Normative performance on the executive clock drawing task in a multi‐ethnic bilingual cohort: a project FRONTIER study

Abstract

The CLOX test is a neuropsychological measure intended to aid in the assessment and detection of dementia in elderly populations. Few studies have provided normative data for this measure, with even less research available regarding the impact of socio-demographic factors on test scores. This study presents normative data for the CLOX in a sample of English- and Spanish-speaking Hispanic and non-Hispanic Whites. The total sample included 445 cognitively healthy older adults seen as part of an ongoing study of rural cognitive aging, Project FRONTIER. Unlike previous studies, criteria for “normality” (i.e., unimpaired) for CLOX1 and CLOX2 were based not merely on global impairment, but also on domain-specific impairment of executive functioning on the EXIT25 and/or Trail Making Test B (Trails B), or visuospatial/constructional impairment on the Line Orientation and Figure Copy subtests of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), respectively. Hierarchical regression analyses revealed that CLOX1 scores require adjustment by Age across ethnicities, while Education and Gender are necessary stratification markers for CLOX1 performance only in non-Hispanic Whites. None of the demographic variables were valid predictors of CLOX2 performance, negating the need for such adjustments. In addition to being the first study to provide separate normative data for CLOX performance in Hispanic and non-Hispanic White samples, the current study offers a novel approach to defining “normal” by cognitive domain. We also highlight the need to directly examine the impact of socio-demographic factors before applying normative corrections based on factors that have negligible impact on test scores.

Specific algorithm method of scoring the Clock Drawing Test applied in cognitively normal elderly

“…The relationship between education, aging and CDT performance is controversial in the literature. 22 , 24 , 38 , 41 , 43 This finding may also be related to the existence of various application methods and different scoring scales. For example, Brodaty and Moore found a correlation of CDT score with years of education for the Shulman and Sunderland, but not for the Wolf-Klein scoring system.…”

“… 39 , 40 There are few studies in community-dwelling samples or cognitively normal elderly. 22 , 41 - 43 …”

“…In addition, the various scoring systems include: 10 hierarchical patterns (0-10), scale based on errors each scored 0/1 (0-20), clock divided into eighths, points given for numbers and hands in right place (0-10) and others. 3 , 14 , 37 , 43 …”

Texas Mexican American adult normative studies: Normative data for commonly used clinical neuropsychological measures for English- and Spanish-speakers

“…Given the size of the U.S. Mexican American population, clinical neuropsychological practitioners would greatly benefit from the provision of normative references on commonly utilized tests for this rapidly growing population. Such efforts to meet this growing need has resulted in initial psychometric analysis and normative references for the Clock Drawing Test (Menon, Hall, Hobson, Johnson, & O’Bryant, 2012), a Spanish-English equivalent version of the Boston Naming Test (Jahn et al, 2013) as well as an IRT-analysis of the Executive Interview (EXIT) which lead to the development of the EXIT8 (Jahn, Dressel, Gavett, & O’Bryant, 2015) based on data obtained from Mexican American and non-Hispanic white participants. Additionally, the SENAS was created specifically for administration of a Spanish-English equivalent neuropsychological instrument for Hispanics (Mungas, Reed, Crane, Haan, & González, 2004).…”

Representation of Older Latinxs in Cohort Studies at the Rush Alzheimer’s Disease Center

“…Research has also focused on blood biomarkers of older Latinxs from select countries of origin with and without a diagnosis of mild cognitive impairment (MCI) or Alzheimer's dementia [4,[16][17][18][19][20]. Other targeted studies of older Latinxs have incorporated a small cadre of cognitive measures in a larger framework [4,21,[22][23][24]. These and other studies [25][26][27][28][29][30][31] have contributed significantly to the field of Latinx health and aging.…”