Clock‐drawing: is it the ideal cognitive screening test?

Shulman, Kenneth I.

doi:10.1002/1099-1166(200006)15:6<548::aid-gps242>3.3.co;2-l

Cited by 410 publications

(670 citation statements)

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“…While there have been concerns regarding its long-term use due to the advent of digital clocks (Clarfield and Bergman, 1990), we predict that it can remain an effective screening instrument for decades to come (Shulman, 2000). Future research should further assess the correlation between the CDT and other cognitive screening batteries so that it can be determined if it is valuable both on its own and as a supplement to these instruments.…”

Section: Resultsmentioning

confidence: 96%

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The test of time: a history of clock drawing

Hazan

Frankenburg

Brenkel

et al. 2017

Int J Geriat Psychiatry

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Objective: The clock drawing test (CDT) has become one of the most widely used cognitive screening instruments in clinical and research settings. Its effectiveness, acceptability, and quick and easy administration have made it a staple for cognitive screening in dementia and a wide range of brain disorders. Despite a spike in popularity since the 1990s, its origins are relatively unknown. The goal of this review is to chronicle its saga and chart its usage over time. Methods: PsycInfo, Medline, and PubMed literature searches were performed from earliest record to June 2016, in addition to manual cross-referencing of bibliographies, with a focus before 1990. Summary of relevant articles and books up until 1989 is included, as well as clinical applications and surveys that track CDT usage over time. Results: While MacDonald Critchley's well-known textbook from 1953, The Parietal Lobes, is often cited as the first mention of the CDT, its recorded use actually stretches back more than a century to 1915. A review of the literature shows that the CDT began as a test for aphasia-related disorders and constructional apraxia until its entry into contemporary cognitive screening in the 1980s when it primarily became a cognitive screen. Its usage took off in 1989 with over 2000 publications since. Conclusions: Despite a fairly obscure existence for decades, the CDT has emerged as an effective and ideal cognitive screening instrument for a wide range of conditions. Its use continues to increase, and it has been incorporated into several widely used cognitive screening batteries.

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Section: Resultsmentioning

confidence: 96%

“…Despite the variability in scoring systems, it has been shown that simpler scoring systems are often better (Mainland and Shulman, 2013). Some also argue that the CDT may be used most appropriately as a qualitative visual display of cognitive ability that can be tracked longitudinally (Shulman, 2000;Mainland and Shulman, 2013).…”

Section: Introductionmentioning

confidence: 99%

The test of time: a history of clock drawing

Hazan

Frankenburg

Brenkel

et al. 2017

Int J Geriat Psychiatry

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“…All subjects were evaluated using established research protocols (ADRC sample; for details see Borson, 1999;2000) or structured multidimensional clinical diagnostic methods for the dementia clinic sample. This process yielded three diagnostic groups: no cognitive impairment (n = 154), subsyndromal cognitive impairment (n = 101), or dementia syndrome (n = 281).…”

Section: Methodsmentioning

confidence: 99%

“…All CDT systems chosen for comparison have long histories of use, and include one previously shown to be sensitive but less specific (Mendez et al, 1992), one with balanced sensitivity and specificity (Shulman, 2000), and one with high specificity but low sensitivity (Wolf-Klein et al, 1989; data from Scanlan et al, 2002). We then examined the specificity and sensitivity of a revised Mini-Cog (three-item delayed recall + the new CDT algorithm) with the original version.…”

Section: Data Analysis Excluding Very Low Education Subjects (≤4 Yearmentioning

confidence: 99%

Time that tells: critical clock-drawing errors for dementia screening

Lessig

Scanlan

Nazemi

et al. 2007

IPG

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Background-Clock-drawing tests are popular components of dementia screens but no single scoring system has been universally accepted. We sought to identify an optimal subset of clock errors for dementia screening and compare them with three other systems representative of the existing wide variations in approach (Shulman, Mendez, Wolf-Klein), as well as with the CDT system used in the Mini-Cog, which combines clock drawing with delayed recall.

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“…The constitution of the test battery varies across organizations (e.g., cognitive functioning may be assessed by the Mini Mental State Examination (11) or by the Clock Drawing Test (12,13)). To promote uniformity in firstgeneration CGA, studies (14,15) have reported on the assembly of individual instruments (e.g., the Minimum Geriatric Screening Tools).…”

Section: Comparison Of the Minimum Geriatric Screening Tools (Mgst)mentioning

confidence: 99%

First-generation versus third-generation comprehensive geriatric assessment instruments in the acute hospital setting: A comparison of the Minimum Geriatric Screening Tools (MGST) and the interRAI Acute Care (interRAI AC)

Wellens

Flamaing²,

Moons

et al. 2011

The Journal of nutrition, health and aging

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Objective:Comparison of the first-generation Minimum Geriatric Screening Tools (MGST) and the third-generation interRAI Acute Care (interRAI AC). Design: Based on a qualitative multiphase exchange of expert opinion, published evidence was critically analyzed and translated into a consensus. Results: Both methods are intended for a multi-domain geriatric assessment in acute hospital settings, but each with a different scope and goal. MGST contains a collection of single-domain, internationally validated instruments. Assessment is usually triggered by care givers' clinical impression based on geriatric expertise. A limited selection of domains is usually assessed only once, by disciplines with domain-specific expertise. Clinical use results in improvement to screen geriatric problems. InterRAI AC, tailored for acute settings, intends to screen a large number of geriatric domains. Based on systematic observational data, risk domains are triggered and clinical guidelines are suggested. Multiple observation periods outline the evolution of patients' functioning over stay in comparison to the premorbid situation. The method is appropriate for application on geriatric and non-geriatric wards, filling geriatric knowledge gaps. The interRAI Suite contains a common set of standardized items across settings, facilitating data transfer in transitional care. Conclusion: The third-generation interRAI AC has advantages compared to the first-generation MGST. A cascade system is proposed to integrate both, complementary methods in practice. The systematic interRAI AC assessment detects risk domains. Subsequently, clinical protocols suggest components of the MGST as additional assessment. This cascade approach unites the strength of exhaustive assessment of the interRAI AC with domain-specific tools of the MGST.

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Clock‐drawing: is it the ideal cognitive screening test?

Cited by 410 publications

References 0 publications

The test of time: a history of clock drawing

The test of time: a history of clock drawing

Time that tells: critical clock-drawing errors for dementia screening

First-generation versus third-generation comprehensive geriatric assessment instruments in the acute hospital setting: A comparison of the Minimum Geriatric Screening Tools (MGST) and the interRAI Acute Care (interRAI AC)

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