Literature Review of the Clock Drawing Test as a Tool for Cognitive Screening

Pinto, Elisabete; Peters, Ruth

doi:10.1159/000203344

Cited by 192 publications

(182 citation statements)

References 93 publications

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“…More than 20 different scoring systems have been developed with variable emphasis on the different cognitive functions that the CDT can assess (Pinto and Peters, 2009;Mainland and Shulman, 2013). Many of these scoring systems have also been tailored specifically to detect impairment related to specific disorders (Mendez et al, 1992;Rouleau et al, 1992).…”

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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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: 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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“…Therefore, busy physicians unfamiliar with formal cognitive testing may find the MMSE to be an unpractical adjunct to frailty screening. The clock drawing test (CDT) is another screening test for global cognition [11] . Compared to the MMSE, the CDT is quicker and easier to administer, is less affected by age, and has a higher ability to detect impairment in visuo-constructional and executive abilities [11,12,13].…”

Section: Introductionmentioning

confidence: 99%

“…The clock drawing test (CDT) is another screening test for global cognition [11] . Compared to the MMSE, the CDT is quicker and easier to administer, is less affected by age, and has a higher ability to detect impairment in visuo-constructional and executive abilities [11,12,13]. The integrity of these abilities is thought to be relevant for survival and other health outcomes in older persons [14,15].…”

Section: Introductionmentioning

confidence: 99%

Combination of the Clock Drawing Test with the Physical Phenotype of Frailty for the Prediction of Mortality and Other Adverse Outcomes in Older Community Dwellers without Dementia

Forti

Maioli²,

Lega³

et al. 2013

Gerontology

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Background: Cognitive assessment is thought to increase the ability of the physical phenotype of frailty to identify older persons at a higher risk for adverse outcomes. Objective: Data from a cohort of dementia-free community dwellers were used to investigate whether the clock drawing test (CDT), a quick and easy cognitive screening test, is associated with adverse health outcomes independently of the physical phenotype of frailty. Methods: Thiswas a prospective population-based cohort study of 766 dementia-free Italian community dwellers aged 65 years or older. Baseline assessment included the physical phenotype of frailty, 3 different CDT protocols [Sunderland, Shulman, and the clock drawing interpretation scale (CDIS)], and several health confounders. Hazard ratios (HR) and odds ratio (OR) along with their corresponding 95% confidence intervals (CI) from models adjusted for frailty and sociodemographic and health confounders were used to estimate the independent association of the CDT with the 7-year risk of all-cause mortality and the 3-year risk of new and worsening disability, hospitalization, and fractures. Results: After adjustment for confounders, the Sunderland CDT was significantly associated with all-cause mortality independently of the physical phenotype of frailty (HR = 1.44, 95% CI 1.03-2.01, p = 0.031). However, compared to all nonfrail participants with a normal Sunderland CDT, the HR was 1.57 (95% CI 1.09-2.26, p = 0.016) for those with impairment on the Sunderland CDT only, 2.48 (95% CI 1.46-4.20, p = 0.001) for those with frailty only, and 2.52 (95% CI 1.34-4.77, p = 0.004) for those with both frailty and impairment on the Sunderland CDT. Mortality was unrelated to the CDIS CDT (p = 0.359) and the Shulman CDT (p = 0.281). No statistically significant relationship was found between nonlethal outcomes and any CDT protocol, although trends were found for an association of both the Sunderland CDT (p = 0.118) and the CDIS CDT with worsening disability (p = 0.154). Conclusions: In older persons, depending on the scoring system, the CDT may predict the mortality risk independently of the physical phenotype of frailty. However, combining the two measurements does not improve their individual prognostic abilities.

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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 prueba del dibujo del reloj (PDR), ha sido empleada para la detección de demencia, siendo de fácil y rápida administración, permite evaluar las siguientes habilidades cognitivas: comprensión auditiva, planeamiento, memoria visual, reconstrucción de una imagen gráfica, habilidades viso-espaciales, programación motora y ejecución, conocimiento numérico y concentración (15,18) ; pero no permite detectar deterioro cognitivo mínimo (DCM) (19) . Una revisión de Pinto et al, muestra diferentes formas de administrar la PDR, así como diferentes maneras de calificar la prueba (20) , cualitativa y cuantitativamente, siendo estas últimas mejor verificables y reproducibles.…”

Section: Introductionunclassified

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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Literature Review of the Clock Drawing Test as a Tool for Cognitive Screening

Cited by 192 publications

References 93 publications

The test of time: a history of clock drawing

The test of time: a history of clock drawing

Combination of the Clock Drawing Test with the Physical Phenotype of Frailty for the Prediction of Mortality and Other Adverse Outcomes in Older Community Dwellers without Dementia

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

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