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AbstractBackground and Objectives: In geriatrics and dementia care, early diagnosis is crucial. We developed a dementia screening model using drawing features from clock drawing tests (CDT) and investigated the features contributing to the discrimination of dementia and its screening performance. Methods: This study included 129 older adults attending a dementia outpatient clinic. We obtained information on the diagnosis of dementia and CDT data from medical records and quantified 12 types of drawing features according to the Freedman scoring system. Based on the dementia diagnosis information, participants were assigned to two groups: 58 in the dementia diagnosis group and 71 in the non-diagnosis group. Using Boruta, an iterative feature selection algorithm, and a support vector machine, a machine learning method, we analyzed the drawing features contributing to dementia discrimination and evaluated discrimination performance. Results: Five types of drawing features were selected as contributors to discrimination, including “numbers in the correct position,” “minute target number indicated,” and “hand in correct proportion.” These features exhibited a discriminating sensitivity of 0.74 ± 0.16 and specificity of 0.74 ± 0.18 for detecting dementia. Conclusion: This study demonstrated a method for identifying individuals likely to be diagnosed with dementia among patients attending a dementia outpatient clinic using drawing features. The knowledge of drawing features contributing to dementia differentiation may assist healthcare practitioners in clinical reasoning and provide novel insights for clinical practice. In the future, we plan to develop a primary screening for dementia based on machine learning using CDT. [ABSTRACT FROM AUTHOR]

Objective: We investigated the diagnostic accuracy of the Clock Drawing Test (CDT) in discriminating Mild Cognitive Impairment (MCI) and dementia from normal cognition. Additionally, its clinical utility in predicting the transition from normal cognition to MCI and dementia over the course of several years was explored. Method: In total, 1037 older adults (633 women) who completed the CDT in a baseline assessment were drawn from the population-based HELIAD cohort. Among these, 848 participants were identified as cognitively normal, 142 as having MCI and 47 with dementia during the baseline assessment. Of these individuals, 565 attended the follow-up assessment (mean interval: 3.21 years). ROC curve and binary logistic regression analyses were performed. Results: The CDT exhibited good diagnostic accuracy for the discrimination between dementia and normal cognition (AUC =.879, SN =.813, SP =.778, LR+ = 3.66, LR- =.240, <.001, d = 1.655) and acceptable diagnostic accuracy for the discrimination between dementia and MCI (AUC=.761, SN=.750, SP=.689, LR+ = 2.41, LR- =.362, p <.001, d = 1.003). We found limited diagnostic accuracy, however, for the discrimination between MCI and normal cognition (AUC =.686, SN =.764, SP =.502, LR+ = 1.53, LR- =.470, p <.001, d =.685). Moreover, the CDT significantly predicted the transition from normal cognition to dementia [Exp(B)= 1.257, p =.022], as well as the transition from MCI to normal cognition [Exp(B) = 1.334, p =.023] during the longitudinal investigation. Conclusions: The CDT is a neuropsychological test with acceptable diagnostic accuracy for the discrimination of dementia from MCI and normal cognition. Furthermore, it has an important predictive value for the transition from normal cognition to dementia and from MCI to normal cognition. [ABSTRACT FROM AUTHOR]

Objectives: The clock drawing test (CDT) is a widely used cognitive screening test. However, CDT performance is affected by education. This study examined an alternative, the Papadum test, designed for people with low levels of education/literacy. The association between education and test performance, correlation between CDT and Papadum test, and diagnostic accuracy of both CDT and Papadum tests were examined. Method: 89 healthy literate adults and 59 literate adults (all Bengali speaking) with a diagnosis of mild-moderate dementia from hospitals in Kolkata, India undertook the CDT and the Papadum test. Results: Education had a significant association with the CDT but not with the Papadum test. Across the whole sample there was a significant correlation between CDT and Papadum, but not within separate groups of healthy controls and patients. Diagnostic accuracy for the Papadum test was similar to that for CDT. Conclusions: Results highlight the strong influence that education has on CDT performance indicating that it is not suitable for those with low levels of literacy. The Papadum test could provide a viable alternative as a screening tool to the CDT for use with people who are illiterate or have low levels of education. Further validation studies are required. [ABSTRACT FROM AUTHOR]

Objective: The Clock Drawing Test (CDT) is commonly used as a screening tool for the assessment of dementia. The association between the CDT in acute stroke and long-term functional and cognitive outcomes in this population is unknown. The present prospective study is the first to examine if CDT scores in the acute stage after stroke are related to long-term outcomes and to compare the predictive ability of two scoring systems in a large sample of stroke patients. Method: A total of 340 patients admitted to an acute stroke unit were included in the present study. Separate stepwise multiple linear regression analyses were performed with eight independent variables (demographic/pre-stroke variables – age, sex, premorbid functioning; stroke-related variables – stroke severity, localization; cognitive variables – Orientation Test, CDT [2 scoring systems]), and four dependent variables administered one year post-stroke (Barthel Index, modified Rankin Scale, Reintegration to Normal Living index, Global Deterioration Scale). Results: Although both CDT scoring methods were related to all long-term outcome measures, the more comprehensive scoring system was the only baseline variable that significantly explained the variance in outcome measures in all four multiple regression models. Conclusion: Performance on the CDT in acute stroke is related to long-term outcomes including patients' degree of independence in performing activities of daily living, the degree to which they achieved reintegration into daily occupations, and the degree of cognitive decline observed one-year post-stroke. Future studies are needed to clarify the nature of the relationship between different CDT scoring systems and post-stroke outcomes. [ABSTRACT FROM AUTHOR]

Objective: The Clock Drawing Test (CDT) is widely used as a cognitive screening tool. The purpose of this study was to investigate the influence of gender, age, and education on CDT scores in a sample of elderly, community-dwelling adults in China. Methods: The sample was derived from a cross-sectional survey, "The study on the early screening methods for senile dementia." It included Chinese-speaking persons 65 years of age or older with normal cognitive functioning. All the participants underwent neuropsychological assessments, including the Mini-Mental State Examination (MMSE) and the CDT. The CDT was administered and scored using Shulman's methodology. The effects of gender, age, and education on CDT performance were analyzed. Results: The sample contained 440 males and 445 females, ranging from 65 to 93 years of age, with a mean age of 74.94 ± 6.17 years old. The mean CDT and MMSE scores were 4.81 ± 0.54 and 28.79 ± 1.35, respectively. CDT performance was significantly different among age groups (χ2 = 22.85, p <.01) and educational levels (χ2 = 6.94, p =.03). However, there was no significant difference in CDT scores between males and females (t = 0.56, p =.57). The gender difference remained non-significant when the sample was divided according to age group and educational level. Conclusions: The study provides preliminary normative data on the CDT for the older population of China. CDT performance was significantly influenced by age and education, which must be taken into account when using the CDT as a cognitive screening tool in the Chinese population. [ABSTRACT FROM AUTHOR]

Objective: The Clock Drawing Test (CDT) is frequently used to screen for cognitive impairment, however, normative data for Rouleau et al.'s scoring system are scarce. The present study aims to provide norms for Rouleau et al.'s scoring system that are tailored to Quebec French-speaking mid- and older aged healthy adults. Methods: Six researchers from various research centers across the Province of Quebec (Canada) sent anonymous data for 593 (391 women) healthy community-dwelling volunteers (age range: 43-93 years; education range: 5-23 years) who completed the CDT 'drawing on command' version. This command version (setting the clock hands to 11:10, without a pre-drawn circle) was administrated as part of a more extensive neuropsychological assessment, or along with cognitive screening instruments. Each drawn clock was scored according to the quantitative criteria set by Rouleau et al.'s scoring system. Results: CDT scores were significantly correlated with age (r(592) = −.132, p = .001) and years of education (r(592) = .116, p = .005), but not with sex (r(592) = .065, p = .112). Since data were skewed towards higher test scores, the percentiles method was used for analysis. Percentile ranks stratified by age and education are presented. Conclusion: These normative data for Rouleau et al.'s scoring system will contribute towards adequately screening for cognitive decline in Quebec French-speaking healthy adults, by also taking into account individual characteristics such as age and education. [ABSTRACT FROM AUTHOR]

Objective: The Clock Drawing Test (CDT) is widely used as a screening tool for discriminating cognitively normal individuals from patients with mild dementia. The aim of present study was to provide normative values for a 10-point quantitative scoring system proposed by Rouleau and colleagues (1992), including CDT total score and subscales score assessing representation of clock face (RC), layout of numbers (LN), and position of hands (PH), in a large sample of Italian healthy individuals. Method: Eight hundred and seventy-two Italian healthy participants (483 women; age range 20-94 years) with educational level from primary school to university underwent CDT and Mini Mental State Examination (MMSE). Results: Multiple linear regression analysis revealed that age and education significantly influenced CDT total score and its subscale scores. Moreover, a significant effect of gender was found only in RC subscale. From the derived linear equation, a correction grid for raw scores was built. Inferential cut-off values were estimated using a non-parametric technique and equivalent scores (ES) were computed. Correlation analysis showed a weakly significant correlation between adjusted CDT total score and adjusted MMSE scores. Conclusions: The present study provided normative data for the Rouleau and colleagues version of CDT in an Italian sample, useful for clinical and research purposes. [ABSTRACT FROM AUTHOR]