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Abstract
Objectives: The clock drawing test (CDT) is a widely used cognitive screening tool that has been well accepted. However, it is still questionable which scoring system is the best. We assessed the correlation of five common scoring methods of the CDT with Mini Mental State Examination (MMSE), and intercorrelations between each different scoring system.
Methods: CDT scores of different scoring systems from participants from the geriatric club in Pondok Kopi Jakarta Islamic Hospital, were compared. The CDT was scored according to the methods of Rouleau, Babins, Mendez, Lin, and Shulman. Correlation coefficients between the five scoring methods of the CDT with MMSE were calculated, as well as the intercorrelations between each different scoring system.
Results: The study sample consisted of 106 non-demented subjects, aged between 60 and 77 years. The five scoring methods of the CDT correlated significantly with MMSE, but correlation coefficients were moderate (r = 0.43 to r = 0.46). The highest was Lin's method (r = 0.46). Especially, correlation coefficients between the five scoring methods of the CDT with MMSE attention domain were higher (r = 0.42 to r = 0.52). The intercorrelations between each different scoring system were high (r = 0.87 to r = 0.99). The correlation coefficients between Rouleau's method with Mendez's method was the highest (r = 0.99).
Conclusions: The correlation of five common scoring methods of the CDT with MMSE were moderate positive. The CDT scored according to the method of Lin was the highest. The intercorrelations between each different scoring system were high.
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References
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Wan He, Daniel Goodkind, Paul Kowal. (2016). An Aging World: 2015, U.S. Census Bureau, International Population Reports, P95/16-1, U.S. Government Publishing Office, Washington, DC
Alzheimer's Disease International. (2015). World Alzheimer Report 2015, The Global Impact of Dementia, An Analysis of Prevalence, Incidence, Cost and Trends, Alzheimer's Disease International (ADI), London
Pinto E, Ruth Peters. (2009). Literature Review of the Clock Drawing Test as a Tool for Cognitive Screening, Dement Geriatr Cogn Disord; 27:201–213
Ehreke Lena, Tobias Luck, Melanie Luppa, Hans-Helmut K¨onig, Arno Villringer and Steffi G. Riedel-Heller. (2011). Clock Drawing Test – screening utility for mild cognitive impairment according to different scoring systems: results of the Leipzig Longitudinal Study of the Aged (LEILA 75+), International Psychogeriatrics, 23:10, 1592–1601
Brian J. Mainland, Sean Amodeo, Kenneth I. Shulman. (2014). Multiple clock drawing scoring systems: simpler is better, Int J Geriatr Psychiatry, 29: 127–136
Lorentz W. J., Scanlan J. M., Borson S. (2002). Brief Screening Tests for Dementia, Can J Psychiatry; 47:723–733
Rouleau I, Salmon DP, Butters N, Kennedy KC. (1992). Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease. Brain Cogn, 18(1): 70–87
Babins L, Slater ME, Whitehead V, Chertkow H. (2008). Can an 18-point clockdrawing scoring system predict dementia in elderly individuals with mild cognitive impairment? J Clin Exp Neuropsychol 30(2): 173–186
Mendez MF, Ala T, Underwood KL. (1992). Development of scoring criteria for the clock drawing task in Alzheimer's disease. J Am Med Inform Assoc 40(11): 1095–1099
Lin KN, Wang PN, Chen C, et al. 2003. The three-item clock-drawing test: a simplified screening test for Alzheimer's disease. Eur Neurol 49(1): 53–58
Shulman KI, Shedletsky R, Silver IL. 1986. The challenge of time: clock-drawing and cognitive function in the elderly. Int J Geriatr Psychiatry 1(2):135–140
Shulman K. 2000. Clock-drawing: is it the ideal cognitive screening test? Int J Geriatr Psychiatry 15(6): 548–561
Eva Seigerschmidt, Edelgard Mo¨sch, Margarete Siemen, Hans Fo¨rstl, Horst Bickel. (2002). The clock drawing test and questionable dementia: reliability and validity. Int J Geriatr Psychiatry; 17: 1048–1054
Phillips Jill. (2011). Timely Diagnosis of Dementia: Can we do better?, A report for Alzheimer's Australia, Paper 2
References
Alzheimer's Disease International. (2015). World Alzheimer Report 2015, The Global Impact of Dementia, An Analysis of Prevalence, Incidence, Cost and Trends, Alzheimer's Disease International (ADI), London
Pinto E, Ruth Peters. (2009). Literature Review of the Clock Drawing Test as a Tool for Cognitive Screening, Dement Geriatr Cogn Disord; 27:201–213
Ehreke Lena, Tobias Luck, Melanie Luppa, Hans-Helmut K¨onig, Arno Villringer and Steffi G. Riedel-Heller. (2011). Clock Drawing Test – screening utility for mild cognitive impairment according to different scoring systems: results of the Leipzig Longitudinal Study of the Aged (LEILA 75+), International Psychogeriatrics, 23:10, 1592–1601
Brian J. Mainland, Sean Amodeo, Kenneth I. Shulman. (2014). Multiple clock drawing scoring systems: simpler is better, Int J Geriatr Psychiatry, 29: 127–136
Lorentz W. J., Scanlan J. M., Borson S. (2002). Brief Screening Tests for Dementia, Can J Psychiatry; 47:723–733
Rouleau I, Salmon DP, Butters N, Kennedy KC. (1992). Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease. Brain Cogn, 18(1): 70–87
Babins L, Slater ME, Whitehead V, Chertkow H. (2008). Can an 18-point clockdrawing scoring system predict dementia in elderly individuals with mild cognitive impairment? J Clin Exp Neuropsychol 30(2): 173–186
Mendez MF, Ala T, Underwood KL. (1992). Development of scoring criteria for the clock drawing task in Alzheimer's disease. J Am Med Inform Assoc 40(11): 1095–1099
Lin KN, Wang PN, Chen C, et al. 2003. The three-item clock-drawing test: a simplified screening test for Alzheimer's disease. Eur Neurol 49(1): 53–58
Shulman KI, Shedletsky R, Silver IL. 1986. The challenge of time: clock-drawing and cognitive function in the elderly. Int J Geriatr Psychiatry 1(2):135–140
Shulman K. 2000. Clock-drawing: is it the ideal cognitive screening test? Int J Geriatr Psychiatry 15(6): 548–561
Eva Seigerschmidt, Edelgard Mo¨sch, Margarete Siemen, Hans Fo¨rstl, Horst Bickel. (2002). The clock drawing test and questionable dementia: reliability and validity. Int J Geriatr Psychiatry; 17: 1048–1054
Phillips Jill. (2011). Timely Diagnosis of Dementia: Can we do better?, A report for Alzheimer's Australia, Paper 2