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

Abstract

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.

Dual Task Gait Performance in Frail Individuals with and without Mild Cognitive Impairment

“…Furthermore, the relationship between the activity of the neuromuscular and central nervous systems has been shown to be very strong [16,17], and gait variability increases in adults with cognitive impairment [15,18]. Consequently, dual task walking has become the standard measure of the relationship between cognitive ability and gait [19,20].…”

Clock Test Deficits Related to the Global Cognitive State in Alzheimer’s and Parkinson’s Disease

“…The CDT has a high sensitivity and specificity for the detection of Alzheimer’s dementia (AD) [10], but a poor sensitivity for the detection of amnestic MCI (aMCI) [11,12,13,14,15,16] that is assumed to reflect the prodromal stage of AD [17]. Cognitive processes involved in CD seem to be impaired quite late when AD has already manifested.…”

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+)

“…Moreover, the CDT requires different cognitive abilities including auditory and visual comprehension, concentration, visuospatial abilities, abstract conceptualization, and executive control (Shulman, 2000). However, the findings concerning the CDT's ability to differentiate between subjects with and without MCI are rather inconsistent (Lee et al, 2008;Pinto and Peters, 2009;Ehreke et al, 2010). For example, Yamamoto et al (2004) found that the CDT has utility to screen for MCI, whereas Lee et al (2008) did not recommend the use of the CDT as a screening instrument for MCI.…”