Clock Drawing Test in Very Mild Alzheimer's Disease

Esteban-Santillan, C.; Praditsuwan, Rungnirand; Ueda, Hiroyuki; Geldmacher, David S.

doi:10.1111/j.1532-5415.1998.tb04543.x

Cited by 94 publications

(76 citation statements)

References 21 publications

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“…13 The CDT also correlates with disease progression 12 and is useful in detecting very mild dementia. 15,16 Our results demonstrate that the CDT is strongly associated with driving performance. This may be because executive function is a critical component of safe driving, and in the presence of executive dysfunction, the automatized and procedural skills learned over decades of daily driving do not protect the older driver from errors.…”

Section: Discussionmentioning

confidence: 62%

Drawing clocks and driving cars

et al. 2005

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OBJECTIVE:The purpose of the study was to determine whether a new method of scoring the Clock Drawing Test (CDT) is a reliable and valid method for identifying older adults with declining driving competence. DESIGN: Prospective cohort study.SETTING: An outpatient driving evaluation clinic. PARTICIPANTS:One hundred nineteen community-dwelling, active drivers with a valid driver's license, aged 60 and older referred for driving evaluation. MAIN OUTCOME MEASURES:The CDT and a driving test using a STISIM Drive simulator.RESULTS: The CDT showed a high level of accuracy in predicting driving simulation outcome (area under the receiver-operator curve, 0.90; 95% confidence interval, 0.82 to 0.95). CDT scoring scales were comparable and all correlations between CDT scores and driving performance were negative, implying that as the CDT score decreases, the number of errors increases. Interrater reliability of CDT scores was 0.95. Subjects scoring less than 5 out of 7 points on the CDT made significantly more driving errors, hazardous and in total (Po.001). CONCLUSIONS:The CDT can help establish problems with executive function and indicate the need for a formal driving evaluation. Our CDT scoring scale is a reliable, valid, and time-effective screening tool for identifying elderly drivers in need of further evaluation. D riving places demands on attention, memory, problem solving, and information processing, cognitive skills that often decline with aging. Older drivers crash at a rate second only to the youngest drivers.1,2 Older driver involvement in fatal crashes is projected to increase 155% by 2030, accounting for 54% of the total projected increase in fatal crashes among all drivers.3 As the population ages and the number of older drivers increases, declining driver competence becomes an urgent public health problem and a challenge for health professionals to recognize impaired driving ability in the elderly. Declining driving competence is associated with impairments in vision, functional abilities, and cognition. However, it is especially true that cognitive impairment is overlooked in the context of a brief office visit as are issues related to driving ability. Cognitive impairment and dementia are surprisingly prevalent among older apparently healthy individuals, affecting up to one third of people aged over 65 years, yet it remains undiagnosed in 25% to 90%. [4][5][6][7] Consequently, the impact on driving ability persists unnoticed. The responsibility for determining the driving fitness of older adults is increasingly falling upon the medical profession; however, clinicians have few tools and few data on which to base decisions about driving. A brief and time-efficient screening test is needed to assist clinicians to identify older drivers who may represent a public health hazard and need to undergo a driving evaluation.The purpose of the study was to determine whether a new method of scoring the Clock Drawing Test (CDT) is a reliable and valid method for identifying older adults with declining driving competen...

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Section: Discussionmentioning

confidence: 62%

Drawing clocks and driving cars

et al. 2005

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“…Similarly, it is not recommended as a single tool to screen for possible prodromal stages of dementia [2, 3]. Although some suggest that normal CDT performance most likely excludes the presence of even very mild Alzheimer’s disease [4], the opposite may not hold true and recent studies have found a high number of CDT errors in normal elderly subjects [2, 5]. …”

Section: Introductionmentioning

confidence: 95%

Clock-Drawing Test Performance in the Normal Elderly and Its Dependence on Age and Education

et al. 2008

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Objective: The main objective was to assess the relative frequency and types of errors on the clock-drawing test (CDT) in normal elderly subjects, and the dependence of their CDT performance upon their age and education. Method: The CDT performance of 242 normal elderly subjects, stratified according to age and education, was analyzed using both an absolute error count and a modified scoring sheet derived from 2 scales. Results: Normal elderly subjects (average age: 73.4 ± 8.4 years; mean Mini-Mental State Examination score: 27.7 ± 1.6) often have problems placing figures on the clock face and differentiating the clock hands correctly. The absolute number of errors increases with age and decreases with formal school education. A cumulative effect of both high age and a low level of school education yields substantially inferior scores, on the modified scale used, in comparison with younger subjects and those with higher levels of education. Conclusion: The frequent errors made by normal elderly subjects, and a combined negative influence of high age and low education level, suggest caution when interpreting the significance of CDT performance in the elderly.

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“…The background neuropsychological tests were administered to the PD patients as part of their inpatient stay but were also administered to the healthy control group who took part in the study. Clock Drawing was administered (Agrell & Dehlin, 1998;Esteban-Santillan, Praditsuwan, Veda, & Geldmacher, 1998;Storey, Rowland, Basic, & Conforti, 2001), as it is considered predictive of dementia in primary care (Kirby, Denihan, Bruce, Coakley, & Lawlor, 2001). Abstract reasoning was assessed using Raven's Coloured Progressive Matrices (Raven, Raven, & Court, 1998), verbal intelligence through the Brief Intelligence Test , and general knowledge through the WAIS information subtest (Wechsler, 1997).…”

Section: Neuropsychological Assessmentmentioning

confidence: 99%