Search

• The Clock Drawing Test (CDT) is a useful risk stratification tool for older emergency department patients presenting with non-specific complaints. • The CDT can be used as predictor for 30-day mortality and hospital length of stay. • The early identification of individuals at risk may help to attribute resources, support disposition decisions, and may ultimately lead to improved quality of care. Cognitive impairment (CI) is common among older patients presenting to the emergency department (ED). The failure to recognize CI at ED presentation constitutes a high risk of additional morbidity, mortality, and functional decline. The Clock Drawing Test (CDT) is a well-established cognitive screening test. In patients presenting to the ED with non-specific complaints (NSCs), we aimed to investigate the usability of the CDT and its prognostic value regarding length of hospital stay (LOS) and mortality. Secondary analysis of the Basel Non-specific Complaints (BANC) trial, a prospective delayed type cross-sectional study with a 30-day follow-up. In three EDs, patients presenting with NSCs were enrolled. The CDT was administered at enrollment. In the 1,278 patients enrolled, median age was 81 [74, 87] years and 782 were female (61.19%). A valid CDT was obtained in 737 (57.7%) patients. In patients without a valid CDT median LOS was higher (29 [9, 49] days vs. 22 [9, 45] days), and 30-day mortality was significantly higher than in patients with a valid CDT (n = 45 (8.32%) vs. n = 39 (5.29%)). Of all valid CDTs, 154 clocks (20.9%) were classified as normal, 55 (7.5%) as mildly deficient, 297 (40.3%) as moderately deficient, and 231 (31.3%) as severely deficient. Mortality and LOS increased along with the CDT deficits (p = 0.012 for 30-day mortality; p < 0.001 for LOS). The early identification of patients with CI may lead to improved patient management and resource allocation. The CDT could be used as a risk stratification tool for older ED patients presenting with NSCs, as it is a predictor for 30-day mortality and LOS. [Display omitted] [ABSTRACT FROM AUTHOR]

The clock drawing test (CDT) is a widely recognized neurocognitive test for executive and visuospatial functions. However, no normative data exist for Generation Z young adults (born on or after 1997). The widespread use of digital displays among this generation may impair performance on the analog CDT. Young Generation Z adults with at least 12 years of education, who were evaluated at the Israel Defense Forces (IDF) outpatient neurology clinic between 2021 and 2022, completed a CDT using the Manos-Wu method and drew a digital clock. Patients with possible cognitive impairment were excluded. Three hundred Generation Z patients were recruited, with a mean age of 19.7 ± 1.2 years. 171 (57.0 %) were female. Mean CDT score was 8.1 ± 2.5 out of 10 (Manos & Wu). A lower CDT score was associated with younger age (p = 0.031). No association was found with chief complaint, presence of ADHD diagnosis, gender, or postsecondary education. Digital clock drawing (4/4 digits) was successful in 100 % of patients. Generation Z adults demonstrate lower CDT scores than previously reported for older generations. The CDT may require revision to maintain its specificity for this population. Developing an alternative, digital-based tool for cognitive screening in young generations could be advisable. [Display omitted] • Many Generation Z young adults reportedly struggle with reading analog clocks. • The performance of Generation Z on the Clock Drawing Test (CDT) is not well studied. • We report poor than expected CDT scores in cognitively normal young adults. • Younger individuals tended to have lower CDT scores. • A subsample achieved perfect scores (100 %) on a digital clock drawing. [ABSTRACT FROM AUTHOR]

Background: Cognitive dysfunction after surgery includes delirium and postoperative cognitive dysfunction. Important risk factors for these include increased age and pre-existing cognitive dysfunction. This study describes preoperative cognitive dysfunction and its associated factors in patients aged ≥60 yr awaiting elective noncardiac surgery in a developing country.Methods: A prospective, contextual, descriptive study design with consecutive convenience sampling was used at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa. Assessment of cognition was subjective (through casual conversation, henceforth referred to as observer assessment) and objective (using the Mini-Cog test).Results: A total of 194 outpatients (median age: 65 yr) were assessed. A score ≤3 (indicating mild cognitive impairment) was obtained by 111 patients (57.2%). Subjective memory complaints were reported by 124 patients (63.9%). Univariate analyses demonstrated significant associations between low Mini-Cog scores and increasing age (rs=-0.1901; P=0.0079), unskilled occupation (P=0.0033), low functional status (rs=-0.1831; P=0.0106), low level of education (P=0.0005), and frailty (rs=-0.3010; P<0.0001). Logistic regression showed level of education and frailty to be significant. A score ≤3 is more likely in frail patients (odds ratio: 7.54; P=0.003) and those with only primary school education (odds ratio: 3.54; P=0.003).Conclusions: Undiagnosed pre-existing cognitive dysfunction was common in older patients awaiting surgery at a regional academic hospital in South Africa. Patients at risk for cognitive dysfunction should be identified through brief preoperative screening. [ABSTRACT FROM AUTHOR]

Abstract Background and aim CDT is a collective biomarker including asialo- and disialo-Tf, but researchers have generally focused attention on disialo-Tf, because of its easier detectability, since asialo-Tf is typically not detectable by the current methods in abstinent individuals, social drinkers and in many alcohol abusers with moderate CDT increases. In the search of a confirmation marker of alcohol-related CDT increases, the detectability of asialo-Tf was re-evaluated comparatively by using CE vs. HPLC. Methods 468 serum samples compulsorily drawn in a forensic/administrative context were analyzed by CE and HPLC to compare their sensitivity towards asialo-Tf. Results CE allowed the identification of asialo-Tf in 108 out of 165 CDT "positive" cases, based on disialo-Tf measurement (cut-off 1.8%). HPLC showed a detectable asialo-Tf peak only in 2 cases. In addition, in some cases of disputed CDT increases, the quasi-absence of this Tf component in front of an important increase of disialo-Tf allowed the ruling out of a diagnosis of alcohol abuse, in agreement with all other clinical and laboratory data. Conclusions The present work shows a superior performance of CE vs. HPLC for the determination of asialo-Tf and the importance of this CDT component to avoid misinterpretation of non-alcohol related CDT increases. Highlights • CE and HPLC were compared in their ability to detect asialo-Tf. • CE showed a substantial prevalence over HPLC in the detection of asialo-Tf. • The results showed cases of discordant increases of disialo-Tf and asialo-Tf • In some of these cases the increase of CDT was not related with alcohol abuse [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

It is unclear whether clock drawing test (CDT) performance relies on a widely distributed cortical network, or whether this test predominantly taps into parietal cortex function. So far, associations between cortical integrity and CDT impairment in Alzheimer's disease (AD) and mild cognitive impairment (MCI) largely stem from cortical volume analyses. Given that volume is a product of thickness and surface area, investigation of the relationship between CDT and these two cortical measures might contribute to better understanding of this cognitive screening tool for AD. 38 patients with AD, 38 individuals with MCI and 31 healthy controls (HC) underwent CDT assessment and MRI at 3 Tesla. The surface-based analysis via Freesurfer enabled calculation of cortical thickness and surface area. CDT was scored according to the method proposed by Shulman and related to the two distinct cortical measurements. Higher CDT scores across the entire sample were associated with cortical thickness in bilateral temporal gyrus, the right supramarginal gyrus, and the bilateral parietal gyrus, respectively ( p < 0.001 CWP corr.). Significant associations between CDT and cortical thickness reduction in the parietal lobe remained significant when analyses were restricted to AD individuals. There was no statistically significant association between CDT scores and surface area ( p < 0.001 CWP corr.). In conclusion, CDT performance may be driven by cortical thickness alterations in regions previously identified as “AD vulnerable”, i.e. regions predominantly including temporal and parietal lobes. Our results suggest that cortical features of distinct evolutionary and genetic origin differently contribute to CDT performance. [ABSTRACT FROM AUTHOR]

A clock drawing test (CDT) is a neurological test used for the assessment of cognitive impairment based on sketches of a clock completed by a patient. Usually, a medical expert assesses the sketches to discover any deficiencies in the cognitive processes of the patient. More recently, automatic tools for assessing such tests have been developed. However, the problem of automatic interpretation of clock drawings, especially those sketched by people with cognitive impairment, is not fully solved, and in more difficult cases, the automatic systems have to revert to the help of human assessors in labelling the sketched objects forming the clock drawing. Moreover, the labelling of the sketched objects could be more reliable if prior knowledge of the expected CDT sketch structure and human reasoning could be integrated into the drawing interpretation system. This paper proposes a novel CDT sketch interpretation system, which represents the prior knowledge of the CDT structure by using ontology and integrating human reasoning through a fuzzy inference engine. The combination of the above technologies fuses multiple sources of information concerning the sketch structure and the visual appearance of the sketched objects whilst dealing with the interpretation uncertainty inherent to CDT sketches. The proposed CDT interpretation system is evaluated using two CDT data sets. The first data set consists of 65 drawings made by healthy people, while the second set contains 100 drawings reproduced from the drawings of dementia patients to simulate the kind of challenging sketches the system may have to work with. The evaluation analysis shows an improved interpretation performance of the proposed system in comparison with the classical approach, which does not receive benefits from the prior knowledge of the CDT sketch structure or simulated human reasoning. [ABSTRACT FROM AUTHOR]

Conventional bedside tests of visuospatial function such as the Clock Drawing (CDT) and Intersecting Pentagons (IPT) lack consistency in delivery and interpretation. We compared performance on a novel test of visuospatial ability - the LSD – with the IPT, CDT and MMSE in 180 acute elderly medical inpatients [mean age 79.7±7.1 (range 62–96); 91 females (50.6%)]. 124 (69%) scored ≤23 on the MMSE; 60 with mild (score 18–23) and 64 with severe (score ≤17) impairment. 78 (43%) scored ≥6 on the CDT, while for the IPT, 87 (47%) scored ≥4. The CDT and IPT agreed on the classification of 138 patients (77%) with modest-strong agreement with the MMSE categories. Correlation between the LSD and visuospatial tests was high. A four–item version of the LSD incorporating items 1,10,12,15 had high correlation with the LSD-15 and strong association with MMSE categories. The LSD-4 provides a brief and easily interpreted bedside test of visuospatial function that has high coverage of elderly patients with neurocognitive impairment, good agreement with conventional tests of visuospatial ability and favourable ability to identify significant cognitive impairment. [181 words]. [ABSTRACT FROM AUTHOR]

Increasing the number of elderly persons who have dementia is one of the severe social problems. In Japan, the Ministry of Health, Labor and Welfare expects that the number of dementia patients will be around 5 million in 2025. It is also easily estimated that they require various living supports. Therefore, early detection and prevention of dementia are important. The authors have been developing a new system for quantitative and accurate evaluation of dementia. The basic concept of our system is evaluating a patient's dementia types and progression without awareness. To realize this, we are now developing the system using daily conversations, drawings, facial expressions and so on. In this paper, we focused on Clock Drawing Test (CDT) and proposed a dementia evaluation method for CDT. In the proposed method, Weighted Direction Index Histogram Method was used to extract features from given images, and Support Vector Machine (SVM) detected dementia cases from them. As a result of evaluation experiments, the proposed method could detect 97.1% of dementia cases correctly. [ABSTRACT FROM AUTHOR]

The clock drawing test (CDT) is a standard neurological test for detection of cognitive impairment. A computerised version of the test promises to improve the accessibility of the test in addition to obtaining more detailed data about the subject's performance. Automatic handwriting recognition is one of the first stages in the analysis of the computerised test, which produces a set of recognized digits and symbols together with their positions on the clock face. Subsequently, these are used in the test scoring. This is a challenging problem because the average CDT taker has a high likelihood of cognitive impairment, and writing is one of the first functional activities to be affected. Current handwritten digit recognition system perform less well on this kind of data due to its unintelligibility. In this paper, a new system for numeral handwriting recognition in the CDT is proposed. The system is based on two complementary sources of data, namely static and dynamic features extracted from handwritten data. The main novelty of this paper is the new handwriting digit recognition system, which combines two classifiers—fuzzy k -nearest neighbour for dynamic stroke-based features and convolutional neural network for static image- based features, which can take advantage of both static and dynamic data. The proposed digit recognition system is tested on two sets of data: first, Pendigits online handwriting digits; and second, digits from the actual CDTs. The latter data set came from 65 drawings made by healthy people and 100 drawings reproduced from the drawings by dementia patients. The test on both data sets shows that the proposed combination system can outperform each classifier individually in terms of recognition accuracy, especially when assessing the handwriting of people with dementia. [ABSTRACT FROM AUTHOR]

Objective: To explore the microstructural integrity of the optic nerve and its role as a cognitive predictor in patients with de novo Parkinson's disease (PD) using diffusion tensor image-based magnetic resonance scans.Methods: We enrolled 82 patients with de novo PD, 36 patients with drug-induced parkinsonism (DIP), and 36 controls. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were measured on the mid-portion of the intraorbital optic nerve. Using a multivariate analysis of variance with repeated measures, longitudinal changes in cognitive subscores of a comprehensive neuropsychological test were evaluated in PD patients according to optic nerve integrity.Results: The mean FA value in PD was significantly lower (0.552 ± 0.103, p < 0.001) than that in DIP (0.645 ± 0.099) or the controls (0.689 ± 0.089), whereas the mean ADC value was significantly higher in the PD group compared to the DIP or control group (p < 0.001). Optic nerve integrity was not associated with parkinsonian motor severity, striatal dopamine transporter activity, olfaction, or baseline cognitive performance in PD patents. In a longitudinal assessment of cognition in PD, the lower FA group showed significant decline in the performance of Clock Drawing Test (F = 3.39, p = 0.038), but no significant differences in the other cognitive subsets.Conclusion: This study demonstrated that microstructural integrity in the optic nerve was distorted in PD patients, and that this nerve integrity might act as a cognitive predictor of visuospatial dysfunction. [ABSTRACT FROM AUTHOR]

We investigated whether graphomotor organization during a digitized Clock Drawing Test (dCDT) would be associated with cognitive and/or brain structural differences detected with a tractography-derived structural connectome of the brain. 72 non-demented/non-depressed adults were categorized based on whether or not they used ‘anchor’ digits (i.e., 12, 3, 6, 9) before any other digits while completing dCDT instructions to “draw the face of a clock with all the numbers and set the hands to 10 after 11”. ‘Anchorers’ were compared to ‘non-anchorers’ across dCDT, additional cognitive measures and connectome-based metrics. In the context of grossly intact clock drawings, anchorers required fewer strokes to complete the dCDT and outperformed non-anchorers on executive functioning and learning/memory/recognition tasks. Anchorers had higher local efficiency for the left medial orbitofrontal and transverse temporal cortices as well as the right rostral anterior cingulate and superior frontal gyrus versus non-anchorers suggesting better regional integration within local networks involving these regions; select aspects of which correlated with cognition. Results also revealed that anchorers’ exhibited a higher degree of modular integration among heteromodal regions of the ventral visual processing stream versus non-anchorers. Thus, an easily observable graphomotor distinction was associated with 1) better performance in specific cognitive domains, 2) higher local efficiency suggesting better regional integration, and 3) more sophisticated modular integration involving the ventral (‘what’) visuospatial processing stream. Taken together, these results enhance our knowledge of the brain-behavior relationships underlying unprompted graphomotor organization during dCDT. [ABSTRACT FROM AUTHOR]

Objectives: The present study evaluated the metabolic syndrome (MetS) as independent predictor of 1-year longitudinal changes in cognitive function.Methods: 104 stroke- and dementia-free older hypertensive subjects were studied. MetS was defined by NCEP ATP-III criteria. Cognitive function was assessed by the Clock Drawing Test (CDT); 1-year changes in cognitive function were expressed as annual changes in CDT performance. Brain magnetic resonance imaging studies (1.5T) were performed.Results: Participants with MetS exhibited greater cognitive decline than those without (-1.78 ± 1.47 versus -0.74 ± 1.44 CDT points, t = 3.348, df = 102, p < 0.001). MetS predicted cognitive decline (β = -0.327, t = -3.059, df = 96, p = 0.003) independently of its components, age, baseline cognition, neuroimaging findings, blood pressure levels, and duration of hypertension. With the exception of systolic blood pressure, none of the individual components of MetS explained 1-year changes in CDT performance.Conclusions: MetS as an entity predicted accelerated 1-year decline in cognitive function, assessed by CDT, in a sample of older hypertensive subjects. [ABSTRACT FROM AUTHOR]

The Clock Drawing Test (CDT) is an inexpensive and effective measure for early detection of cognitive impairment in the elderly, which is important for timely diagnosis and initiation of appropriate treatment. Currently, medical experts assess the drawings based on their judgement and a number of available scoring systems. An automatic system for assessment of CDT drawings would simultaneously decrease the waiting time for a specialist appointment and improve accessibility of the test to the patients. Published research has only started to address the problem of automatic assessment of CDT drawings and existing systems require user intervention during the segmentation of the CDT drawing into its composing parts, such as numbers and clock hands. In this paper, a new set of temporal and spatial features automatically extracted from the CDT data acquired using a graphics tablet is proposed. Consequently, a Support Vector Machine (SVM) classifier is employed to segment the CDT drawings into their elements, such as numbers and clock hands, on the basis of the extracted features. The proposed algorithm is tested on two data sets, the first set consisting of 65 drawings made by healthy people, and the second consisting of 100 drawings reproduced from actual drawings of dementia patients. The test on both data sets shows that the proposed method outperforms the current state-of-the-art method for CDT drawing segmentation. [ABSTRACT FROM AUTHOR]

Recently, the number of elderly persons with dementia has been increasing. In the past, we proposed a dementia evaluation system using daily conversations and developed the system with a conversational robot. However, the current system is not ready for practical use because it can only evaluate time/geographical orientation and short-term memory, and some methods to evaluate other orientations and functions is required as well. In this paper, we discuss a new dementia evaluation system using not only daily conversations but also drawing tests. The authors employed a Clock Drawing Test (CDT) as a new dementia evaluation test and implemented it in a tablet device. This paper discusses a feature extraction and recognition method to distinguish normal cases from dementia cases. After evaluation experiments, the proposed method could recognize 87.6% of the clock drawing images. [ABSTRACT FROM AUTHOR]

Background Children with perinatal stroke may show evidence of contralateral spatial neglect. The goal of this study was to determine whether the Clock Drawing Test commonly used in adults to identify neglect would be effective in detecting neglect in children with perinatal stroke. Methods Thirty-eight individuals (age range 6-21 years) with left hemisphere or right hemisphere perinatal onset unilateral lesions and 179 age-matched controls were given a free-drawn Clock Drawing Test in a cross-sectional design. An adapted scoring system that evaluated right- and left-sided errors separately was developed as part of the investigation. Results Children with right hemisphere lesions made a greater number of errors on both the right and left sides of the clock drawings in all age subgroups (6-8 years, 9-14 years, and 15-21 years) compared with controls. Children with right hemisphere lesions showed greater left and right errors in the younger groups compared with controls, with significantly poorer performance on the left at 6-8 years, suggestive of contralateral neglect. However, by ages 15-21 years, the right hemisphere lesion subjects no longer differed from controls. Conclusions Clock drawing can identify spatial neglect in children with early hemispheric damage. However, brain development is a dynamic process, and as children age, spatial neglect may no longer be evident. These findings demonstrate the limitations of predicting long-term outcome after perinatal stroke from early neurocognitive data. Children with perinatal stroke may require different neural pathways to accomplish specific skills or to overcome deficits, but ultimately they may have “typical” outcomes. [ABSTRACT FROM AUTHOR]

Background Carbohydrate-deficient transferrin measurement is currently used for the routine monitoring of excessive alcohol intake, thus playing a fundamental role in the management of alcohol consumption disorders as well as for medico-legal purposes. The aim of the present paper is to report the results obtained from the first performance evaluation of a new CDT quantification assay, and to assess its suitability in routine work. Methods We assessed the analytical performances of the multi-capillary electrophoresis analyser Helena Biosciences' V8® E-class and compared the results obtained with those from the HPLC BioRad Ready-Prep CDT assay. Furthermore, we evaluated the robustness of the system in a routine work conditions. Results Within laboratory imprecision CV% ( n = 40) using four commercially available quality control materials and two serum pool samples with different concentrations of CDT were < 11.2%. The comparison made with the established method was CDT [V8capillary electrophoresis] = 0.84 × CDT [HPLC] + 0.03, with a Pearson coefficient of r = 0.970, and with the Bland–Altman plot showing a significant bias − 0.3 (− 0.4 to − 0.22, 95% CI). The obtained accuracy was highly satisfactory. Conclusions The findings made in the present study indicated that the proposed analytical system is a valid alternative to other CDT screening assays currently proposed for routine use in clinical laboratories, since it is precise, accurate and robust, with a high throughput. Moreover, investment in the training of staff is of fundamental importance in ensuring correct interpretation of the electrophoretic pattern, thus providing reliable CDT results. [ABSTRACT FROM AUTHOR]

Highlights: [•] We first investigated the functional neuroanatomical correlates of CLOX with FDG-PET. [•] CLOX1 reflected brain function of the bilateral diffuse fronto-temporo-parietal areas. [•] CLOX2 was dominantly associated with the right side cortical function in AD patients. [•] CLOX1 correlated with left side function in early stage vs. right one in the later stage. [•] CLOX2 was related to right side function in the later stage but not any in the early stage. [ABSTRACT FROM AUTHOR]

Abstract: The Clock Drawing Test is one of the most widely used screening tools for cognitive impairment and dementia. Since its introduction, more than fifteen scoring systems have been developed to assess the clock drawings. However, very little research has been conducted to study the significance of the elements (features) of the clock drawings for the correct diagnosis of dementia. This paper employs a feature selection method called Feature Interaction Maximization (FIM) to identify the most significant visual features of the test, which can be associated with dementia. The proposed approach is tested with a dataset of 648 clock drawings produced by dementia patients and healthy individuals. The results are compared with other methods used by medical experts. Furthermore, the paper compares the FIM method with an alternative feature selection method based on Information Gain. The results show that the FIM method selects features with higher discriminative power which leads to a deeper understanding of the Clock Drawing Test. [Copyright &y& Elsevier]

Abstract: Objectives: We aimed to determine an optimal cut-off score for the Clock Drawing Test (CDT), scored by the scale of Freund, for efficient screening for cognitive impairment in elderly (cancer) patients within a Comprehensive Geriatric Assessment (CGA) and to compare the Freund CDT to the Mini-Cog. Materials and Methods: Data of 221 elderly (≥70years) patients, comprising of an OncoGeriatric (OG) and General Geriatric (GG) group, were retrospectively reviewed. All patients were evaluated with both the CDT and Mini Mental State Examination (MMSE) as the gold standard. Receiver Operating Characteristics (ROC) analysis was used to determine diagnostic performance. A pre-established algorithm was applied to retrieve Mini-Cog results through a combination of the CDT and the 3-Word Delayed Recall (3-WDR) test (included within MMSE). Results: Data of 105 OG and 116 GG patients were evaluated. Potential cognitive impairment (MMSE≤23) was detected in 29.5% and 65.8% of patients, respectively. The CDT showed good diagnostic accuracy in the OG (0.88±0.03) and GG (0.85±0.03) group, based on the area under the ROC curve (AUC±SE). CDT (cut-off≤4) provided good sensitivity (80.7%) and specificity (81.1%) in the OG group and excellent sensitivity (89.6%) and moderate specificity (51.3%) in the GG group. Addition of the 3-WDR test, to form the Mini-Cog, resulted in similar positive and negative predictive values for the OG group and higher negative predictive value for the GG group. Conclusion: These data suggest that the Freund CDT, at the cut-off score of ≤4, is promising for use within a CGA. The Mini-Cog might be preferable in the GG population. [Copyright &y& Elsevier]

Abstract: The objective of this study was to investigate the associations between clock drawing test (CDT) performance and subcortical brain morphology. Fifty-four participants (21 patients with Alzheimer''s disease, 23 with mild cognitive impairment and 10 healthy controls) underwent neuropsychological assessment and high-resolution magnetic resonance imaging at 3T. CDT performance was related to volume and shape measurements of amygdala, caudate nucleus, hippocampus, nucleus accumbens, pallidum, putamen, and thalamus, respectively. Impaired CDT performance was correlated with alterations predominantly in the hippocampus bilaterally and in the right globus pallidus. These associations referred to regionally specific morphometric alterations rather than to global atrophy of the respective structures. Our findings support an involvement of subcortical brain regions in CDT performance. [Copyright &y& Elsevier]

Abstract: Parkinson''s Disease Dementia (PD-D) is one of the most important non-motor signs in advanced PD and is the most influencing factor predicting nursing home placement. PD-related Mild Cognitive Impairment (PD-MCI) is a potential prodromal stage of PD-D. The Grand Total EEG (GTE) score is a rating scale for clinical EEG (Electroencephalography) analyses which is useful in the evaluation of different types of dementia. The purpose of the present study was to investigate the relationship between a short version of the GTE score and severity of cognitive deficits in PD. Nineteen patients with PD underwent neuropsychological testing and resting state EEG. Significant correlations with deteriorating cognition (combined Mini Mental Status Examination/Clock Drawing Test) were found for the overall short GTE score (Spearman Rank correlation, ρ=−.6; p<.05) and for the subscore “Frequency of Rhythmic Background Activity” (ρ=−.6; p<.05), indicating that these EEG measures increase with deteriorating cognition. [Copyright &y& Elsevier]

Abstract: The accuracy and consuming-time of screening methods are important factors in the early diagnosis of dementia. In this study, we aimed to know whether the eight-item test (including three-item recall, attention and calculation, subtracted from the mini-mental state examination (MMSE), clock drawing test (CDT), and instrumental activities of daily living (IADL) impairment or any combination of the above tests can be used as a quick and effective dementia screening tool. A total of 188 seniors aged over 60 years were enrolled at a geriatric clinic. The result revealed that a cutoff score of 6/7 in an eight-item scale had a sensitivity of 94.9% and a specificity of 59.1% in the detection of dementia. In terms of sensitivity and specificity, the eight-item scale performed better than a score of two in three-item recall (51.3%/87.3%), a score of one in three-item recall (83.3%/53.6%), CDT (39.0%/96.9%), mini-cognitive assessment instrument (Mini-Cog) test (53.7%/95.5%), a score of less than three in attention/calculation test (74.7%/77.3%), impairment of transportation or medication in IADL (67.2%/90.6%), and any impairment in IADL (77.2%/67.9%). In subgroup analysis, a cutoff score of 5/6 were adjusted for the low-education group. We conclude that an eight-item test is a sufficient and simple tool for the screening of early dementia in primary-care clinics focused on older people care. [Copyright &y& Elsevier]

Abstract: The aim of this study was to identify brain regions associated with performance on various measures of the clock drawing test (CDT) using magnetic resonance imaging (MRI).We recruited 48 participants (four healthy, eight with mild cognitive impairment and 36 with Alzheimer''s disease). Multiple regression analyses identified relationships between each CDT scoring system (Shulman CDT, Rouleau CDT and CLOX1) and regional gray matter (GM) volume.CDT scores were positively correlated with regional GM volume in the right parietal lobe for all three CDT scoring systems. In addition, CDT scores were positively correlated with regional GM volume in the bilateral posterior temporal lobes for the Shulman CDT, in the right posterior inferior temporal lobe for the Rouleau CDT and in the right posterior superior temporal lobe for the CLOX1.Although the scoring systems share commonalities, each CDT scoring system may reflect different areas of brain damage. [Copyright &y& Elsevier]

Objective: The Clock Drawing Test (CDT) is commonly used for cognitive screening, but there are few studies that compare performance on the CDT among schizophrenic patients of different ages. The objective of this study was to investigate the influence of schizophrenia and aging on performance in the CDT. Method: Schizophrenic patients (TV = 244) and a comparison group (TV = 875) were recruited as subjects, Freedman 's CDT was completed by all subjects, and the influences of disease and aging on performance in the CDT were examined. Multiple comparisons of the CDT scores between patients and the comparison group and within three age subgroups (young: less than 40 years, middle aged: 40-59 years, elderly: more than 60 years) were performed. Results: There was a significant interaction of diagnosis and age, and the education significantly influenced the total score for all CDT conditions. For almost all age subgroups of patients, individuals with schizophrenia had significantly lower scores on all the CDT conditions than did the comparison group subjects. For patients and the comparison group, the elderly subgroup performed significantly worse than the young and middle-aged subgroups on almost all conditions of the CDT. Qualitative analysis of the clocks drawn revealed that the number of CDT categories in which schizophrenic patients scored significantly lower than the comparison group tended to increase with aging across both groups. Conclusions: This study suggests that performance on the CDT was impaired not only by disease but also by aging. The study confirms that the CDT is sensitive enough to screen for cognitive impairments in schizophrenia. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the diagnostic validity of single-domain cognitive tests for detecting dementia. These methods were defined as those that focus mainly on one domain of cognitive function such as orientation, memory, or executive function. Methods: A meta-analysis of robust studies was conducted. There were 15 categories of single-domain methods assessed in 45 analyses, including 27 performed head-to-head against the Mini-Mental State Examination (MMSE). Thirteen studies took place in community settings, 9 in primary care, and 23 in specialist settings. Results: In community settings, single-domain cognitive tests helped detect 64.2% of all dementias. In this setting, specificity (Sp) was 84.9%, positive predictive value (PPV) was 57.1%, and negative predictive value (NPV) was 883%. This was significantly less accurate than the MMSE itself. The optimal individual method was the memory impairment screen (MIS). In primary care, the sensitivity (Se) and specificity of single-domain tests were 69.5% and 82.5%, respectively. The PPV and NPV were 36.5% and 95.8%. Considered together, these methods were less specific but equally sensitive as the MMSE when applied in primary care. Here, the most successful methods were the selective reminding test (SRT) and clock drawing test, the latter having data from independent samples. In specialist settings, single-domain methods had a Se of 76.6%, a Sp of 81.9%, a PPV 80.8%, and a NPV 74.9%. This represented almost equivalent accuracy to the MMSE. The optimal method for specialist settings (based on accuracy alone) was the memory alteration test. Conclusion: Brief single-domain methods offer diagnostic performance for detection of dementia that is surprisingly close to that offered by cognitive batteries such as the MMSE. As a method of screening or as part of a diagnostic algorithm, brief single-domain tests may be an efficient first step in identifying cognitive impairment. (Am J Geriatr Psychiatry 2010; 18:783-800) [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to test the accuracy of patient colorectal cancer (CRC) screening self-report and CRC screening documented in their medical record for those who are cognitively impaired and those who are not based on the clock drawing task. A cross-sectional study where patient survey and medical record information were linked was conducted in 16 primary care offices. Of the 960 patients mailed questionnaires, there were 493 respondents who completed the questionnaire and clock drawing, had a chart review, and had no help in drawing the clock or completing the questionnaire. Chart review was conducted for CRC screening in physician offices. Clock drawings were scored 0–7 according to the Watson method. Accuracy of ever being screened for CRC or being up-to-date for CRC screening was determined by comparing self-report with medical records and calculating sensitivity, specificity, positive and negative predictive values, false positive rate, and false negative rate. Seventy-five clocks were abnormal, scoring 4 or more. Agreement between self-reported colonoscopy and medical record review was higher in subjects with normal clock drawings than those with abnormal clock drawings. When examining predictors of agreement/disagreement for colonoscopy screening, abnormal clock drawing was the single predictor for higher disagreement. [Copyright &y& Elsevier]

Abstract: The aim of this study was to report the prevalence of cognitive decline as well as its recognition rates in elderly inpatients in a general hospital in Greece. Two hundred randomly selected patients, 65 years old and over, hospitalized in surgery and internal medicine departments, were assessed for cognitive decline in a period of 12 months by means of structured clinical interview for DSM-IV axis-I disorders, clinical version (SCID-IV), mini-mental state examination (MMSE) and the clock drawing test (CDT). During the next 12 months the liaison calls were evaluated and the two periods were compared. During the first screening period, when psychiatric assessment was performed, 61 patients (30.5%) were diagnosed to present cognitive decline. During the second period, there were only 20 liaison calls from the same departments for patients over 65 years of age, from which 15 patients were found to present cognitive decline. Comparison between the two periods showed significant underestimation of cognitive decline. In the general hospital the cognitive decline of elderly inpatients remains still under-recognized. [Copyright &y& Elsevier]

Abstract: The clock drawing test (CDT) is a widely used dementia screening instrument that assesses executive and visuospatial abilities; studies in patients with Alzheimer''s disease (AD) suggest frontoposterior networks to be involved in clock drawing. Clock drawing errors are also often observed in dementia with Lewy bodies (DLB), but the functional neuroanatomical substrate of impaired clock drawing has not been firmly established in this disorder. The present study was designed to provide initial evidence for brain metabolic alterations associated with CDT performance in DLB. Twenty-one patients with DLB were enrolled. CDT ratings were correlated with the regional cerebral metabolic rate of glucose (rCMRglc) measured by 18F-fluoro-2-deoxy-glucose positron emission tomography (18F-FDG PET) in the statistical parametric mapping software package SPM5, controlling for overall cognitive impairment as measured by the Mini-Mental-State Examination (MMSE) score. There was a significant negative association between test scores and rCMRglc in a left-hemispheric posterofrontal network including the temporoparietal and dorsal pre-motor cortices and the precuneus. The present study provides evidence for a direct association between frontoparietal dysfunction and impaired CDT performance in DLB. These findings also suggest that the CDT is an appropriate screening instrument for this disorder and that metabolic dysfunction, and therefore disease severity, is mirrored by performance on the test. [Copyright &y& Elsevier]

Abstract: Background: Folstein''s Mini Mental Status Examination (MMSE) often fails to identify executive dysfunction even if quite severe. Detailed neuropsychological tests and extensive bedside tests are available to evaluate executive function, but most of them are time consuming. This study was done to determine the value of a Clock Drawing Test (CDT) as a simple tool to identify cognitive dysfunction in various neurological disorders and to assess its utility as an adjunct to MMSE in identifying executive dysfunction in a a busy out patient department (OPD). Methods: A total of 81 patients suffering from neurological disorders and 81 controls were studied. All subjects received the MMSE and the CDT. The CDT is divided into an unprompted task that is sensitive to executive control (CDT 1) and a copying task which is not (CDT 2). Result: All the three tests (CDT 1, CDT 2 and MMSE) could recognize cognitive and executive function deficits, when compared with age and sex matched controls (p<0. 001). CDT scores correlated strongly with the level of executive function deficits. CDT+MMSE detected 95% cases as abnormal as compared to 47% detected by MMSE alone. Conclusion: CDT along with MMSE can detect executive control deficits and cognitive deficits. The CDT 1 tests executive control performance, while CDT 2 tests posterior cortical deficits. [Copyright &y& Elsevier]

High altitude cerebral edema (HACE) is a life-threatening condition that can affect people who ascend to altitudes above 2500 m. Altered mental status and the presence of ataxia distinguishes HACE from acute mountain sickness (AMS). We describe a patient with subtle cognitive dysfunction, likely due to HACE that had not fully resolved. When he initially presented, the patient appeared to have normal mental status and was not ataxic. The diagnosis of HACE was missed initially but was made when further history became available. Cognitive dysfunction was then diagnosed based on abnormal performance of a clock drawing test. A formal mental status examination, using a clock drawing test, may be helpful in assessing whether a patient at high altitude with apparently normal mental status and with normal gait has HACE. [ABSTRACT FROM AUTHOR]

Abstract: Cognitive impairment either as dementia (PD–D) or mild cognitive impairment (PD–MCI) is common in Parkinson''s disease (PD). The clinical features and cognitive profile differs from Alzheimer''s disease (AD) or amnestic MCI (aMCI). In this study we aim to disclose the utility of pre-selected practical neuropsychological tests in differentiation of PD–D and AD, and also PD–MCI and aMCI. Consecutive cases with mild to moderate AD (n = 32) and PD–D (n = 26); aMCI (n = 34) and PD–MCI (n = 19) were evaluated. Although MMSE scores were similar in PD–D and AD or in PD–MCI and aMCI groups, memory impairment assessed by enhanced cued recall (ECR) was more apparent in AD than PD–D; and ECR scores tended to be worse in aMCI group than PD–MCI group. In contrast, clock drawing was more impaired in PD–D than AD. For differentiation of PD–D from AD, ECR, clock drawing and letter fluency were found to be valuable with moderately high sensitivity and specificities. In differentiation of aMCI and PD–MCI, ECR, clock drawing test and copying of intersecting pentagons were helpful. Stepwise linear discrimination function analysis disclosed that combination of ECR and clock drawing tests correctly classified 70.7% of the overall study population (71.4% of AD, 71.9% of aMCI, 69.6% of PD–D and 68.8% of PD–MCI). These findings suggest that ECR and clock drawing tests can be valuable as an additive to clinical diagnostic criteria in differentiation of PD–D and PD–MCI cases from AD and aMCI. [Copyright &y& Elsevier]

Abstract: The clock drawing test (CDT) is an easy to apply, well accepted and reliable test that is widely used to screen for visuo-constructional difficulties in the aged people. Yet, besides visual agnosia and constructional apraxia, executive control influences performances in this task. Execution modalities and rating schemes vary widely, as for the way stimuli are proposed, the time to which the clock is set, and the elements that are considered for scoring. The scoring system we have selected is called clock drawing interpretation scale (CDIS) contains 20 items in 3 areas: visuo-perceptual, attentional and numerical factors. Our aim is to know the meanings of the CDIS total and sub-areas score, investigating the relationships with specific neuropsychological tests, in elderly persons with moderate cognitive impairment. CDIS has been administered to 90 people, aged about 75 years, attending our rehabilitative day hospital or our memory clinic. A neuropsychological battery has been administered to a sample of 47 outpatients, selected by contingence. Respective mean MMSE for the 2 samples are 24 and 25.1 (adjusted for age and education). The score method shows good internal consistency, with Cronbach''s a about 0.75, either for total score or for the 3 sub-scores. Both total score and all sub-scores share correlations with mini mental state examination (MMSE), geriatric depression scale (GDS 5-item form), digit-symbol test, phonetic fluency and constructional apraxia tests. Total score and Group A (visuo-perceptive items) correlate also with cancellation attentional matrices, trail making test A and B, Corsi''s cubes and Raven''s colored matrices. Group B (attention items) and Group C (numerical factors) lack some of these correlations (Pearson correlation coefficients between 0.264 and 0.629). Neither CDIS total score nor sub-scores (except for numerical factors) correlate with verbal learning and memory. CDIS total cores correlates also with the level of education (r=0.418; p=0.001), but not with age. In conclusion, the clock drawing test, scored by the 20-item CDIS, looks as a homogeneous and analytic test, which is focused on visuo-perceptive and executive skills, while it disregards verbal learning and memory, in elderly people with moderate cognitive impairment. Its 3-item groups show good internal consistency; they also plausibly correlate to specific neuropsychological tests. The almost overlapping results of total and visuo-perceptual sub-score come from the way the test is performed and evaluated. The correlation between CDIS and GDS confirms the relevance of mood towards executive functions. [Copyright &y& Elsevier]

The objective of our study was to assess the correlation of routine neuropsychological test results in elderly patients referred to a gerontopsychiatric ward. MMSEs, CTs and SKTs were performed in 94 patients (age: median = 74 years, range = 54–89 years; 64 f, 30 m) with mild to moderate dementia and evaluated retrospectively. Pairwise Spearman rank correlation, multiple regression and response surface analysis were used to assess relations between test results. The scores of all three tests used were reciprocally correlated (P < 0.05) yielding the following pairwise R-values: SKT versus MMSE: -0.77, SKT versus CT: 0.69, MMSE versus Clock test: -0.61. Multiple regression analysis showed a maximum correlation of 0.87 and marked standardised β values, if SKT was chosen as dependent variable. Test scores could be well fitted to both symmetric linear (SKT = a + b × CT + c × MMSE; R2 = 0.67, P < 0.01) and non-linear (SKT = a + b × CT + c × MMSE + d × CT2 + e × MMSE2 + f × CT × MMSE; R2 = 0.67, P < 0.01) response surfaces. In conclusion, test scores of SKT, CT or MMSE in patients with dementia showed a marked correlation. In clinical practice the may be considered as almost interchangeable test options. [Copyright &y& Elsevier]

Investigations of the usefulness of the Clock Drawing Test (CDT) in schizophrenia have focused primarily on institutionalized or elderly patients. The purpose of the present study was to compare CDT performance of patients with schizophrenia living in the community with that of normal controls. Fifty-three patients with schizophrenia were compared with 66 age- and gender-matched normal controls. The CDT (‘free-drawn’, ‘pre-drawn’ and three ‘examiner’ conditions) and the Mini-Mental State Examination (MMSE) were administered to all participants. In patients with schizophrenia, symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS). Patients with schizophrenia had significantly lower scores on the MMSE and the five CDT conditions than the control group. When MMSE scores and level of education were included in the comparisons as covariates, the differences between the two groups remained significant. MMSE scores of the patients with schizophrenia correlated significantly with four clock conditions: ‘free-drawn’ ‘pre-drawn’ and two of the ‘examiner’ conditions (11:10 and 8:20). Poorer performance on the CDT correlated with higher scores on the PANSS positive symptoms subscale. Qualitative analysis of the clocks that were drawn revealed specific errors in the schizophrenia group relating to frontal processes: difficulty placing numbers in the correct position, failure to indicate the minute targets, displacement of the minute hand from the minute number, and failure to draw a longer minute hand. The fact that the CDT is sensitive enough to detect the cognitive impairment inherent in schizophrenia, as well as being correlated with symptom severity, makes this test useful in roughly assessing cognitive state in schizophrenia. [Copyright &y& Elsevier]

The impaired performance of Alzheimer''s disease (AD) patients on the clock drawing test (CDT) relative to age-matched normal controls is a well-documented finding in the literature. On the other hand, there is sparse information regarding the use of this test in schizophrenia. We examined three groups of subjects matched for gender and education: institutionalized patients with schizophrenia (n=32), patients with AD (n=32), and normal controls (n=36). The CDT (“free-drawn”, “pre-drawn”, and three “examiner” conditions) and Mini-Mental State Examination (MMSE) were administered to all participants. In patients with schizophrenia, symptom severity was assessed with the Brief Psychiatric Rating Scale (BPRS). Patients with schizophrenia were significantly younger than AD patients and normal controls (56.78 versus 71.41 and 66.25, respectively), and normal controls had significantly higher MMSE scores than patients with schizophrenia and AD (27.58 versus 20.75 and 18.44, respectively). In all of the clock conditions, the two patient groups performed significantly poorer than the normal controls, with the exception of the “pre-drawn” clock in which AD patients also performed worse than patients with schizophrenia. Age and duration of illness did not correlate significantly with CDT scores. When MMSE scores were used as a covariate, all significant differences on the CDT among the three groups disappeared, with the exception of the “pre-drawn” clock (AD patients had lower scores than both control and schizophrenia groups). In patients with schizophrenia, scores on the BPRS were not related with any CDT variable. Institutionalized patients with schizophrenia and AD patients showed similar deficits on a neuropsychological test sensitive to changes in visual–analytic function, attention, receptive language, and executive functions such as planning, organization, and simultaneous processing. [Copyright &y& Elsevier]

Abstract: Type 2 diabetes mellitus and hypertension are two widely spread diseases among the adults that are known to be risk factors for vascular disease. They are highly related such that comorbidity is common. The purpose of the present study was to investigate the comorbid effects of type 2 diabetes and hypertension on cognitive decline. One hundred and thirteen patients with type 2 diabetes (women, age 56±7.4years, diabetes duration 8±6.7years, hypertension duration 13.4±7.7years) were assessed for cognitive impairment (CI) in comparison with 27 diabetes patients without hypertension (women, age 53±7.45years, diabetes duration 4.4±5.6years), all non-demented at baseline. Patients were screened for cognitive dysfunction with the Mini Mental State Examination (MMSE), a clock-drawing test (CDT) and Frontal Assessment Battery (FAB). We assessed history of DM and hypertension by interview. 87% of women with diabetes and hypertension and 70% of normotensive diabetic patients had cognitive impairment (p=0.0282), of mild and subtle degree. The frequency of alterations in the FAB was higher in subjects with diabetes and hypertension (48%) compared to normotensive diabetic patients (26%) p=0.0402. Our results show that people with diabetes type 2 and hypertension demonstrate greater cognitive changes as compared to normotensive diabetic patients. [ABSTRACT FROM AUTHOR]

Abstract: The progressive increase of prevalence and incidence of dementia require growing attention in identifying subjects with early cognitive impairment. We have evaluated the results of mini mental state examination (MMSE) and CDT in elderly patients affected by MCI and mild dementia and in subjects without cognitive impairment, to measure whether combined use of two well-known cognitive screening tests (MMSE, CDT) is useful to identify precociously subjects with possible MCI. Using the statistical model of binomial logistic regression we have pointed out that CDT better differentiates healthy controls from MCI patients. MMSE, on the contrary of CDT, differentiates MCI patients from subjects affected by dementia. Finally, during screening, administration of both CDT and MMSE can be useful to identify precociously subjects with possible MCI. [Copyright &y& Elsevier]

To explore differences in self-care maintenance, management and confidence levels between American heart failure (HF) patients with and without executive dysfunction. Evidence indicates some aspect of cognitive impairment is prevalent in up to 75% of the HF patient population. Moreover, cognitive impairment has been identified as a barrier to adequate self-care contributing to poor outcomes. There is limited understanding of the role executive function, a domain of cognitive performance, has on self-care behaviors for patients with HF. This secondary analysis examined the role of executive function, measured by the Clock Drawing Test (CDT), in relation to self-care measures. The Self Care of Heart Failure Index v6.2 (SCHFI v6.2) was used to measure self-care maintenance, management, and confidence. Participants had a mean age of 75.1 ± 12.5 years, identified as male (59.4%), with New York Heart Association (NYHA) class III (57.3%). Executive function impairment was present in 28% of the sample. Comparison of self-care maintenance and management scores between the two groups were not significant. However, participants with executive dysfunction demonstrated an average self-care confidence score of 48.6 ± 23.3, while participants with no executive function impairment demonstrated a higher average self-care confidence score of 61.5 ± 18.4. Differences in self-care confidence scores between the groups were statistically significant (p =.014). HF self-care confidence is considered a moderator of self-care behaviors. Understanding the influence executive function has on self-care confidence may lead to a better understanding of those needing greater support with self-care behaviors. • Cognitive impairment has been identified as a barrier to adequate self-care contributing to poor outcomes. • There is limited understanding of the role executive function has on self-care behaviors for patients with HF. • HF patients with executive dysfunction had significantly poorer self-care confidence scores than those without dysfunction. • Understanding the role of executive function in HF may assist in identifying interventions to improve HF self-care. [ABSTRACT FROM AUTHOR]

Objective: Executive dysfunction following stroke is well documented, but less is known about whether it occurs in mild stroke patients. The purpose of the study was to investigate executive impairment in this population and explore the correlation between executive function tests and cognitive tests of other domains.Methods: Cross-sectional study was undertaken to compare 139 mild ischemic stroke patients (National Institute of Health Stroke Scale (NIHSS) ≤ 7) aged 40-80 with 131 normal controls matched age, gender and levels of education. All participants were administered a neuropsychological test battery including three measures of executive functioning: Clock Drawing Test (CDT), Trial Making Test-A and B (TMT-A and B), and Stroop Color Word Test (SCWT). The CDT was evaluated using three quantitative scoring rubrics, with a total score of 3,10,18, respectively and a qualitative scoring method with six types of errors. Spearman's correlations were made to analyze the correlation between executive function tests and other neuropsychological tests.Results: Control group performed better than stroke group on most executive function tests at a statistical significance. Qualitative CDT showed that errors of "graphic difficulties", "conceptual deficits" and "spatial and/or planning deficits" occurred frequently in the early stage of mild stroke. Correlation data clarified that among the executive function tests, time for TMT-B correlated with global cognition most.Conclusion: Executive dysfunction is common following even mild strokes, and that relatively brief measures such as CDT, TMT and SCWT can be employed for it before discharge as part of rehabilitation planning. [ABSTRACT FROM AUTHOR]

Abstract: The CDT requires a patient to draw the face of a clock, insert all the numbers and set the hands for a specified time. This task engages a number of cognitive abilities including verbal understanding, memory, spatially coded knowledge, planning, concentration and visuoconstructive skills. Although CDT has been regarded as a simple and useful screening tool in dementia, little is known about the longitudinal changes in CDT performance and error types, according to dementia subtypes and their severity. Materials and methods: Two hundred thirty-five consecutive patients with dementia (Alzheimer disease=AD, n =94, Parkinson''s disease with dementia (PDD), n =119, Vascular dementia=VaD, n =22) were recruited from the memory clinic at Chungnam University hospital from January 2005 to July 2009. The Korean version of the mini-mental state examination (MMSE-K) and CDT were performed by all participants every 6 months. Scoring of the CDT performance was in accordance with the method of Mano and Wu. Error types of CDT were classified as follows: stimulus-bound response (SBR), conceptual deficit (CD), spatial and/or planning deficit (SPD) and perseveration error (PE). We divided patients into 3 groups by their initial MMSE-K score (severe, MMSE-K≤17; moderate, 18≤MMSE-K<24; mild, 24≤MMSE-K). Comparisons of CDT scores and error types in the three dementia subtypes and three cognitive groups were conducted. Results: Longitudinal changes on CDT and MMSE-K scores were not different between the three dementia subtypes. From the analysis of CDT error type, the most common error type was SPD in patients with mild to moderate dementia. In contrast, CD error was the most frequent in severe dementia group. The order of error frequency in all subjects from baseline to the last follow-up was as follows: SPD, CD, SBR and PE except CD was the most frequent error type in AD patients after 18 months from baseline. Conclusion: Longitudinal analysis of error on CDT may reflect different characteristics of cognitive deterioration according to dementia subtypes and dementia stages. [Copyright &y& Elsevier]

Abstract: Influence of sun exposure and physical activity on cognition has not been evaluated simultaneously. We aimed to evaluate predictors of clock drawing test (CDT) performance on n =125 patients attending an internal medicine outpatient clinic. Interview data was gathered on sociodemographic, health-related and lifestyle factors referring to the last year. Factors associated with obtaining a score >0 and a full score (10/10) were analyzed by univariate (UVA) and multivariate (MVA) logistic regression analyses. Mean age of the participants was 72±5, 58% were women and 17% were illiterate. Mean CDT score was 4.70±2.27, 61.6% scored >0 and 21.6% scored 10/10. Both duration of walking and summer sun exposure predicted a CDT score >0 in UVA. However only summer sun exposure was an independent predictor (odds ratio=OR=1.73, 95% confidence interval=CI=1.16–2.57). Other factors independently associated with obtaining a score >0 were education level (OR=2.70, 95%CI=1.77–4.12) and cerebrovascular disease (CVD) history (OR=0.08, 95%CI=0.008–0.78). Factors independently associated with obtaining a full score were weight (OR=1.05, 95%CI=1.00–1.10), education level (OR=2.04, 95%CI=1.38–3.00) and visiting the clinic alone (OR=3.92, 95%CI=1.354–11.39). Our study shows that CDT can be utilized to unravel the lifestyle factors associated with cognitive function. To our knowledge, this is the first study to suggest an association between sun exposure and cognition. [Copyright &y& Elsevier]