A comparison of five clock scoring methods using ROC (receiver operating characteristic) curve analysis

Storey, Joella E.; Rowland, Jeffrey; Basic, David; Conforti, David

doi:10.1002/gps.352

Cited by 66 publications

(77 citation statements)

References 26 publications

(25 reference statements)

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“…Stuss states that cognitive screening tests must be formally compared to effectively choose between them (16). (Various studies that have done this [16][17][18] favour comparisons using receiver-operating characteristics [ROC], because these are better measures of performance when cut-off points are not standard or do not apply to a given sample. )…”

Section: Conceptual and Methodological Issues In Evaluating Screeningmentioning

confidence: 99%

“…Numerous guidelines have been proposed for scoring both the quantitative and qualitative aspects of clock drawings (22,(24)(25)(26)(27)(28), and several papers have directly compared various CDT methods (18,21,(29)(30)(31). Overall, the Shulman and Mendez methods, included in most comparison studies, have proven among the most reliable, but still modest, predictors of dementia, with ROC analyses giving areas under the curve of 0.79 for the Shulman and 0.78 for the Mendez (18). Royall compared several CDTs to a version explicitly designed to reflect executive control (CLOX 1), finding good correlations with scores on the MMSE and an interview measure of executive dysfunction (30).…”

Section: Very Short Screens (0 To 2 Minutes)mentioning

confidence: 99%

“…Borson reported that the CERAD CDT did better than the MMSE and the Cognitive Abilities Screening Instrument in detecting dementia in poorly-educated Englishspeaking subjects, but its overall performance was not adequate for dementia screening (32). Storey reached a similar conclusion, finding that CDTs should not be used alone as the sole dementia screening test (18).…”

Section: Very Short Screens (0 To 2 Minutes)mentioning

confidence: 99%

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Brief Screening Tests for Dementia

2002

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Objective: To compare brief dementia screening tests as candidates for routine use in primary care practice. Method:We selected screening tests that met 2 criteria: 1) administration time of 10 minutes or less in studies including individuals with, and without, dementia; and 2) performance characteristics evaluated in at least 1 community or clinical sample of older adults. We compared tests for face validity, sensitivity, and specificity in a clearly defined subject sample; for vulnerability to sociodemographic biases unrelated to dementia; for direct comparison with an accepted standard; for acceptability to patients and doctors; and for brevity and ease of administration, scoring, and interpretation by nonspecialists.Results: Thirteen instruments met our inclusion criteria. Very short tests (1 minute or less) proved unacceptable by several criteria. Standard instruments requiring more than 5 minutes to complete, including the best-studied Mini-Mental State Examination (MMSE), were found to be too long for routine application. Several failed other performance tests or could not be adequately assessed. Short tests taking between 2 and 5 minutes that can be administered by nonspecialists with little or no training and are relatively unbiased by language and education level appear to be superior to both shorter and longer instruments. Conclusions:Three tests showed the most promise for broad application in primary care settings: the Mini-Cog, the Memory Impairment Screen, and the General Practitioner Assessment of Cognition (GPCOG). Formal practice intervention trials are now needed to validate the utility of short screens with regard to implementation, effect on rates of diagnosis and treatment of dementia patients, and outcomes for patients, families, and health care systems. Clinical Implications · Methods currently exist that can likely improve recognition of dementia in elderly primary care patients. · No single dementia screening tool has been shown to pass all the relevant performance tests needed to include it in a guideline-level recommendation. · Not all screening methods are equal, and care must be used in interpreting the results of published studies. Proof of the value of widespread screening must be established by health services intervention trials in primary care practices. Limitations· We included only papers published in English. · We did not explicitly consider application costs. · We make no recommendations regarding practical responses to false-positive and falsenegative screens.

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Section: Conceptual and Methodological Issues In Evaluating Screeningmentioning

confidence: 99%

Section: Very Short Screens (0 To 2 Minutes)mentioning

confidence: 99%

Section: Very Short Screens (0 To 2 Minutes)mentioning

confidence: 99%

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Brief Screening Tests for Dementia

2002

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“…Debido a que el área bajo la curva ROC es un método estadístico que determina la eficiencia de un test de detección y muestra la relación de sensibilidad y especificidad (20)(21)(22)(23)(24)(25)(26)(27)(28) .…”

Section: Discussionunclassified

“…La población evaluada en nuestro estudio tiene como idioma el castellano, que aunque mayoritario en el Perú, no es el único que se habla, lo que impediría su empleo en poblaciones que usan otros idiomas o dialectos en nuestro país (28,31) .…”

Section: Discussionunclassified

Validación de la prueba de dibujo del reloj - versión de Manos - como prueba de cribado para detectar demencia en una población adulta mayor de Lima, Perú

Custodio¹,

García²,

Montesinos³

et al. 2011

Rev Peru Med Exp Salud Publica

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Introducción. La prueba de dibujo del reloj versión de Manos (PDR-M) es un instrumento de evaluación cognitiva breve para la detección de demencia. Objetivos. Evaluar la validez y confiabilidad de la PDR-M para discriminar entre pacientes con demencia y sujetos controles sanos. Materiales y métodos. Se evaluaron sujetos mayores de 65 años de edad, excluyendo los que presentaban enfermedades concomitantes graves y con dificultades auditivas o visuales. Se recogieron datos demográficos y se les realizó PDR-M y Mini Mental State Examination (MMSE). A los individuos del grupo de demencia se les realizó además evaluaciones clínicas, de laboratorio, neuropsicológicas y tomografía cerebral. Se calculó la sensibilidad y especificidad de la PDR-M así como el área bajo la curva ROC. Resultados. Se evaluó 210 individuos, 103 con diagnóstico confirmado de demencia y 107 controles sanos, con edad y sexo similares en ambos grupos; y mayor nivel educativo en el grupo control. Estableciendo un punto de corte de 7 se obtuvo una sensibilidad de 99,0% y una especificidad de 83,5%. Cuando se compararon las áreas bajo la curva ROC de la PDR-M y del MMSE no se encontraron diferencias significativas. Conclusiones. La PDR-M es un instrumento breve y confiable para la detección de demencia en la población urbana de Lima en el Perú. VALIDATION OF THE CLOCK DRAWING TEST -MANOS´ VERSION -AS A SCREENING TEST FOR DETECTION OF DEMENTIA IN OLDER PERSONS OF LIMA; PERU ABSTRACT Introduction. The clock drawing test (PDR-M) -Manos´ version -is a brief cognitive assessment tool for dementia detection.Objectives. To assess the validity and reliability of the PDR-M to discriminate between patients with dementia and healthy control subjects. Materials and methods. We evaluated subjects over 65 years of age, excluding those with severe concomitant diseases and those with hearing or visual impairment. We obtained demographic data and performed the PDR-M and Mini Mental State Examination (MMSE). Subjects of the dementia group were also submitted to clinical, laboratory and neuropsychological evaluations as well as computed tomography scanning. Sensitivity and specificity of the PDR-M were calculated as well as the area under the ROC curve. Results. We evaluated 210 individuals, 103 with confirmed diagnosis of dementia and 107 healthy controls with similar age and sex in both groups, but a higher educational level in the control group. Setting a cutoff point of 7, a sensitivity of 99.0% and a specificity of 83.5% were found. When comparing the areas under the ROC curves of the PDR-M and MMSE we found no statistically significant difference. Conclusions. The PDR-M is a brief and reliable instrument for the detection of dementia in the urban population of Lima, Peru.

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