The accuracy of the Clock Drawing Test compared to that of standard screening tests for Alzheimer's disease: results from a study of Brazilian elderly with heterogeneous educational backgrounds

Aprahamian, Ivan; Martinelli, José Eduardo; Néri, Anita Liberalesso; Yassuda, Mônica Sanches

doi:10.1017/s1041610209991141

Cited by 93 publications

(90 citation statements)

References 37 publications

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“…Although educa tion entered as a covariate on the ordinal linear regression models, the low variance between the groups (not signifi cant) may reduce its influence on test performance. Although some studies reported good criterion validity for the CDT among poorly educated older adults 8,10,11 , these findings are controversial 3,9 . Concerning construct validity, for patients with very low formal education, the drawing processes may demand, besides more cognitive effort than better educated subjects, the recruitment of different cognitive abilities to im prove task performance.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, it showed good evi dence of reliability, but reduced criterion-related validity for this population 9 . Other studies 10,11 , however, assessed CDT validity for cognitive assessment among individuals with heterogeneous educational backgrounds, including illitera cy, showing good results, but emphasizing the role of formal edu cation on test performance.…”

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confidence: 99%

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Mapping the clockworks: what does the Clock Drawing Test assess in normal and pathological aging?

Paula

Miranda

Moraes

et al. 2013

Arq. Neuro-Psiquiatr.

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Brief cognitive tests are widely used in neuropsychology and related areas, in order to assess and diagnose develop mental, neurological, and psychiatric conditions. The Clock Drawing Test (CDT) is also adopted as a screening tool for cognitive impairment in several conditions such as dementia, stroke, schizophrenia, mild cognitive impairment and mood disorders¹. The CDT basically consists of the drawing of dif ferent elements of a clock, including the clock face, numbers, and arrow-hands. The instructions and scoring methods vary according to each version. Influences of aging and education are also related to test performance, where children and the elderly perform worse than adults and lower education asso ciates with worse performance².Different versions of the CDT were developed. Although very similar and highly correlated³, they differ in diagnosis accuracy 4 and probably on the cognitive processes involved ABSTRACTThe Clock Drawing Test (CDT) is a cognitive screening tool used in clinical and research settings. Despite its role on the assessment of global cognitive functioning, the specific cognitive components required for test performance are still unclear. We aim to assess the role of executive functioning, global cognitive status, visuospatial abilities, and semantic knowledge on Shulman's CDT performance. Fifty-three mild cognitive impairment, 60 Alzheimer's dementia, and 57 normal elderly controls performed the CDT, the Frontal Assessment Battery, the Mini-Mental State Examination, the Stick Design Test, and a naming test (TN-LIN). An ordinal regression assessed specific neuropsychological in fluences on CDT performance. All the cognitive variables were related to the CDT, accounting for 53% of variance. The strongest association was between the CDT and executive functions, followed by global cognitive status, visuospatial processing, and semantic knowledge. Our result confirms the multidimensional nature of the test and the major role of executive functions on performance.Keywords: clock drawing test, executive functions, visuospatial abilities, semantic knowledge, dementia. Palavras-chave: teste do desenho do relógio, funções executivas, habilidades visioespaciais, conhecimento semântico, demência. RESUMO

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Mapping the clockworks: what does the Clock Drawing Test assess in normal and pathological aging?

Paula

Miranda

Moraes

et al. 2013

Arq. Neuro-Psiquiatr.

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“…Diversos estudios han mostrado correlación de la PDR con otras pruebas de detección de demencia, incluido el MMSE (21,35,36) . En la presente investigación se obtuvo un resultado similar al analizar la sensibilidad y especificidad de la PDR-M y el MMSE; obteniendo áreas bajo la curva ROC similares.…”

Section: Discussionunclassified

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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“…[21][22][23][24][25][26][27][28][29]. The neuropsychological test battery included the Boston Naming Test (BNT) [21], Rey Auditory Verbal Learning Test (RAVLT5 -sum of 5 recall trials of 15 words, RAVLT6 -immediate recall after inference and RAVLT7 -delayed recall after 30 minutes) [25], the Rey-Osterrieth Complex Figure Test copy and delayed recall (REY-C and REY-30) [26], Semantic Verbal Fluency animal category (VF) [22], Phonological Verbal Fluency (FAS), [24] Forward and Backward Digit Span Test (FDST and BDST) [29], Trail Making Test part A and B (TMT-A and TMT-B) [23], Clock Drawing Test (CDT) [27], and Digit Symbols Substitution Test (DSST) [28].…”

Section: Neuropsychological Evaluation (Npe)mentioning

confidence: 99%

Impact of hypertension on cognitive performance in individuals with high level of education

Muela¹,

Costa-Hong²,

Yassuda³

et al. 2017

Brain Nerves

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Education is considered to provide a cognitive and neurological reserve through neuronal changes or increased efficacy of processing networks. The hypothesis of cognitive reserve asserts that older individuals with greater experiential resources exhibit better cognitive functioning and are able to tolerate higher levels of brain pathology before displaying clinical symptoms. Hypertension is linked to cognitive impairment. We evaluated the impact of hypertension on cognitive performance in hypertensive patients with high level of education. In a cross-sectional study 163 patients (61 normotensive and 102 hypertensive) with 9 or higher schooling years were comparatively evaluated. Hypertension was defined as blood pressure (BP) levels ≥140/90 mmHg or use of antihypertensive drugs. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA), and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Hypertension group had higher weigh, BMI and lower education level and family income. Hypertension group performed worse either on MMSE (27.7 ± 1.9 vs 28.3 ± 1.7, p=0.049) or MoCA (25.2 ± 2.6 vs 26.1 ± 2.5, p=0.022); similar poorer performance in hypertensive group were also seen at different domains on neuropsychological evaluation. We concluded that even in those with high level of education, patients with hypertension have poorer cognitive performance compared to control pairs.

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The accuracy of the Clock Drawing Test compared to that of standard screening tests for Alzheimer's disease: results from a study of Brazilian elderly with heterogeneous educational backgrounds

Cited by 93 publications

References 37 publications

Mapping the clockworks: what does the Clock Drawing Test assess in normal and pathological aging?

Mapping the clockworks: what does the Clock Drawing Test assess in normal and pathological aging?

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

Impact of hypertension on cognitive performance in individuals with high level of education

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