychogeriatr 2011;23(10):1592– 601. doi: 10.1017/ S104161021100144X.

28. Nishiwaki Y, Breeze E, Smeeth L, et al. Validity of the Clock-Draw­ing Test as a screen­ing tool for cog­nitive impairment in the elderly. Am J Epidemiol 2004;160(8):797– 807.

29. Rubinova E, Nikolai T, Markova H, et al. Clock Draw­ing Test and the dia­gnosis of amnestic mild cognitive impairment: can more detailed scor­ing systems do the work? J Clin Exp Neuropsychol 2014;36(10):1076– 83. doi: 10.1080/ 13803395.2014.977233.

30. Yamamoto S, Mogi N, Umegaki H, et al. The clock draw­ing test as a valid screen­ing method for mild cog­nitive impairment. Dement Geriatr Cogn Disord 2004;18(2):172– 9.

31. Patocskai AT, Pakaski M, Vincze G, et al. Is there any dif­ference between the findings of Clock Draw­ing Tests if the clocks show dif­ferent times? J Alzheimers Dis 2014;39(4):749– 57. doi: 10.3233/ JAD-131313.

32. Folstein MF, Folstein SE, McHugh PR. „Mini-mental state.“ A practical method for grad­ing the cognitive state of patients for the clinician. J Psychiatr Res 1975;12(3):189– 98.

33. Albert MS, DeKosky ST, Dickson D, et al. The dia­gnosis of mild cognitive impairment due to Alzheimer’s disease: recom­mendations from the National Institute on Aging-Alzheimer’s As­sociation workgroups on dia­gnostic guidelines for Alzheimer’s disease. Alzheimers Dement 2011;7(3):270– 9. doi: 10.1016/ j.jalz.2011.03.008.

34. McKhann GM, Knopman DS, Chertkow H, et al. The dia­gnosis of dementia due to Alzheimer’s disease: recom­mendations from the National Institute on Aging-Alzheimer’s As­sociation workgroups on dia­gnostic guidelines for Alzheimer’s disease. Alzheimers Dement 2011;7(3):263– 9. doi: 10.1016/ j.jalz.2011.03.005.

35. Bartoš A. Kdy vlastně začíná Alzheimerova nemoc –  nová kritéria mírné kognitivní poruchy a Alzheimerovy nemoci. Cesk Slov Neurol N 2012;75/ 108(1):108– 9.

36. Bartoš A, Čechová L, Švarcová J, et al. Likvorový triplet (tau proteiny a beta-amyloid) v dia­gnostice Alzheimerovy-Fisherovy nemoci. Cesk Slov Neurol N 2012;75/ 108(5):587– 94.

37. Bartoš A, Píchová R, Trojanová H, et al. SPECT mozku v dia­gnostice Alzheimerovy nemoci. Psychiatrie 2008;12(Suppl 3):8– 11.

38. Bartoš A, Zach P, Diblíková F, et al. Vizuální kategorizace mediotemporální atrofie na MR mozku u Alzheimerovy nemoci. Psychiatrie 2007;11(Suppl 3):49– 52.

39. Dušek L, Pavlík T, Koptíková J. Analýza dat v neurologii VI. Přesnost, spolehlivost a reprodukovatelnost měření u diskrétních dat. Cesk Slov Neurol N 2007;70/ 103(6):719– 21.

40. Mittal C, Gorthi CS, Rohatgi MG. Early cognitive impairment: role of clock draw­ing test. MJAFI 2010;66:20– 8.

41. Scanlan JM, Brush M, Quijano C, et al. Compar­ing clock tests for dementia screening: naive judgements vs. formal systéme –  what is optimal? Int J Geriatr Psychiatry 2002;17(1):14– 21.

42. Schramm U, Berger G, Mül­ler R, et al. Psychometric properties of Clock draw­ing test and MMSE or Short Performance Test (SKT) in dementia screen­ing in a memory clinic population. Int J Geriatr Psychiatry 2002;17(3):254– 60.

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