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Background: Cognitive impairment is common and disabling in Parkinson’s disease (PD). Cognitive testing can be time consuming in the clinical setting. One rapid test to detect cognitive impairment in non-PD populations is the Clock Drawing Test (CDT), which calls upon the brain’s executive and visuospatial abilities to draw a clock designating a certain time. Objective: Test the hypothesis that PD participants would perform worse on CDT compared to controls and that CDT would correlate with other measures of cognition. Methods: This study evaluated two independent CDT scoring systems and differences in CDT performance between PD (N = 97) and control (N = 54) participants using a two-sample t-test. Pearson’s correlations were conducted between the CDT and tests of sleepiness (Epworth Sleepiness Scale) and vigilance (Psychomotor Vigilance Test); executive function (Trails B-A); and global cognition (Montreal Cognitive Assessment). Receiver operating characteristic curves were used to determine cut points on the CDT that identify individuals who need additional cognitive testing. Results: PD participants had worse performance on CDT compared to controls. The CDT was correlated with executive function (Trails B-A) and global cognition (Montreal Cognitive Assessment). The CDT correlated with vigilance (Psychomotor Vigilance Task) only in healthy controls. However, the CDT was not correlated with measures of sleepiness (Epworth Sleepiness Scale) in either group. A cut point of 9 on the Rouleau scale and 18 on the Mendez scale identified PD participants with cognitive impairment. Conclusion: The CDT is a rapid clinical cognitive assessment that is feasible in PD and correlates with other measures of cognition.

Resumen Introduccion La demencia es una enfermedad cronica degenerativa de alto impacto para las familias y los sistemas de salud. Los instrumentos de medicion del deterioro cognitivo que se utilizan actualmente tienen caracteristicas psicometricas diferentes en cuanto a tiempo de aplicacion, punto de corte, confiabilidad y validez. El objetivo de la presente revision fue describir las caracteristicas de las escalas Mini Cog, Prueba del reloj y Mini- Mental para tamizaje de deterioro cognitivo validadas al idioma espanol. Desarrollo La busqueda bibliografica se realizo en 3 etapas mediante la base de datos Medline a partir del ano 1953. Se realizo una seleccion de publicaciones validadas al espanol que incluyeran la confiabilidad, validez, sensibilidad y especificidad de las escalas. Conclusiones Las 3 herramientas de tamizaje descritas en este articulo proporcionan un apoyo para el personal de salud. La deteccion oportuna es crucial para el pronostico de las personas que viven con deterioro cognitivo leve o demencia.

Послеоперационная когнитивная дисфункция (ПОКД), является одним из наиболее часто встречающих осложнений аорто-коронарного шунтирования (АКШ) с искусственным кровообращением. Цель исследования – изучить влияние динамики насосной функции сердца на динамику когнитивных способностей больных ИБС пожилого возраста с помощью «Теста рисования часов» (ТРЧ), в периоперационном периоде АКШ с ИК. Материалы и методы. Было обследовано (ЭхоКГ, тест «Рисование часов») 60 пациентов страдающих ишемической болезнью сердца, стенозирующим коронаросклерозом, стенокардией III-IV функционального класса, перенесших коронарное шунтирование в условиях искусственного кровообращения и фармако-холодовой кровяной кардиоплегии, находящихся на лечении в кардиохирургическом отделении Белгородской областной клинической больницы Святителя Иоасафа (г. Белгород), с 2019 г. по 2021 г. Результаты и обсуждения. В результате обследования 60 пациентов (30 человек среднего возраста, 30 человек пожилого возраста) в периоперационном периоде коронарного шунтирования, была доказана прямая корреляционная связь между послеоперационными результатами ТРЧ и периоперационной динамикой фракции выброса левого желудочка (ФВлж)(R=0,385) (p=0,035) у пациентов пожилого возраста, чего не наблюдалось у больных среднего возраста. Также была выявлена прямая корреляционная связь между динамикой результатов ТРЧ и периоперационной динамикой ФВлж (R=0,516)(p=0,003). Из чего можно сделать вывод, что динамика насосной функции сердца может прямо влиять на динамику когнитивного статуса у пожилых больных ИБС в периоперационном периоде АКШ с ИК. Выводы. Данное исследование установило возрастные особенности формирования когнитивного дефицита у больных ИБС пожилого возраста, перенесших АКШ с ИК., Postoperative cognitive dysfunction (POCD) is one of the most common complications of coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB). The aim of the work is to study the influence of the dynamics of the pumping function of the heart on the dynamics of the cognitive abilities of elderly patients with coronary artery disease using the “Clock Drawing Test” (CDT) in the perioperative period of CABG with CPB. Materials and methods. 60 patients with ischemic heart disease, stenosing coronary atherosclerosis, functional class III-IV angina pectoris, who underwent coronary bypass grafting under cardiopulmonary bypass and pharmaco-cold blood cardioplegia, who were being treated in the cardiosurgical department of the Belgorod Regional St. Ioasaph Clinical Hospital (Belgorod), from 2019 to 2021 Results and discussion. As a result of a survey of 60 patients (30 middle-aged, 30 elderly) in the perioperative period of coronary bypass grafting, a direct correlation was proved between the postoperative results of CDT and the perioperative dynamics of the left ventricular ejection fraction (LVEF) (R=0.385) (p=0.035 ) in elderly patients, which was not observed in middle-aged patients. A direct correlation was also found between the dynamics of the results of CDT and the perioperative dynamics of LVEF (R=0.516) (p=0.003). From which it can be concluded that the dynamics of the pumping function of the heart can directly affect the dynamics of the cognitive status in elderly patients with coronary artery disease in the perioperative period of CABG with CPB. Conclusions. This study established the age-related features of the formation of cognitive deficits in elderly patients with coronary artery disease who underwent CABG with CPB.

Frailty has been suggested to take part in the recently demonstrated link between olfactory dysfunction and overall mortality risk. Preoperative assessment of frailty is essential to detect the most vulnerable patients scheduled for surgery. The aim of this study was to evaluate whether olfactory dysfunction is a reliable predictor of preoperative frailty and postoperative outcome. This was a single-center prospective observational study conducted between July and October 2020 in Brussels, Belgium. 155 preoperative patients aged from 65 years old and scheduled for elective non-cardiac surgery. Olfactory function was examined using the Sniffin' Sticks 12-item identification test. Frailty was assessed using the Edmonton Frail Scale (EFS) and handgrip strength. The clock drawing test (CDT) from the EFS was also analyzed separately to evaluate cognitive function. Patients were followed for postoperative complications and mortality over one year. Olfactory dysfunction was significantly associated with the EFS score, anosmic patients having a higher median EFS score than normosmic patients (6[4-7] vs 4[2-5], p = .025). Anosmic patients had an increased odds of being frail after adjusting for possible confounding factors (OR: 6.19, 95% CI: 1.65-23.20, p = .007) and were more at risk of poor postoperative outcome (including complications and death) (OR: 4.33, 95% CI: 1.28-14.67, p = .018). Olfactory dysfunction is associated with preoperative frailty determined by the EFS and with poor post-surgical outcome at one-year.

Background: Poor sleep is a potential modifiable risk factor for later life development cognitive impairment. The aim of this study is to examine if subjective measures of sleep duration and sleep disturbance predict future cognitive decline in a population-based cohort of 60, 66, 72 and 78-year-olds with a maximal follow up time of 18 years. Methods: This study included participants from the Swedish National Study on Ageing and Care – Blekinge, with assessments 2001–2021. A cohort of 60 (n = 478), 66 (n = 623), 72 (n = 662) and 78 (n = 548) year-olds, were assessed at baseline and every 6 years until 78 years of age. Longitudinal associations between sleep disturbance (sleep scale), self-reported sleep duration and cognitive tests (Mini Mental State Examination and the Clock drawing test) were examined together with typical confounders (sex, education level, hypertension, hyperlipidemia, smoking status, physical inactivity and depression). Results: There was an association between sleep disturbance at age 60 and worse cognitive function at ages 60, 66 and 72 years in fully adjusted models. The association was attenuated after bootstrap-analysis for the 72-year-olds. The items of the sleep scale most predictive of later life cognition regarded nightly awakenings, pain and itching and daytime naps. Long sleep was predictive of future worse cognitive function. Conclusion: Sleep disturbance was associated with worse future cognitive performance for the 60-year-olds, which suggests poor sleep being a risk factor for later life cognitive decline. Questions regarding long sleep, waking during the night, pain and itching and daytime naps should be further explored in future research and may be targets for intervention. CC BY 4.0© 2022 The AuthorsCorresponding author at: Department of Health, Blekinge Institute of Technology, Valhallavägen 1, 371 41 Karlskrona, Sweden. E-mail address: anders.behrens@bth.se (A. Behrens). SNAC is financially supported by the Ministry of Health and Social Affairs, Sweden, and the participating county councils, municipalities, and university departments.

Background: Widespread dementia detection could increase clinical trial candidates and enable appropriate interventions. Since the Clock Drawing Test (CDT) can be potentially used for diagnosing dementia-related disorders, it can be leveraged to develop a computer-aided screening tool. Objective: To evaluate if a machine learning model that uses images from the CDT can predict mild cognitive impairment or dementia. Methods: Images of an analog clock drawn by 3,263 cognitively intact and 160 impaired subjects were collected during in-person dementia evaluations by the Framingham Heart Study. We processed the CDT images, participant’s age, and education level using a deep learning algorithm to predict dementia status. Results: When only the CDT images were used, the deep learning model predicted dementia status with an area under the receiver operating characteristic curve (AUC) of 81.3% ± 4.3%. A composite logistic regression model using age, level of education, and the predictions from the CDT-only model, yielded an average AUC and average F1 score of 91.9% ±1.1% and 94.6% ±0.4%, respectively. Conclusion: Our modeling framework establishes a proof-of-principle that deep learning can be applied on images derived from the CDT to predict dementia status. When fully validated, this approach can offer a cost-effective and easily deployable mechanism for detecting cognitive impairment.

Актуальність. Депресія є фактором ризику виникнення цукрового діабету (ЦД) та негативно впливає на його перебіг, підвищуючи ризик розвитку ускладнень. Метою дослідження було оцінити стан когнітивної функції у хворих на ЦД 2-го типу похилого віку з депресивними розладами та без них. Матеріали та методи. Було обстежено 115 хворих на ЦД 2-го типу, із них жінок було 78, чоловіків — 37. Пацієнти були розподілені на дві групи: з депресивними розладами та без них. Оцінка депресивних виявів проводилася за допомогою самоопитувальника депресії. Оцінка когнітивних порушень здійснювалася зранку за допомогою таких методів: тесту «5 слів», шкали оцінки психічного статусу, батареї тестів на лобну дисфункцію, тесту малювання годинника. Результати. У 68,7 % хворих на ЦД 2-го типу похилого віку не відзначаються депресивні розлади за даними самоопитувальника депресії, легкі вияви спостерігались у 17,4 % обстежених, помірні — у 10,4 % та 3,5 % хворих мали тяжкі вияви депресії. У пацієнтів із депресивними розладами спостерігаються вірогідно гірші показники когнітивної функції. У хворих на ЦД із помірними та тяжкими виявами депресії стан когнітивної функції вірогідно гірший порівняно з пацієнтами, які мають легкі вияви депресії чи без депресивних розладів. Висновки. Необхідно проводити скринінг у всіх пацієнтів із ЦД 2-го типу на наявність депресивних розладів із метою профілактики порушень когнітивних функцій.

Background: Few studies have investigated associations between types of clock drawing test (CDT) errors and cognitive impairment. Objective: To explore associations of qualitative errors in the CDT with comprehensive neurocognitive assessment scores and clinical diagnosis. Methods: Outpatients at a memory clinic were enrolled. Frequencies of errors determined by Cahn’s method were explored according to cognitive status (cognitively normal [CN] (n = 279), mild cognitive impairment [MCI] (n = 321), and Alzheimer’s disease [AD]) (n = 575). Neuropsychological assessment scores were compared between participants with and without errors. Results: Stimulus-bound response (SB) was relatively rare (6.8%) in the CN group but was markedly more common in the MCI (23.4%) and AD (33.2%) groups. Conceptual deficit (CD) was found in more than 20%of CN individuals, as well as about 50%of AD patients. Planning deficit (PD) frequencies were relatively similar among the groups. SB in both of CN and MCI individuals, and CD in both of CN and MCI individuals were associated with lower scores in several neuropsychological assessments. Meanwhile, PD was not associated with lower assessment scores in any of CN, MCI, or AD individuals. Conclusion: The frequencies of SB and CD increased from CN, MCI, to AD but showed somewhat different patterns. Both SB and CD were associated with lower cognition in all three cognitive stages.

Aim: Although clinicians primarily diagnose dementia based on a combination of metrics such as medical history and formal neuropsychological tests, recent work using linguistic analysis of narrative speech to identify dementia has shown promising results. We aim to build upon research by Thomas JA & Burkardt HA et al. (J Alzheimers Dis. 2020;76:905–2) and Alhanai et al. (arXiv:1710.07551v1. 2020) on the Framingham Heart Study (FHS) Cognitive Aging Cohort by 1) demonstrating the predictive capability of linguistic analysis in differentiating cognitively normal from cognitively impaired participants and 2) comparing the performance of the original linguistic features with the performance of expanded features. Methods: Data were derived from a subset of the FHS Cognitive Aging Cohort. We analyzed a sub-selection of 98 participants, which provided 127 unique audio files and clinical observations (n = 127, female = 47%, cognitively impaired = 43%). We built on previous work which extracted original linguistic features from transcribed audio files by extracting expanded features. We used both feature sets to train logistic regression classifiers to distinguish cognitively normal from cognitively impaired participants and compared the predictive power of the original and expanded linguistic feature sets, and participants’ Mini-Mental State Examination (MMSE) scores. Results: Based on the area under the receiver-operator characteristic curve (AUC) of the models, both the original (AUC = 0.882) and expanded (AUC = 0.883) feature sets outperformed MMSE (AUC = 0.870) in classifying cognitively impaired and cognitively normal participants. Although the original and expanded feature sets had similar AUC, the expanded feature set showed better positive and negative predictive value [expanded: positive predictive value (PPV) = 0.738, negative predictive value (NPV) = 0.889; original: PPV = 0.701, NPV = 0.869]. Conclusions: Linguistic analysis has been shown to be a potentially powerful tool for clinical use in classifying cognitive impairment. This study expands the work of several others, but further studies into the plausibility of speech analysis in clinical use are vital to ensure the validity of speech analysis for clinical classification of cognitive impairment.

Background The early detection of patients at risk of post-stroke cognitive impairment (PSCI) may help planning subacute and long-term care. We aimed to determine the predictivity of two screening cognitive tests on the occurrence of mild cognitive impairment or dementia in acute stroke patients. Methods A cognitive assessment within a few days of ischemic or hemorrhagic stroke was performed in patients consecutively admitted to a stroke unit over 14 months by means of the Clock Drawing Test (CDT) and the Montreal Cognitive Assessment-Basic (MoCA-B). Results Out of 191 stroke survivors who were non-demented at baseline, 168 attended at least one follow-up visit. At follow-up (mean duration ± SD 12.8 ± 8.7 months), 28 (18.9%) incident cases of MCI and 27 (18%) cases of dementia were recorded. In comparison with patients who remained cognitively stable at follow-up, these patients were older, less educated, had more comorbidities, a higher score on the National Institutes of Health Stroke Scale (NIHSS) at admission, more severe cerebral atrophy, and lower MoCA-B and CDT scores at baseline. In multi-adjusted (for age, education, comorbidities score, NIHSS at admission and atrophy score) model, a pathological score on baseline CDT (p Conclusion A bedside cognitive screening with the CDT helps identifying patients at higher risk of PSCI.

Background: Traumatic brain injuries (TBIs) are the leading cause of morbidity, mortality, disability, and socioeconomic losses globally, but of more concern, in India and other developing countries. The Mini mental state examination (MMSE) and clock drawing test (CDT) are the two mostly adapted methods for cognitive impairment screening. Therefore, it is necessary to establish a robust evaluation system exclusively for post-TBI cognitive impairment. Materials and Methods: One hundred and thirty-four cases treated previously at the health facility for TBIs were evaluated for cognitive functions during the follow-up period ranging from 3 weeks to 6 months in the out-patient department. All cases underwent mini-mental score examination (MMSE) and CDT to assess their cognitive performances. The data were analyzed statistically using Chi-square and ANOVA tests of significance. Results: Statistically significant association (P < 0.001) between the cognitive status of patients on the basis of overall MMSE score and the site of brain injury was observed. It was noted that 76 (56.7%) of the cases had cognitive impairment (MMSE score

Introduction Hypertension (HTN) is the most frequent cause of subcortical vascular brain injury (VBI) and its cognitive consequences. The aims were to show the usefulness of the Clock Drawing Test (CDT) to detect cognitive impairment in hypertensive patients and to compare it with the Mini-Mental Test (MMSE). Methods A subset of hypertensive patients of the Heart-Brain Study in Argentina was included. Demographic characteristics, vascular risk factors, blood pressure (BP) and schooling level were recorded. The MMSE and CDT tests were used for neurocognitive assessment and Hospital Anxiety Depression scale (HAD) for mood disorder evaluation. Results 1414 hypertensive patients (age 59.7 ± 13.8 years, female (62.3%). The prevalence of cognitive impairment was 20.7% (using MMSE) and 36.1% (using CDT). Among hypertensive patients with normal MMSE (>24) 29.3% had cognitive impairment (abnormal CDT). The CDT was associated with level of education but not with age or mood status. Conclusions The CDT is a useful screening tool to detect hypertension-mediated brain damage earlier (especially in midlife) and is more sensitive than MMSE.

Objectives: The clock drawing test (CDT) is a commonly used cognitive screening test. The purpose of this study was to investigate the effect of selected sociodemographic, clinical and lifestyle factors on the CDT performance in the Polish elderly population. Methods: CDT performance was assessed in 399 elderly subjects randomly selected out of all participants of a nationwide study on aging, PolSenior2, who met the inclusion criteria. CDT was scored using the Manos–Wu method. The short version of the Geriatric Depression Scale (15-item GDS) was used as a mood measuring tool. Results: Our study revealed a significant relationship between CDT performance and age. Multivariate regression analysis demonstrated also that interactions between reading newspapers and gender and between playing games and GDS score were independent predictors of an incorrect CDT. Of note, even though years of education were related to the CDT score (0–10) in the correlation analysis, education did not predict the global CDT score in the regression analysis. Conclusions: Advanced age was related to incorrect CDT performance. Engagement in some leisure activities may predict the CDT score, while global CDT performance, as assessed by the Manos–Wu method, is relatively unaffected by education.

The clock-drawing test (CDT) has been used as a screening tool to identify cognitive deficit in patients with dementia. However, it has not been extensively evaluated for categorizing patients with vascular mild cognitive impairment (vMCI). This study aimed to examine the discrimination of vMCI using various CDT scoring methods.A total of 120 vMCI patients and 119 normal control (NC) subjects were tested using three CDT quantitative scoring systems: the one from the Montreal Cognitive Assessment (MoCA) (CDT3) and the systems of Rouleau (CDT10) and Babins (CDT18). We used a revised scoring method to evaluate the effectiveness in differentiating vMCI patients from NC subjects, which combined the CDT10 quantitative score and three qualitative errors with a significantly higher prevalence in vMCI group (called hereinafter CDTcomb, including CDTcomb13 and CDTcomb16 based on different weights of the three error types). The sensitivity and specificity of the CDT methods were determined by the receiver operating characteristic (ROC) curve. The results of the scoring systems were compared with those of the Mini-Mental State Examination (MMSE).The results of the ROC analyses with the CDT3, CDT10, and CDT18 systems produced a sensitivity of 71.1%, 81.8%, and 60.3%, and a specificity of 66.12%, 58.68%, and 73.55%, respectively, for the diagnosis of vMCI. Compared with the separate MMSE score, the combination of MMSE with the CDT3, CDT10 and CDT18 scores did not increase the sensitivity and specificity. When three qualitative errors were incorporated into the CDT10 quantitative score, CDTcomb13 and CDTcomb16 provided a sensitivity of 87.6% and 86.78%, and a specificity of 74.79% and 80.67%, respectively, in differentiating vMCI patients from the NC group.Our findings suggest that the combination of CDT quantitative score with qualitative observations of the clock-drawing errors can provide a better discrimination between vMCI patients and cognitively normal subjects.

Klampis Ngasem is one of the areas in East Surabaya, precisely in Sukolilo sub-district, Surabaya. The target group in the community partnership program (PKM) is the Elderly Posyandu "Barokah" in RW 3. Problems that occur in the Elderly Barokah Posyandu are less varied activities and innovation so that some elderly are less interested and bored to follow routinely as indicated by the presence of the elderly < 75%, the absence of efforts to prevent dementia that is carried out regularly and continue for the elderly, lack of elderly knowledge about changes in cognitive function and efforts to maintain cognitive function so as to prevent dementia, and the availability of leisure time for the elderly in addition to routine posyandu activities and those that have not been utilized to be useful and productive. The solution to overcome these problems is through the application of Art Therapy to make colet batik. The purpose of this community service is to help express themselves, maintain the cognitive function of the elderly and provide new skills in making batik as an activity in the Posyandu Elder Barokah Klampis Ngasem Village. The activities carried out are screening to see the cognitive function of the elderly using Mini mental state examination (MMSE) and clock drawing test (CDT), counseling about prevention of dementia which includes knowing dementia, prevention of dementia, and art therapy, batik colet training with demonstration methods, and simulation. The results of batik colet will be processed again with the help of cadres or the elderly who have sewing skills to be used as sofa pillowcases. From this process, a work or product will be produced from the batik colet method.

Objective: Delirium is a common neurocognitive syndrome among hospitalised older adults. The clock drawing test (CDT) is a relatively simple bedside test of cognitive function. This systematic revi...

Objective The aim: To assess the severity of cognitive impairment (CI) in patients with cerebrovascular disease (CVD) depending on the number of vascular risk factors (VRF). Patients and methods Materials and methods: The study consisted of five hundred and eighty patients with CVD (247 females and 333 males) aged from 45 to 89 years (mean age: 64,1±8,9 years). The patients were divided into 6 groups (I, II, III, IV, V, VI) depending on the number of VRF. The examination consisted of a standard clinical evaluation, neurological examination, the application of neuropsychological tests (the MMSE; the PALT/The Paired Associates Learning Test; clock drawing test), laboratory tests, MRI of brain. Results Results: According to ANOVA, the greater the number of VRF the patients had, the lower was their total MMSE score corresponding to more pronounced cognitive decline (F=2,97, p=0,012). A significant negative correlation between patients' age and their MMSE score was detected regardless of their VRF count. The patients of the V and VI groups had substantially lower parameters of immediate, delayed memory and clock drawing test score comparing to the patients of the I group. Conclusion Conclusions: The presence of 4 and more VRF was related to more pronounced CI in the patients with CVD. Decline of different aspects of memory, attention, spatial orientation, abstract thinking, planning, concentration, executive and visuospatial skills in groups of patients with 4,5 and 6 vascular risk factors was established. Age was substantially associated with cognitive decline in all the group of patients.

Vitamin C is a powerful antioxidant and facilitates neurotransmission. This study explored association between vitamin C deficiency and cognitive impairment in older hospitalised patients. This prospective study recruited 160 patients ≥ 75 years admitted under a Geriatric Unit in Australia. Cognitive assessment was performed by use of the Mini-Mental-State-Examination (MMSE) and patients with MMSE scores

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Individuals with mild cognitive impairment (MCI) often make qualitative errors on the Clock Drawing Test (CDT), and these errors are reported to be associated with lower scores on neuropsychological assessments. However, the association of CDT errors with non-cognitive characteristics has not been investigated in individuals with MCI to date. In this study, we explored this association in older adults with MCI who made qualitative errors on the CDT. Outpatients at a memory clinic with a Clinical Dementia Rating (CDR) of 0.5 (n = 193) were included. The CDT was evaluated using Cahn et al.’s method and non-cognitive characteristics were compared between participants with and without CDT errors. The non-cognitive characteristics compared included normal and maximum gait speeds, grip strength, muscle mass, and severity of white matter lesions. Participants with the CDT error type of conceptual deficit (CD; n = 58) had significantly slower normal and maximum gait speeds, and multiple logistic regression analysis adjusted for age and sex revealed CD was significantly associated with the slowest tertile of maximum gait speed. No other non-cognitive characteristics were significantly associated with errors on the CDT.

SekretnyiVolodymyr, Nekhanevych Oleh. Long-term consequences of traumatic brain injuries with ice-hockey players. Journal of Education, Health and Sport. 2021;11(10):204-214. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2021.11.10.018 https://apcz.umk.pl/JEHS/article/view/JEHS.2021.11.10.018 https://zenodo.org/record/5603131 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2021; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.10.2021. Revised: 10.10.2021. Accepted: 26.10.2021. LONG-TERM CONSEQUENCES OF TRAUMATIC BRAIN INJURIES WITH ICE-HOCKEY PLAYERS Volodymyr Sekretnyi, Oleh Nekhanevych e-mail: dr.sekretnyi@gmail.com Dnipro state medical university Department of physical rehabilitation, sports medicine and valeology V. Vernadskogo str., 9, Dnipro, 49044, Ukraine Abstract Introduction Contact sports (football, hockey, boxing, mixed martial arts, rugby and American football) are sports with high frequency of traumatic brain injuries (TBI). But a significant part of sports related concussions (SRC) are below thelevel of clinical diagnosis of SRC or are unnoticed. The most severe cumulative consequence of SRC is chronic traumatic encephalopathy (CTE). CTE is a progressive neurodegenerative disease accompanied by motor, psychological and cognitive disorders. Today, CTE widely resonates in the science world due to suicides among famous athletes. Despite the fact that this disease has been studied for almost 100 years, the diagnosis of CTE can be made only after autopsy. That is why the study of a wide range of clinical manifestations of CTE plays an important role. Purpose To establish long-term cognitive consequences of TBI in ice hockey players. Material and methods Retrospectively, we tested retired 20 ice hockey players (17 men and 3 women). All the players were winners of the Ukrainian Ice Hockey Championship and members of the national teams of Ukraine.The average age is 34 ± 9.4 years, the youngest of them is 21 years old, the oldest is 51 years old. Also, players were divided into age groups: 18-28 years, 29-38 years, 39 and older. All athletes had at least one SRC (7 athletes had 1 SRC, 2 SRC – 3 athletes, 3 SRC – 6 athletes, 4 and more – 4 athletes). 7 hockey players were hospitalized after having had SRC (which indicates the severity of SRC). All athletes completed a questionnaire with their team doctor, which included: passport part, sports history, history of SRC, a mini mental scale evaluation (MMSE) and «the clock drawing test». Results Dividing athletes into groups according to the number of SRC received during their professional career, we compared their MMSE result. The results of the analysis showed a statistically significant decrease in the value of MMSE with an increase in SRC more than 1 during a sports career. Thus, in the group with 1 SRC the value of MMSE was 28.7 (1.38) points, while in the group with 2 or more SMS it was equal to 26.7 (1.15) points (p Conclusions Our study has outlined connection between cognitive impairment in ice-hockey players and SRC. Despite the fact that the world literature emphasizes the importance of cognitive testing both to guide athletes before and after SRC, and to assess the long-term effects of SC, there is no one diagnostic protocol and it requires unification and mandatory inclusion in the diagnostic program for the athlete who had SRC. Key words: ice hockey, sports related concussion, chronic traumatic encephalopathy, cognitive impairment.

Clock drawing test is a classic and reliable clinical assessment of cognitive functions. However, it requires manual inspection and scoring. In this paper, via several computer vision and artificial intelligence techniques, we successfully design and implement an intelligent system with the ability to score the test in an automatic manner. As a mobile application, our work allows users to take a clock drawing test anytime and anywhere.

Aims: Reduced pre-operative cognitive functioning in older adults is a risk factor for postoperative complications, but it is unknown if preoperative digitally-acquired clock drawing test (CDT) cognitive screening variables, which allow for more nuanced examination of patient performance, may predict lengthier hospital stay and greater cost of hospital care. This issue is particularly relevant for older adults undergoing transcatheter aortic valve replacement (TAVR), as this surgical procedure is chosen for intermediate-risk older adults needing aortic replacement. This proof of concept research explored if specific latency and graphomotor variables indicative of planning from digitally-acquired command and copy clock drawing would predict post-TAVR duration and cost of hospitalization, over and above age, education, American Society of Anesthesiologists (ASA) physical status classification score, and frailty. Methods: Form January 2018 to December 2019, 162 out of 190 individuals electing TAVR completed digital clock drawing as part of a hospital wide cognitive screening program. Separate hierarchical regressions were computed for the command and copy conditions of the CDT and assessed how a-priori selected clock drawing metrics (total time to completion, ideal digit placement difference, and hour hand distance from center; included within the same block) incrementally predicted outcome, as measured by R2 change significance values. Results: Above and beyond age, education, ASA physical status classification score, and frailty, only digitally-acquired CDT copy performance explained significant variance for length of hospital stay (9.5%) and cost of care (8.9%). Conclusions: Digital variables from clock copy condition provided predictive value over common demographic and comorbidity variables. We hypothesize this is due to the sensitivity of the copy condition to executive dysfunction, as has been shown in previous studies for subtypes of cognitive impairment. Individuals undergoing TAVR procedures are often frail and executively compromised due to their cerebrovascular disease. We encourage additional research on the value of digitally-acquired clock drawing within different surgery types. Type of cognitive impairment and the value of digitally-acquired CDT command and copy parameters in other surgeries remain unknown.

Background/objectives The Clock Drawing Test (CDT) is a widely used measure, which has been included as a recommended cognitive screen for driving evaluations. This study aimed to develop an optimized scoring method-the West Haven-Yale CDT (WHY-CDT)-based on the scoring methods of Freund and Royall's CLOX, the latter of which is significantly associated with executive control functions. Design Retrospective cohort study. Setting Greater New Haven, Connecticut, area. Participants A total of 237 adults, aged 70 years and older, who had a current driver's license and drove at least once a month. Measurements Clock drawings were independently scored using both scoring systems, as well as a qualitative-based 5-point gestalt score. Interrater reliability was calculated using Light's κ for dichotomous variables and intraclass correlations for continuous variables. A categorical principal component analysis was conducted to determine which items from the Freund and Royall scoring systems should be retained in the modified system, with the Kuder-Richardson test used to assess internal consistency (reliability). Results The majority of the quantitative scoring items had moderate to almost perfect interrater reliability, with excellent interrater reliability for the qualitative gestalt score. The final scoring method retained seven items from the Freund and Royall versions, of which over 85% were from the latter. Internal consistency was fair to acceptable for the WHY-CDT's two dichotomously scored subscales, but poor for both the Freund and Royall scoring methods. Conclusions The WHY-CDT is a simple scoring method that combines elements of the Freund and Royall methods, as well as an overall gestalt score, and has strong interrater reliability. Future directions for use of this modified system are discussed. J Am Geriatr Soc 67:2129-2133, 2019.

Objectives. Therapeutic monitoring and evaluation of the efficacy of neurotrophic therapy in patients with amnestic-type mild cognitive decline syndrome (aMCI) were performed in a model using courses of cerebrolysin. Materials and methods. A total of 19 elderly patients meeting the diagnostic criteria for aMCI syndrome were studied. All patients received treatment with cerebrolysin: 20 intravenous dropwise infusions of 30 ml in 100 ml of physiological saline. Treatment efficacy was evaluated using psychometric tests and scales (CGI, MMSE, MoCA, MDRS, clock drawing test, BNT, 10-word memory test, 10-word delayed reproduction test, forward number naming test, backward number naming test) at study weeks 0, 4, 10, and 26. Levels of autoantibodies to p75 neurotrophin receptor were determined by solid-phase immnoenzyme analysis. Serum from 19 patients was studied before cerebrolysin treatment (day 0) and at weeks 10 and 26 after treatment initiation. Results and conclusions. Patients with aMCI had increased levels of autoantibodies to p75 fragment, with gradual decreases by 5.5 months of cerebrolysin treatment, indicating that this can potentially be used as a biomarker for long-term therapeutic efficacy. The modified p75 receptor fragment 155–164, assayed in patients’ serum, may provide an effective tool for monitoring and predicting the efficacy of long-term neurotrophic therapy.

Background Frailty and cognitive impairment (CI) are associated and often coexist in older adults. Whether temporal patterns of occurrence reflect different etiologies remain unknown. Methods Participants from the National Health and Aging Trends Study were assessed annually (2011–2016) for frailty (Fried’s criteria) and CI (bottom quintile of clock drawing test or immediate and delayed recall; proxy-report of dementia diagnosis or AD8 ≥ 2). We used the Fine & Gray model to identify correlates of frailty onset before CI, CI onset before frailty, and frailty-CI co-occurrence, accounting for death as a competing risk. Results Of 3,848 free of frailty, CI, and dementia at baseline, 2,183 (61.2%) developed neither frailty nor CI during the 5-year follow-up; 343 (8.3%) developed frailty first; 1,014 (24.4%) developed CI first; and 308 (6.0%) developed frailty-CI co-occurrence. Incident dementia, as a marker of underlying neuropathologies, was associated with greater likelihood of CI onset first (subdistribution hazard ratios [SHR] = 2.60, 95% confidence interval [ci] 2.09 to 3.24), and frailty-CI co-occurrence (SHR = 8.77, 95% ci 5.79 to 13.28), but lower likelihood of frailty onset first (SHR = 0.38, 95% ci 0.21 to 0.68). Number of comorbidities was only associated with frailty occurrence first (1 comorbidity: SHR = 2.51, 95% ci 1.15 to 5.47; 4+ comorbidities: SHR = 6.48, 95% ci 2.78 to 15.48). Conclusions Different patterns of frailty and CI occurrence exist, and dementia-related pathologies and comorbidities may be important correlates of order of emergence, potentially reflecting different etiologies. Future investigation into relationships between these patterns and dementia subtypes and related pathologies is needed to elucidate etiologic pathways and to provide new targets for prevention, intervention, and risk screening.

Objectives. To assess changes in cognitive functions in patients with ischemic heart disease before and after elective aortocoronary bypass (ACB). Materials and methods. A total of 192 patients took part in the study and were divided into three groups. Group 1 included 88 patients who underwent ACB using the standard method (SM) with extracorporeal circulation; group 2 consisted of 61 patients who received a differential methodology approach (DM) to selection of the method for ACB; the control group included 43 patients. Neurological testing was performed using the Mini Mental State Examination, the Frontal Assessment Battery, the clock drawing test, Schulte tables, the verbal associations test, and the Wechsler Adult Intelligence Scale. Results and conclusions. Post-operative cognitive dysfunction was found to occur 3.2 times more frequently using SM ACB, while patients in the DM group showed a tendency to improved cognitive functions after surgery.

Objectives: In dementia with Lewy bodies (DLB) recurrent visual hallucinations (VH) often coexist or occur consecutively to impaired visual perception. Since in-depth neuropsychological testing is time-consuming, and therefore, not routinely performed in clinical settings, we aimed to explore whether standard cognitive screening tests may be helpful to alert a clinician to the presence of VH in DLB by exploring association between visuo-spatial dysfunction and VH. Method: The clock drawing, cube, and pentagons copying items from Montreal Cognitive Assessment and Mini-Mental State Exam and nonmotor Hooper visual organization test (HVOT) have been scored in DLB patients with and without VH using traditional and extended scoring methods. Results: Forty-five of 69 (65%) DLB patients were VH-positive (VH+). VH+ patients performed worse on the clock drawing (8.8/16 vs. 11.9/16, p = .016) with a higher rate of misrepresentation of time (69% vs. 29%, p = .002) and numbers (53% vs. 25%, p = .024). Likewise, VH+ patients performed worse on the HVOT (13.3/30 vs. 15.7/30, p = .009) having more isolated (6.2/30 vs. 4.4/30, p = .012) types of responses compared to VH- patients. Both groups had similar copying ability (p > .05). The VH discriminative accuracy of the clock drawing was comparable to that of the more elaborate test of visual perception, the HVOT. Conclusions: In DLB impaired drawing and visual organization, but not copying ability is associated with the presence of VH. The simple clock drawing test can be helpful to alert a clinician to the possibility of VH in DLB. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Digital drawing tests have been proposed for cognitive screening over the past decade. However, the diagnostic performance is still to clarify. The objective of this study was to evaluate the diagnostic performance among different types of digital and paper-and-pencil drawing tests in the screening of mild cognitive impairment (MCI) and dementia. Diagnostic studies evaluating digital or paper-and-pencil drawing tests for the screening of MCI or dementia were identified from OVID databases, included Embase, MEDLINE, CINAHL, and PsycINFO. Studies evaluated any type of drawing tests for the screening of MCI or dementia and compared with healthy controls. This study was performed according to PRISMA and the guidelines proposed by the Cochrane Diagnostic Test Accuracy Working Group. A bivariate random-effects model was used to compare the diagnostic performance of these drawing tests and presented with a summary receiver-operating characteristic curve. The primary outcome was the diagnostic performance of clock drawing test (CDT). Other types of drawing tests were the secondary outcomes. A total of 90 studies with 22,567 participants were included. In the screening of MCI, the pooled sensitivity and specificity of the digital CDT was 0.86 (95% CI = 0.75 to 0.92) and 0.92 (95% CI = 0.69 to 0.98), respectively. For the paper-and-pencil CDT, the pooled sensitivity and specificity of brief scoring method was 0.63 (95% CI = 0.49 to 0.75) and 0.77 (95% CI = 0.68 to 0.84), and detailed scoring method was 0.63 (95% CI = 0.56 to 0.71) and 0.72 (95% CI = 0.65 to 0.78). In the screening of dementia, the pooled sensitivity and specificity of the digital CDT was 0.83 (95% CI = 0.72 to 0.90) and 0.87 (95% CI = 0.79 to 0.92). The performances of the digital and paper-and-pencil pentagon drawing tests were comparable in the screening of dementia. The digital CDT demonstrated better diagnostic performance than paper-and-pencil CDT for MCI. Other types of digital drawing tests showed comparable performance with paper-and-pencil formats. Therefore, digital drawing tests can be used as an alternative tool for the screening of MCI and dementia.

Background: The ongoing scientific debate regarding the association between physical function and cognitive impairment has focused mainly on global cognitive performance rather than specific cognitive functions tests and the importance of recognition of its associations and any factors that could play a role later in the prevention of such decline. Objective: This study examined the association between physical function, using handgrip strength (HGS) and Timed Up-and-Go test (TUGT), and executive function (EF), using Clock Drawing Test (CDT), among community-dwelling Egyptian elderly. Methods: A cross-sectional study was conducted in 5 social clubs in Cairo, Egypt and included a sample of 136 elderly males and females aged≥55 years old. All participants had their physical function assessed using TUGT, and measurement of HGS using a pneumatic hand-held dynamometer. Assessment of EF using CDT was also done. Results: Higher CDT scores were significantly associated with both better HGS, and lower TUGT (OR = 3.77, and 0.65 respectively). This persisted even after adjustment for age and gender (OR = 2.56, and 0.71 respectively) and after further adjustment for weight, systolic blood pressure, education, smoking, hyperlipidemia, hypothyroidism, and physical activity (O.R. = 4.79, and 0.76 respectively). Adjustment for both male and female genders showed an association between physical (HGS and TUGT) and EF was stronger among men. Conclusion: A strong association between CDT score and both of HGS and TUGT was found among the studied sample. Higher HGS and lower TUGT was significantly associated with better performance in the CDT. This association is stronger in males than in females for both HGS and TUGT.

BackgroundWidespread early dementia detection could drastically increase clinical trial candidates and enable early interventions. Since the Clock Drawing Test (CDT) can be potentially used for diagnosing dementia related diseases, it can be leveraged to devise a computer-aided screening tool.ObjectiveThis work aims to develop an online screening tool by leveraging Artificial Intelligence and the CDT.MethodsImages of an analog clock drawn by 3, 263 cognitively intact and 160 impaired subjects were used. First, we processed the images from the CDT by a deep learning algorithm to obtain dementia scores. Then, individuals were classified as belonging to either category by combining CDT image scores with the participant’s age.ResultsWe have evaluated the performance of the developed models by applying 5-fold cross validation on 20% of the dataset. The deep learning model generates dementia scores for the CDT images with an Area Under the ROC Curve (AUC) of 81.3% ± 4.3%. A composite logistic regression model using age and the generated dementia scores, yielded an average AUC and average weighted F1 score of 92% ± 0.8% and 94.4% ± 0.7%, respectively.DiscussionCDT images were subjected to distortion consistent with an image drawn on paper and photographed by a cell phone. The model offers a cost-effective and easily deployable mechanism for detecting cognitive impairment online, without the need to visit a clinic.

Introduction: The aim of this study was to determine the developmental stages-specific normative values of Trial Making Test (TMT), Enhanced Cued Recall Test (ECRT) and Clock Drawing Test (CDT) which are commonly used in adults for the evaluation of cognitive functions affected by psychiatric and neurological diseases and developmental disorders for a healthy Turkish sample between 6-18 years of age. Method: A total of 249 primary and secondary school students between 6-18 years of age and living in Ankara and educated in public and/or private schools participated in the study. Primary analysis was conducted by appropriate ANOVA and/or MANOVA for 2 (Developmental Stage: Middle-Late Childhood (6-11 years) and Adolescence (12-18 years)) x 2 (Gender: Female and Male) factorial design. In addition, another group of ANOVA and/or MANOVA analyses for 3 (Adolescence Sub-Stages) x 2 (Gender) was also performed for the adolescence stage that was sub-grouped as early (12-13 years), middle (14-15 years) and late (16+ years). Results: Normative values were determined both for two different developmental stages and for the adolescence sub-stages. Comparisons indicated that main effect of gender and interactions were non-significant for all tests. On the other hand, the main effects of the developmental stage and adolescence sub-stages were significant for many of the test scores. Conclusion: As a result of the study, three neuropsychological tests and their normative values for children and adolescents were presented as available for use in future research.

Introduction: It is essential to have sensitive, economical and quick cognitive screening tools for early detection of Mild Cognitive Impairment (MCI). The objective of the present study was to assess a new way of interpreting widely used screening tests, generating a new score: the CSIS (Combined Screening Interpretation Score). The CSIS considers the performance in various routine screening tests (MMSE, Clock drawing test, Short form of the Boston naming test, Phonological and Semantic fluency tests and the Frontal Assessment Battery) by summing up their gross scores in one general score. Methods: We calculated the CSIS of 90 Hispanic older adults without dementia (40 controls and 50 patients with a diagnosis of MCI). The differences of the CSIS between the groups, and the discriminative capacity of the CSIS and each separate test were analyzed. Results: Significant differences in the CSIS were observed between the groups, as a higher discriminative capacity of the CSIS compared to the other screening tests. A score of 86 points in the CSIS discriminates the groups with 84% sensitivity and 90% specificity. Conclusion: It is concluded that the CSIS is a useful, simple and brief tool to assess the cognitive performance of subjects with MCI.

Background The Clock Drawing Test (CDT) and Rey–Osterrieth Complex Figure Test (RCFT) are widely used as a part of neuropsychological test batteries to assess cognitive function. Our objective was to confirm the prediction accuracies of the RCFT-copy and CDT for cognitive impairment (CI) using convolutional neural network algorithms as a screening tool. Methods The CDT and RCFT-copy data were obtained from patients aged 60–80 years who had more than 6 years of education. In total, 747 CDT and 980 RCFT-copy figures were utilized. Convolutional neural network algorithms using TensorFlow (ver. 2.3.0) on the Colab cloud platform (www.colab.research.google.com) were used for preprocessing and modeling. We measured the prediction accuracy of each drawing test 10 times using this dataset with the following classes: normal cognition (NC) vs. mildly impaired cognition (MI), NC vs. severely impaired cognition (SI), and NC vs. CI (MI + SI). Results The accuracy of the CDT was better for differentiating MI (CDT, 78.04 ± 2.75; RCFT-copy, not being trained) and SI from NC (CDT, 91.45 ± 0.83; RCFT-copy, 90.27 ± 1.52); however, the RCFT-copy was better at predicting CI (CDT, 77.37 ± 1.77; RCFT, 83.52 ± 1.41). The accuracy for a 3-way classification (NC vs. MI vs. SI) was approximately 71% for both tests; no significant difference was found between them. Conclusions The two drawing tests showed good performance for predicting severe impairment of cognition; however, a drawing test alone is not enough to predict overall CI. There are some limitations to our study: the sample size was small, all the participants did not perform both the CDT and RCFT-copy, and only the copy condition of the RCFT was used. Algorithms involving memory performance and longitudinal changes are worth future exploration. These results may contribute to improved home-based healthcare delivery.

Dementia refers to a group of syndromes with cognitive impairment as the main clinical manifestation. Amongst various neuropsychological tests for clinical diagnosis of dementia, the clock drawing test (CDT) is frequently used due to its simplicity and effectiveness. In order to extricate physicians from their involvement in CDT scoring, we propose an automatic scoring method via object detection for accurate and efficient dementia screening. Given the drawn clock picture by a testee, this end-to-end method for CDT scoring directly produces the final score without any human interventions. Moreover, the proposed method can handle two ways of data acquisition scanned data set which contains the scanned version of drawn clocks and camera data set which consists of the drawn clocks taken from normal cameras. Extensive experimental results demonstrate the validity and feasibility of the proposed method. Specifically, the precision of the scanned dataset scored by a seven-point method and the camera dataset by a three-point method is 94.64% and 92.36% respectively, while that of junior outpatient physicians is 92.03% within the camera dataset.

Decisions related to driving safety and when to cease driving are complex and costly. There is an interest in developing an off-road driving test utilizing neuropsychological tests that could help assess fitness-to-drive. Serial trichotomization has demonstrated potential as it yields 100% sensitivity and specificity in retrospective test samples. The purpose of this study was to test serial trichotomization using four common neuropsychological tests (Trail Making Test Part A and B, Clock Drawing Test, and Modified Mini-Mental State Examination). Test scores from 105 patients who were seen in a memory clinic were abstracted. After applying the model, participants were classified as unfit, fit, or requiring further testing, 38.1%, 25.8%, and 36.1%, respectively. This study provides further evidence that trichotomization can facilitate the assessment of fitness-to-drive.

Background: Differentiating mild cognitive impairment (MCI) from subjective cognitive decline (SCD) is important because of the higher progression rate to dementia for MCI and when considering future disease-modifying drugs that will have treatment indications at the MCI stage. Objective: We examined if the two most widely-used cognitive tests, the Mini-Mental State Examination (MMSE) and clock-drawing test (CDT), and a test of attention/executive function (AQT) accurately can differentiate MCI from SCD. Methods: We included 466 consecutively recruited non-demented patients with cognitive complaints from the BioFINDER study who had been referred to memory clinics, predominantly from primary care. They were classified as MCI (n = 258) or SCD (n = 208) after thorough neuropsychological assessments. The accuracy of MMSE, CDT, and AQT for identifying MCI was examined both in training and validation samples and in the whole population. Results: As a single test, MMSE had the highest accuracy (sensitivity 73%, specificity 60%). The best combination of two tests was MMSE 91 seconds (sensitivity 56%, specificity 78%), but in logistic regression models, their AUC (0.76) was not significantly better than MMSE alone (AUC 0.75). CDT and AQT performed significantly worse (AUC 0.71; p

Alzheimer’s disease is a chronic neurodegenerative disease that usually starts slowly and gradually worsens over time. Although there’s no cure for Alzheimer’s disease yet, a number of recent researches have shown that the early diagnosis and intervention could not only improve the quality of life but also help to slow the progression of the disease. Clock Drawing Test (CDT) is one of the commonly used clinical methods for screening cognitive impairment, due to its simplicity and convenience. In this paper, we’d like to introduce DCDT, a novel Clock Drawing Test system based on digital collection and intellectualized analysis. We first introduce the background of AD and CDT, and then describe the DCDT system from the external and internal aspects. Finally, the demonstration scenario is described briefly.

Background Little is known regarding the standardized neuropsychological tests available in Arabic. The aim is to determine the diagnostic performance and the best cutoff value for the clock drawing test (CDT), animal category test of semantic verbal fluency (VF), and the short form of the Boston Naming Test (BNT) in identifying patients with mild and major neurocognitive disorders among community-dwelling educated Egyptian older adults using Arabic versions of those tests. Community-dwelling educated male and female older adults aged 60 years or older. Successive patients were attending the outpatient geriatrics clinic at the Ain Shams University Hospital during a 12-month study period from January to December 2016. The study was approved by the ethics committee of the Faculty of Medicine, Ain Shams University, Cairo, Egypt. Informed consent to participate in the study was received from each participant and/or his/her next of kin. Patients and/or their next of kin who declined to participate were excluded, as were those who refused to complete the assessment. A two-step protocol was followed. Step 1: Participants were divided into three groups according to DSM-V diagnostic criteria for neurocognitive disorders. The assessment of cognitive function included Mini-Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR), patient’s current functional status regarding basic and instrumental activities of daily living by the Blessed Dementia Scale (BDS), and patient detailed history and examination based on protocol five of the CERAD assessment packet. Step 2: The application of the Arabic versions of ELokl et al. 2001 VF test, the BNT, and the CD by a clinical psychologist blinded to the initial assessment results. Results In current study, AUC for CD, VF, and BN are 0.807, 0.77, and 0.753 respectively for mild NCD and 0.884, 0.877, and 0.839 respectively for major NCD while cutoff values for CD, VF, and BN are 2, 12, and 14 respectively for mild NCD and 2, 9, and 13 respectively for major NCD. Conclusion Verbal fluency, clock drawing, and Boston naming showed reasonable diagnostic performance in educated Egyptian elderly and should be considered separately or in combination for the assessment of cognitive function. Further research is warranted.

Background: Dementia is a collective term for several diseases that affect memory, other cognitive abilities, and behavior. These diseases can seriously interfere with people’s ability of daily living. This is not a normal phenomenon of aging. With the increasing prevalence of dementia in the elderly, the importance of dementia as a comorbidity of hypertension is increasing. However, several questions regarding the link between hypertension and dementia remain unresolved. This study aimed to determine Orientation-Memory-Concentration-Test (OMCT) can be used to assess cognitive function in the elderly as an early step in the early detection of dementia. Subjects and Method: This was a comparative study using a case-control design. The study was conducted in Jetis Sub-District, Yogyakarta from September 2019 to June 2020. A total sample of 110 of elderly was divided into two groups 42 elderly (case), and 68 elderly (control) selected by consecutive sampling using the Mini-Mental State Examination (MMSE), Clock-Drawing Test (CDT) and Orientation-Memory-Concentration Test (OMCT). The dependent variables were the sensitivity and specificity level of the OMCT instrument while the scores of the MMSE. The independent variable was CDT instruments. The collected data will then be processed by diagnostic analysis followed by analysis of ROC and Youden’s index to determine the optimal cut off. Respondents are categorized as having impaired cognitive function if the MMSE (cut off ≤ 24) or CDT (cut off 11) it has a sensitivity (29%) and specificity (97%) to the combination of MMSE and CDT. In populations with hypertension OMCT (cut off> 2.5) has sensitivity (68%) with specificity (46%). In a population without hypertension OMCT (cut off> 7) has a sensitivity (55%) and specificity (90%) to the combination of MMSE and CDT. Conclusion: OMCT can be used as a screening tool for cognitive dysfunction in older people with hypertension because of its short duration, ease of use, and can be used in patients with visual impairments. Keywords: Dementia, cognitive dysfunction, OMCT, 6-CIT. Correspondence: Darren Eduardo William. School of medicine Universitas Kristen Duta Wacana, Yogyakarta. Jl. Dr. Wahidin Sudirohusodo 5-25 Yogyakarta 55224, Indonesia. Email: Darreneduardowilliam@gmail.com. Mobile: 0813-4136-9999 DOI: https://doi.org/10.26911/the7thicph.05.17

Objective The popular clock drawing test (CDT) is easy to administer, acceptable to patients, and has excellent psychometric properties. Although it has been used primarily as a cognitive screening test, many studies have attempted to establish the CDT's ability to localize specific brain lesions or pathology. This systematic review aimed to summarize the evidence on the neuroanatomical correlates of the CDT. Methods Using PRISMA guidelines, the authors systematically reviewed the evidence on neuroanatomical correlates of clock drawing by a systematic search in six databases (Pubmed, CINHL, PsychINFO, HealthStar, Embase, and Web of Science) until January 2018. Studies were included if they reported CDT correlations with anatomical brain lesions documented by neuroimaging. Results Forty-five papers met inclusion criteria. Thirty-one studies identified distinct areas of neuroanatomical correlates of CDT utilizing different scoring methods and imaging techniques. Nine articles reported on the degree of white matter hyperintensities that correlated with lower scores on CDT and the severity of cognitive deficits. Five articles focused on postacute cerebrovascular accidents correlated with CDT performance. A variety of different anatomical lesions, located in all areas of the brain, were associated with abnormalities on the CDT. Conclusions The CDT, regardless of scoring method and population studied, was not associated with any consistent, specific brain localization. This systematic review supports the use of the CDT as a cognitive screening test rather than a method of localizing brain lesions.

Introduction The clock drawing test is a neuropsychological screening test that is frequently used in clinical practice. Aim To evaluate the usefulness of the clock drawing test in the forensic environment. To evaluate 3 methods of correction, and to determine its reliability and validity, and assess its usefulness in judicial processes of modification of legal capacity of a person. Material and methods A total of 40 cases were analysed in legal proceedings. A structured clinical interview, and a neurological and psychopathological examination were conducted using the CAMDEX-R test. The Mini-Mental State Examination, the Global Deterioration Scale, and the clock drawing test were administered to the order corrected using the CAMCOG, Manos and Mendez methods. The sample was divided into 3 groups: degenerative, psychiatric, and without pathology. Results The degenerative group obtained the worst results in the clock drawing test in the 3 correction methods. The reliability and validity of the test were adequate. Patients judged not to be legally capable had a worse performance in the clock drawing test. Conclusions The 3 methods of correction of the clock drawing test are shown to be effective. Evaluating the cost-benefit of the short method is recommended. Patients with a modification of legal capacity ruling showed worse results in the clock drawing test.

Introduction. The Clock Drawing Test (CDT) is a widely used instrument for identifying neurocognitive disorders (NCDs) in older adults. However, there is insufficient evidence to determine the best scoring method, since current quantitative methods involve the assignment of numerical values, while qualitative ones do not allow for objectivity in the diagnosis. Parsey and Schmitter-Edgecombe (2011) proposed a scoring scheme which, in addition to providing a score of the patient’s performance, permits error analysis, thereby making it possible to identify potential underlying cognitive difficulties. Objective. The purpose of this study was to validate the CDT scoring scheme proposed by Parsey and Schmitter-Edgecombe (2011) for screening for NCDs in Mexican older adults. Method. There were 167 participants: 58 cognitively healthy subjects (CH), 52 with mild neurocognitive disorder (mild-NCD), and 57 with major neurocognitive disorder (major-NCD).The CDT scoring method was compared with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment in Spanish (MoCA-S). Inter- and intra-observer reliability and construct validity were determined and the sensitivity and specificity of this method were calculated. Results. The  age was 75 years (SD ± 8 years) and the  educational attainment was 10.7 years (SD ± 5.2 years). Internal reliability was .750, with an intraclass correlation coefficient of .774. The cut-off point for the CDT in mild-NCD was 14 points (sensitivity: 40%, specificity: 70%) and 12 points for major-NCD (sensitivity: 90%, specificity: 95%).The most frequent errors in the CDT were: graphic, conceptual, spatial, and/or planning difficulties. Discussion and conclusion. This method makes it possibly to quickly and easily explore the cognitive status of the patient. It contains ideal psychometric properties for the detection of patients with major-NCD, in addition to offering the possibility of analyzing performance errors and underlying cognitive difficulties.

Objective: The clock drawing test (CDT) version with the pre-drawn circle has been widely used in research and clinical practice without standardized Turkish norms. The present study aimed to standardize CDT scores according to the most frequently used scoring methods in the literature (Manos-Wu and Shulman) and to estimate the validity and reliability of both methods. Materials and Methods: The norm determination phase of the study was performed with 244 healthy individuals in the age range of 50-92 years. The effects of age, education, and sex on the CDT scores were examined and normative data stratified by age and education were derived. Test-retest reliability, inter-rater reliability, and concurrent validity and criterion validity of the two scoring methods were tested. Criterion validity was assessed using the ROC analysis to examine the extent to which the CDT scores could distinguish among healthy individuals, patients with mild cognitive impairment (MCI), and patients with Alzheimer’s disease (AD). Results: In the Manos-Wu method, age and education had significant effects on CDT scores of healthy individuals; however, in the Shulman method, only an education effect was found. Both methods had high test-retest reliability (Manos-Wu, 0.81; Shulman, 0.72) and inter-rater reliability (Manos-Wu, 0.98; Shulman, 0.96) and showed high correlations with each other and with other cognitive screening tests. The area under the ROC curve had high values only in discriminating between healthy individuals and AD, and healthy individuals and MCI. Conclusion: In the present study, detailed normative data for individuals aged 50 and older were established. Age and education levels should be taken into account when interpreting CDT scores. Both scoring methods provided similar results in terms of high test-retest and inter-rater reliability, as well as high concurrent and criterion validity.

Purpose Cognitive impairment is one of the most common geriatric deficits in old patients with heart failure (HF), but there has been a lack of study on the utility of the Clock Drawing Test (CDT) when used with this group of patients. The aim of the study was to assess the usefulness of the CDT in the geriatric assessment of aged outpatients with chronic HF. Patients and methods A cross-sectional analysis of the results of the comprehensive geriatric assessment (CGA), including the CDT, of 92 aged outpatients with heart failure was conducted. Results We found a high prevalence of five examined geriatric problems. The majority of the patients presented signs of cognitive deterioration of different patterns and severity on the Clock Drawing Test. All the CDT scoring systems correlated significantly with the Mini-Mental Test Examination results. Conclusions It seems reasonable to perform the routine CGA with the CDT examination in all aged heart failure patients.