Understated Cognitive Impairment Assessed with the Clock-Drawing Test in Community-Dwelling Individuals Aged ≥50 Years

Leissing-Desprez, Claire; Thomas, Émilie; Segaux, Lauriane; Broussier, Amaury; Oubaya, Nadia; Marie-Nelly, Nathalie; Laurent, Marie; Langavant, Laurent Cléret de; Fromentin, Isabelle; David, Jean‐Philippe; Bastuji‐Garin, Sylvie

doi:10.1016/j.jamda.2020.03.016

Cited by 8 publications

(4 citation statements)

References 48 publications

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“…Correctly “orienting the minute hand” was found to be the most significant predictor of classification of MCI versus NCF. Our finding is consistent with the data from 2 studies (1 conventional and 1 digital) which reported that correct placement of the “minute arm” was the best predictor of amnesia in individuals with MCI [ 29 , 53 ]. Such comparable results support the adoption of the 3 digital CD Acc item factors in EOmciSS.…”

Section: Discussionsupporting

confidence: 92%

An Effective Test (EOmciSS) for Screening Older Adults With Mild Cognitive Impairment in a Community Setting: Development and Validation Study

Chan¹,

Lee²,

Chen³

et al. 2023

J Med Internet Res

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Background Early detection of mild cognitive impairment (MCI) symptoms is an important step to its diagnosis and intervention. We developed a new screening test called “Efficient Online MCI Screening System” (EOmciSS) for use in community-dwelling older adults. It is a self-paced cognitive test to be completed within 10 minutes on tablets or smartphones in homes or care centers for older adults. Objective This study aims to test the validity of EOmciSS for identifying community-dwelling older adults with MCI risks. Methods Participants (N=827) completed EOmciSS and other screening tests for MCI. The psychometric properties tested were “subscale item difficulty,” “discriminative index,” “internal consistency,” and “construct validity.” We also tested between-group discrimination using the cross-validation method in an MCI group and a normal cognitive function (NCF) group. Results A total of 3 accuracy factors and 1 reaction time factor explained the structure of the 20 item factors. The difficulty level of accuracy factors (ie, “trail making,” “clock drawing,” “cube copying,” “delayed recall”) was 0.63-0.99, whereas that of the reaction time factor was 0.77-0.95. The discriminative index of the medium-to-high-difficulty item factors was 0.39-0.97. The internal consistency (Cronbach α) ranged from .41 (for few item factors) to .96. The training data set contained 9 item factors (CC-Acc1, P<.001; CD-Acc1, P=.07; CD-Acc2, P=.06; CD-Acc3, P<.001; TM-Acc4, P=.07; DR-Acc1, P=.03; RS, P=.06; DR-RT1, P=.02; and DR-RT2, P=.05) that were significant predictors for an MCI classification versus NCF classification. Depressive symptoms were identified as significant factors (P<.001) influencing the performance of participants, and were an integral part of our test system. Age (P=.15), number of years of education (P=.18), and proficiency in using an electronic device (P=.39) did not significantly influence the scores nor classification of participants. Application of the MCI/NCF cutoff score (7.90 out of 9.67) to the validation data set yielded an area under the curve of 0.912 (P<.001; 95% CI 0.868-0.955). The sensitivity was 84.9%, specificity was 85.1%, and the Youden index was 0.70. Conclusions EOmciSS was valid and reliable for identifying older adults with significant risks of MCI. Our results indicate that EOmciSS has higher sensitivity and specificity than those of the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment and the Computerized Cognitive Screen. The user interface, online operation, and self-paced format allowed the test system to be operated by older adults or their caregivers in different settings (eg, home or care centers for older adults). Depressive symptoms should be an integral part in future MCI screening systems because they influence the test performance and, hence, MCI risk. Trial Registration Chinese Clinical Trial Registry ChiCTR2000039411; http://www.chictr.org.cn/showprojen.aspx?proj=62903

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Section: Discussionsupporting

confidence: 92%

An Effective Test (EOmciSS) for Screening Older Adults With Mild Cognitive Impairment in a Community Setting: Development and Validation Study

Chan¹,

Lee²,

Chen³

et al. 2023

J Med Internet Res

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“…Nevertheless, here we found that the MoCA-Thai alone yielded an important separated of AD from aMCI. Studies on the VSS subdomain in the MoCA, as measured by the clock drawing and cube copying, reported some interesting results, as for example, that conceptual clock drawing errors detect cognitive decline most effectively [89-93]. Additionally, the clock drawing task has the ability to differentiate, at baseline, cognitively intact older adults who will develop dementia up to 2 years post-baseline as well as patients with MCI who will progress to dementia up to 6 years post-baseline [92-94].…”

Section: Discussionmentioning

confidence: 99%

Use of the Montreal Cognitive Assessment Thai Version to Discriminate Amnestic Mild Cognitive Impairment from Alzheimer’s Disease and Healthy Controls: Machine Learning Results

Hemrungrojn

Tangwongchai

Charoenboon

et al. 2021

Dement Geriatr Cogn Disord

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Background: The Montreal Cognitive Assessment (MoCA) is an effective and applicable screening instrument to confirm the diagnosis of amnestic mild cognitive impairment (aMCI) from patients with Alzheimer’s disease (AD) and healthy controls (HCs). Objectives: This study aimed to determine the reliability and validity of the following: (a) Thai translation of the MoCA (MoCA-Thai) and (b) delineate the key features of aMCI based on the MoCA subdomains. Methods: This study included 60 HCs, 61 aMCI patients, and 60 AD patients. The MoCA-Thai shows adequate psychometric properties including internal consistency, concurrent validity, test-retest validity, and inter-rater reliability. Results: The MoCA-Thai may be employed as a diagnostic criterion to make the diagnosis of aMCI, whereby aMCI patients are discriminated from HC with an area under the receiver-operating characteristic (AUC-ROC) curve of 0.813 and from AD patients with an AUC-ROC curve of 0.938. The best cutoff scores of the MoCA-Thai to discriminate aMCI from HC is ≤24 and from AD > 16. Neural network analysis showed that (a) aberrations in recall was the most important feature of aMCI versus HC with impairments in language and orientation being the second and third most important features and (b) aberrations in visuospatial skills and executive functions were the most important features of AD versus aMCI and that impairments in recall, language, and orientation but not attention, concentration, and working memory, further discriminated AD from aMCI. Conclusions: The MoCA-Thai is an appropriate cognitive assessment tool to be used in the Thai population for the diagnosis of aMCI and AD.

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“…Our study showed the proportion of clock-drawing errors increased with increasing age, similar to other studies. [25][26][27] Regardless of the type of clock-drawing scoring method, males were significantly more likely to draw an abnormal clock. Other studies have found that females do worse on the clock drawing compared with males, different from our results.…”

Section: Discussionmentioning

confidence: 98%

Clock-Drawing Test as a Screening Tool for Cognitive Impairment Associated With Fecal Immunochemical Test Collection Errors

Daly

Crockett

et al. 2022

Ann Fam Med

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PURPOSEThe purposes of this study were to determine if (1) certain demographic characteristics (potential predictors) of participants, and (2) clock-drawing test results (as a screening test for cognitive impairment) were associated with fecal immunochemical test (FIT) sample collection errors.METHODS Patients scheduled for an upcoming colonoscopy were asked to collect stool samples using 5 different FITs. Patients completed a questionnaire that included the clockdrawing test. Errors included mistakes or omissions in recording the stool collection date and errors in stool collection. Each clock drawing was scored by 2 reviewers using 2 established methods. RESULTSOf the 1,448 participants with a clock drawing, 63% were female with a mean age of 63 years. In this population there were 83% White, 6% Black, and 24% Hispanic persons. Cognitive impairment was found in 292 patients by the Mendes-Santos method. Kappa coefficient for the 2 clock-drawing scores was 0.79 (P <.001). The multivariable generalized linear mixed model for FIT collection errors indicated being female (adjusted odds ratio [AOR], 1.64; 95% CI, 1.09-2.48), having an 8th grade or less education (AOR, 3.40; 95% CI, 1.87-6.18), and having an abnormal Mendes-Santos method clock score (AOR, 1.65; 95% CI, 1.08-2.54) were associated with significantly more errors. CONCLUSION Among the participants who do not have dementia, FIT collection errors were made not only by those who had abnormal clock drawing, but also, by those with normal clock drawings. Subjects being female, having 8th grade education or less, and having an abnormal clock drawing scored by Mendes-Santos's method were associated with FIT collection errors.

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Understated Cognitive Impairment Assessed with the Clock-Drawing Test in Community-Dwelling Individuals Aged ≥50 Years

Cited by 8 publications

References 48 publications

An Effective Test (EOmciSS) for Screening Older Adults With Mild Cognitive Impairment in a Community Setting: Development and Validation Study

An Effective Test (EOmciSS) for Screening Older Adults With Mild Cognitive Impairment in a Community Setting: Development and Validation Study

Use of the Montreal Cognitive Assessment Thai Version to Discriminate Amnestic Mild Cognitive Impairment from Alzheimer’s Disease and Healthy Controls: Machine Learning Results

Clock-Drawing Test as a Screening Tool for Cognitive Impairment Associated With Fecal Immunochemical Test Collection Errors

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