An examination of a proposed scoring procedure for the clock drawing test: Reliability and predictive validity of the clock scoring system (CSS)

Todd, Mark E.; Dammers, Paul M.; Adams, Serrhel G.; Todd, Henry; Morrison, Margaret W

doi:10.1177/153331759501000406

Cited by 13 publications

(12 citation statements)

References 5 publications

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“…The 4 scoring systems (Freedman et al [15] , Rouleau et al [16] , Todd et al [17] , and the CERAD CDT [18] ) lack sensitivity in distinguishing the MCI group from the NCI group. The sensitivity for detecting individuals with MCI was so poor that quantitative analysis of the CDT does not appear to be a good screening instrument for detecting MCI.…”

Section: Discussionmentioning

confidence: 99%

“…The CDT was scored by a general physician according to the rating scales of Freedman et al [15] , Rouleau et al [16] , Todd et al [17] , and the CERAD CDT [18] for quantitative analysis, and a comprehensive CDT scoring system incorporating elements of most previous CDT for qualitative analysis [19] . The CDT scorer for the present study was not given any information about participants, including performance on other cognitive tests or clinical diagnosis.…”

Section: Measurementsmentioning

confidence: 99%

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Clock Drawing Test in Mild Cognitive Impairment: Quantitative Analysis of Four Scoring Methods and Qualitative Analysis

Lee

Kim

Hong

et al. 2008

Dement Geriatr Cogn Disord

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Background: The role of the clock drawing test (CDT) as a screening tool for dementia has been evaluated. However, studies focusing on mild cognitive impairment (MCI) are still lacking. The purpose of this study was to verify the validity of the CDT as a screening method for MCI. Methods: 524 subjects aged 60 years and older were recruited in the community. Of these, 241 were diagnosed as not cognitively impaired (NCI) and 224 were classified as MCI. The CDT was scored according to the Freedman, Rouleau, Todd, and CERAD CDT and an additional comprehensive scoring system incorporating elements of most CDT for qualitative analysis. Results: The sensitivity and specificity of the 4 CDT scoring systems for MCI ranged from 40.7 to 56.4% and from 71.8 to 85.3%, respectively. The likelihood ratio and the positive and negative predictive values of the 4 CDT ranged from 18 to 29, 18.2 to 24.5 and from 55.9 to 78.4%, respectively. In qualitative analysis, a significantly lower performance in the clock numbers category was observed in the MCI group. Conclusion: This study suggests that although some qualitative analyses could help in identifying MCI individuals, the CDT is insufficient as a screening method to distinguish MCI individuals from NCI individuals in a clinical setting.

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Section: Discussionmentioning

confidence: 99%

Section: Measurementsmentioning

confidence: 99%

Clock Drawing Test in Mild Cognitive Impairment: Quantitative Analysis of Four Scoring Methods and Qualitative Analysis

Lee

Kim

Hong

et al. 2008

Dement Geriatr Cogn Disord

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“…A modifi ed version of the Clock Scoring System (CSS) by Todd, Dammers, Adams, Todd, and Morrison ( 1995 ) was used for quantitative analysis (Detailed criteria for the modifi ed CSS are listed in Appendix 1 ). Qualitative error analyses of the CDT were performed using the criteria developed by Rouleau, Salmon, Butters, Kennedy, and McGuire ( 1992 ).…”

Section: The Clock Drawing Testmentioning

confidence: 99%

Effects of education, literacy, and dementia on the Clock Drawing Test performance

Kim

Chey

2010

J Int Neuropsychol Soc

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The Clock Drawing Test (CDT) has been recognized as an effective tool for dementia detection. This study investigated the clock drawing performance of 240 non-demented elderly Korean people with a wide-range of educational levels and 28 patients with mild dementia of the Alzheimer's type (DAT). We examined the effects of demographic factors, including education, and established norms for the elderly population. We found that the educational attainment and literacy status of older people influenced performance on the CDT significantly (p < .001). Furthermore, qualitative error analysis revealed that normal participants with low educational background committed errors similar to errors of the DAT patients. The DAT patients performed significantly worse than the non-demented participants in the CDT Total score (p < .001). However, the CDT has better criterion validity in participants with more than 6 years of education. In conclusion, the CDT performance in older people who are either illiterate or with 6 or less years of education should be interpreted with caution. Conceptual errors in the CDT can be the result of not only dementia but also lack of education.

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“…Although the screening utility of the CDT in dementia has been ascertained (Peters & Pinto, 2008), its utility in mild cognitive impairment (MCI) remains controversial. K. S. Lee et al (2008) investigated this issue using four scoring methods-namely, the Freedman et al (1994), the Rouleau, Salmon, Butters, Kennedy, and McGuire (1992), the Todd, Dammers, Adams, Todd, and Morrison (1995) methods and the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) method (J. H. Lee, Lee, & Lee, 2002). These authors found that the sensitivity and specificity values of these four quantitative scoring methods were not acceptable and concluded that although qualitative analyses (such as the analysis of error types) may help the identification of MCI patients, the CDT alone is not sufficient as a screening tool in this population.…”

mentioning

confidence: 99%

Italian norms for the Freedman version of the Clock Drawing Test

Caffarra

Gardini

Zonato³

et al. 2011

Journal of Clinical and Experimental Neuropsychology

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Standardized norms for the Freedman version of the CDT were collected in a large sample of healthy individuals. No adjustments were required for scores on the free-drawn condition, whereas raw scores on the predrawn and examiner-drawn conditions and the total score needed adjustments to account for age effects. The availability of standardized norms for this version of the CDT could increase the use of this comprehensive tool in the detection of dementia.

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An examination of a proposed scoring procedure for the clock drawing test: Reliability and predictive validity of the clock scoring system (CSS)

Cited by 13 publications

References 5 publications

Clock Drawing Test in Mild Cognitive Impairment: Quantitative Analysis of Four Scoring Methods and Qualitative Analysis

Clock Drawing Test in Mild Cognitive Impairment: Quantitative Analysis of Four Scoring Methods and Qualitative Analysis

Effects of education, literacy, and dementia on the Clock Drawing Test performance

Italian norms for the Freedman version of the Clock Drawing Test

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