Performance of the Pentagon Drawing test for the screening of older adults with Alzheimer's dementia

Abstract

The Pentagon Drawing Test (PDT) is a common cognitive screening test.Objective: The aim of this study was to evaluate performance properties of a specific PDT scoring scale in older adults with Alzheimer's disease (AD) and healthy controls.Methods: A cross-sectional study of 390 elderly patients, aged 60 years or older with at least two years of education was conducted. All participants completed clinical and neuropsychological evaluations, including the Cambridge Cognitive Examination, the Mini-Mental State Examination (MMSE), and the Clock Drawing Test. All PDT were blindly scored with the scale of Bourke et al.Results: PDT analyses of the binary score on the MMSE (0 or 1 point) did not discriminate AD from controls (p = 0.839). However, when PDT was analyzed using the Bourke et al. scale, the two groups could be distinguished (p <0.001). PDT was not affected by education, showed sensitivity of 85.5% and specificity of 66.9%, discriminated different clinical stages of dementia, and correlated with the other cognitive tests (p <0.001). A 1-point difference on the Bourke et al. scale was associated with an odds ratio of 3.46 for AD.Conclusion: PDT can be used as a cognitive screen for suspected cases of dementia, especially AD, irrespective of educational level.

Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review

“…Most of the studies found in this review compared the diagnostic accuracy of new instruments, such as the Rowland Universal Dementia Assessment Scale, or combinations of traditional screening instruments, with the accuracy of the MMSE. These studies have indicated that longer instruments, such as the Mattis Dementia Rating Scale and the Cambridge Cognition Examination, and shorter ones, such as the Cognitive Abilities Screening Instrument-Short Form, may be just as accurate in detecting AD in populations with little educat ion 3,20,21,22,25,36,37,38,39,40,41,42,43,44 . When combined with the MMSE, these instruments may increase the diagnostic accuracy 3 .…”

“…The Bourke scale for scoring the Pentagon Drawing Test proved to be able to distinguish the control from the AD group, although its sensitivity was low. Applying the Bourke scoring scale for analysis of this subtest may contribute to the assessment of visuoconstruction in the MMSE that is not allowed by the usual binary scoring method 25 .…”

“…An effective strategy to improve diagnostic accuracy may include combining tasks that are known to be less influenced by education in a single instrument 36,50 or combining tests for improved accuracy in detecting dementia 21,42,44 . Aprahamian et al 25 combined the MMSE, the Clock Drawing Test, Verbal Fluency test and the Pfeffer Functional Activities Questionnaire to assess illiterate individuals with and without AD. The results suggest that these tests remain highly accurate among illiterate elderly and may aid in identifying positive AD in patients, when appropriate cut-off scores are used.…”

“…The Pentagon Drawing Test contained in the MMSE assesses constructional praxis. Martinelli et al 25 studied the accuracy of the Pentagon Drawing Test binary score and the six-point score suggested by Bourke et al 32 in patients with AD and healthy controls. The results showed that the Pentagon Drawing Test discriminated healthy controls from patients with AD, although with relatively low specificity.…”

Constructional apraxia screening and oral health among hospitalized older adults: A cross‐sectional study

“…More specifically, IPT is aimed to evaluate constructional apraxia (CA), which is defined as the inability to draw two or three‐dimensional objects using single dimension lines . It has already been recognized as valuable screening tool to identify subjects with Alzheimer disease and to predict inability to perform pulmonary function tests correctly …”