The Clock Drawing Test: performance among elderly with low educational level

Lourenço, Roberto Alves; Ribeiro-Filho, Sergio T.; Moreira, Irene de Freitas Henriques; Paradela, Emylucy Martins Paiva; Miranda, Aline

doi:10.1590/s1516-44462008000400002

Cited by 59 publications

(78 citation statements)

References 36 publications

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“…A previous study 9 deconstructing the CDT into different components found moderate associations with tasks related to semantic processing, such as naming and category fluency. Drawing involves the search and recall of semantic representations of the clock itself, such as number disposition, hand-arrow meaning, and the spatial logics of its organization.…”

Section: Discussionmentioning

confidence: 87%

“…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%

mentioning

confidence: 99%

“…A study compared different versions of the CDT in terms of criterion validity and did not find significant differences between them 9 . 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: 87%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

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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“…In this context, researchers and clinicians who use the CDT are faced with the issue of choosing the best way to analyze the drawings. In Brazil, Lourenço et al 17 and Aprahamian et al 5 found equivalence among the quantitative methods examined. Yet, quantitative scales do not allow the description of the error profile of the participant and they do not reveal specific cognitive changes.…”

mentioning

confidence: 97%

Qualitative analysis of the Clock Drawing Test by educational level and cognitive profile

Fabrício

Aprahamian

Yassuda

2014

Arq. Neuro-Psiquiatr.

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The use of a qualitative scale for the Clock Drawing Test (CDT) may add information about the pattern of errors committed. Objective: To translate and adapt the Modified Qualitative Error Analysis of Rouleau into Brazilian Portuguese and to examine the pattern of errors according to educational level and cognitive profile. Method: 180 adults (47-82 years) completed the CDT. Participants were stratified into age and educational levels and separated between those with and without changes in cognitive screening tests (Mini-Mental State Examination, Verbal Fluency). Results: No significant differences were found in CDT scores among age groups. Among participants without cognitive impairment, those with lower education often presented graphic difficulties, conceptual deficits and spatial deficits. Participants with cognitive deficits, demonstrated more frequently conceptual and spatial errors. Conclusion: The qualitative analysis of the CDT may contribute to the identification of cognitive changes. Education level has to be taken into consideration during the analysis.

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