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Background: The clock drawing test (CDT) and the Mini Mental State Examination (MMSE) are frequently used screening instruments for cognitive impairment, however, the precise contribution of the CDT to the MMSE is largely unknown. Methods: We studied patients with subjective cognitive impairment (SCI, n = 481), mild cognitive impairment (MCI, n = 628) and Alzheimer's disease (AD, n = 1099). Discrimination between patients was examined with multiple logistic regression, adjusted for age, sex, and education. Four groups were constructed based on a normal/abnormal MMSE (cut‐off <24/30) versus normal/abnormal CDT (cut‐off ≤2/3). Visually rated medial temporal lobe atrophy (MTA) on CT was used as parameter of neurodegeneration. Results: The CDT significantly contributed to the MMSE in discriminating SCI from both MCI and AD patients. Our four group analyses showed that of those patients with a normal MMSE and incorrectly classified as SCI, an abnormal CDT could significantly identify 10.0% as MCI and 13.2% as AD. Among those with an abnormal MMSE, the percentage AD patients shifted from 53.1% to 82.1% due to an abnormal CDT. Presence of an abnormal CDT was significantly related to MTA increase, regardless of the MMSE score. Conclusion: The CDT is an important additional screening tool to the MMSE. An abnormal CDT with a normal MMSE is an indicator for cognitive impairment. An abnormal CDT in combination with an abnormal MMSE can be considered as an indicator of disease progression. Key points: The clock drawing test (CDT) is widely used as a screening tool for cognitive impairment, often in combination with the Mini Mental State Examination (MMSE), however, very few studies focus on the specific contribution of the CDT when the MMSE is known.To our knowledge, our study is the first to examine the additional value of the CDT to the MMSE in a large elderly memory clinic population to differentiate patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) from those with subjective cognitive impairment (SCI). We focus on the clinical use of both tests using predefined cut‐off scores.When patients have an MMSE of 24 or higher, and are thus classified as having no cognitive impairment by the MMSE, the CDT can significantly identify close to 25% as having either MCI or AD. When the MMSE is below 24, the combination with an abnormal CDT yielded a percentage of 82% AD.When the MMSE is known, an abnormal CDT can give additional information on progression along the SCI‐MCI‐AD trajectory. We therefore recommend the CDT as a highly relevant, quick and easy to administrate screening tool. [ABSTRACT FROM AUTHOR]

Background: Hippocampal calcification (HC), highly prevalent in older people, has not attracted attention until recently. Despite its potential effects on cognition and behaviour, and its possible impact on the diagnosis and severity of dementia, it has not been investigated. This study aimed to evaluate the prevalence of HC and its influence on cognition and behavioural symptoms in patients with dementia. Methods: Data from consecutive patients who visited a medical centre for dementia, for the first time between April 2016 and September 2018, were extracted and analysed. These data included the patients' demographics, the presence of HC and hippocampal thickness as measured on computed tomography, the diagnosis of dementia and its type, cognitive function measured using the Mini‐Mental State Examination and the Clock Drawing Test, and the chief complaints or symptoms prompting the visit. Results: A high incidence of HC (85/267 patients) was observed. There was no significant difference in the ages of patients with and without HC. Patients with HC had higher cognitive function than those without HC at their first visit. This result was contrary to our expectations as it was not explained by the chief complaints recorded at the first visit. Conclusions: Our study showed a high prevalence of HC in older patients with dementia. Patients with HC had better cognitive function than did those without HC during their first hospital visit. This study suggests that HC may not affect the cognitive functions related to dementia. However, further research is needed to evaluate the long‐term consequences of dementia with HC. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to clarify the diagnostic performance and neural basis of the Clock Drawing Test (CDT) combining free‐ and pre‐drawn methods. Methods: This retrospective study included 165 participants (91 with Alzheimer disease [AD], 52 with amnestic mild cognitive impairment [aMCI], and 22 healthy controls [HC]), who were divided into four groups according to their free‐ and pre‐drawn CDT scores: group 1, could do both; group 2, impaired in both; group 3, impaired in pre‐drawn CDT; and group 4, impaired in free‐drawn CDT. The diagnostic performances of the free‐drawn, pre‐drawn, and combination methods were compared using receiver operating characteristics analysis; in voxel‐based morphometry analysis, the gray matter (GM) volume of groups 2–4 were compared with that of group 1. Results: The area under the curve of the combination method was greater than that of the free‐ or pre‐drawn method alone when comparing AD with HC or aMCI. Group 2 had a significantly smaller GM volume in the bilateral temporal lobes than group 1. Group 3 had a trend toward smaller GM volumes in the right temporal lobe when a liberal threshold was applied. Group 4 had significantly smaller GM volumes in the left temporal lobe than group 1. Conclusions: This study suggests that the combination method may be able to screen for a wider range of brain dysfunction. Combined use of free‐ and pre‐drawn CDT may be useful for screening for AD and its early detection and treatment. Key points: The diagnostic performance and neural basis of the combination of free‐ and pre‐drawn Clock Drawing Test (CDT) were investigated in the Alzheimer disease [AD] continuum.The combination method is more sensitive than each method alone as a screening test for AD.The combination can screen for a wider range of brain dysfunction than each method alone. [ABSTRACT FROM AUTHOR]

Objective: Thyroid dysfunction is associated with an elevated risk of cognitive decline, but the mechanism underlying this relationship is elusive. In this study, we investigate the relationships between free thyroxine (FT4), brain frailty and clock drawing test (CDT) performance in patients with acute minor stroke or transient ischaemic attack (TIA). Design, Patients and Measurements: A total of 204 consecutive patients admitted to our hospital within 72 h after the onset of acute minor stroke or TIA were prospectively enroled and categorized in terms of quartiles of FT4 between March 2018 and August 2019. Brain frailty on magnetic resonance imaging was rated according to previously published criteria. Cognitive performance was assessed with the CDT. Results: Generalized linear analysis revealed that FT4 was independently associated with higher brain frailty score after adjusting potential confounders (β, 0.03; 95% confidence interval [CI], 0.00–0.06; p = 0.0205), which is consistent with the result of FT4 (quartile) as a categorical variable (β, 0.34; 95% CI, 0.01–0.68; p = 0.0059; ptrend = 0.0807). A nonlinear relationship was detected between FT4 and brain frailty score, which had an inflection point of 1.19. FT4 was also associated with poor CDT performance (odds ratio, 1.15; 95% CI, 1.04–1.26; p = 0.0051). And mediation analysis found that brain frailty partially mediated the positive relationship between FT4 and poor CDT performance (indirect effect = 0.0024; 95% CI, 0.0003–0.01, p = 0.04). Conclusions: Our findings suggested that a higher FT4 level was associated with a higher brain frailty score and poorer CDT performance, and brain frailty might play an important effect on the association between FT4 and cognitive decline. [ABSTRACT FROM AUTHOR]

Objective: The clock drawing test (CDT) has become one of the most widely used cognitive screening instruments in clinical and research settings. Its effectiveness, acceptability, and quick and easy administration have made it a staple for cognitive screening in dementia and a wide range of brain disorders. Despite a spike in popularity since the 1990s, its origins are relatively unknown. The goal of this review is to chronicle its saga and chart its usage over time.Methods: PsycInfo, Medline, and PubMed literature searches were performed from earliest record to June 2016, in addition to manual cross-referencing of bibliographies, with a focus before 1990. Summary of relevant articles and books up until 1989 is included, as well as clinical applications and surveys that track CDT usage over time.Results: While MacDonald Critchley's well-known textbook from 1953, The Parietal Lobes, is often cited as the first mention of the CDT, its recorded use actually stretches back more than a century to 1915. A review of the literature shows that the CDT began as a test for aphasia-related disorders and constructional apraxia until its entry into contemporary cognitive screening in the 1980s when it primarily became a cognitive screen. Its usage took off in 1989 with over 2000 publications since.Conclusions: Despite a fairly obscure existence for decades, the CDT has emerged as an effective and ideal cognitive screening instrument for a wide range of conditions. Its use continues to increase, and it has been incorporated into several widely used cognitive screening batteries. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: The clock drawing test (CDT) is a commonly used brief cognitive measure. We evaluated diagnostic accuracy of subjective ratings of CDT by physicians (with/without specialty in cognitive neurology) and neuropsychologists in discriminating amnestic mild cognitive impairment (aMCI), Alzheimer's dementia (AD) and cognitively healthy older adults. We further compared the diagnostic accuracy of subjective categorical ratings with complex scoring of CDT.Methods: Three cognitive neurologists, three neuropsychologists and six neurology residents without experience in cognitive neurology blinded to the diagnosis rated 187 CDTs (50 mild AD, 49 aMCI and 88 cognitively healthy older adults) using a "yes" (abnormal) versus "suspected" versus "no" (normal) classification. The rating suspected was combined with yes or no to obtain two sets of sensitivity estimates. We also used a 17-point CDT rating system.Results: When using the categorical rating, neuropsychologists had highest sensitivity (89%) in differentiating patients with mild AD (yes/suspected versus no), followed by neurologic residents (80%) and cognitive neurologists (79%). When differentiating patients with aMCI (yes/suspected versus no), the sensitivity was 84% for neuropsychologists, 64% for cognitive neurologists and 62% for residents. The sensitivity using the complex scoring system was 92% in patients with mild AD and 69% in patients with aMCI.Conclusions: A categorical rating of CDT shows high sensitivity for mild AD even in non-experienced raters. Neuropsychologists outperformed physicians in differentiating patients with aMCI from cognitively healthy older adults (specificity), which was counterbalanced by the lower specificity of their ratings. The diagnostic accuracy was not substantially improved by using complex scoring system. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: With declining general health, the maintenance of oral health becomes increasingly difficult. Unfortunately, health care resources are limited. An assessment tool for detecting a patient's need for oral health care assistance would promote its adequate distribution. The aim of this study is to evaluate if the Shulman clock-drawing test score is a suitable assessment tool for determining the need for oral hygiene assistance.Methods: Data collected from recent dental checkups of 126 inhabitants of five Austrian residential care facilities were analyzed. The Shulman clock-drawing test score was used as a measure for cognitive abilities and related to tooth and denture hygiene indices, which were assessed using the approximal space plaque index (API) and the denture plaque index (DPI).Results: Shulman score values were distributed almost evenly in the study population. The mean API was 83.6% (SD 20.2%) for the maxilla and 94.9% (SD 15.6%) for the mandible. The mean DPI was 43.9% (SD 31.4%). Cognitive impairment was not statistically related to the dental or denture hygiene index.Conclusions: A high Shulman clock-drawing test score indicates the need for oral hygiene assistance, but it is not suitable as a single tool to assess this need. Patients with other disabilities might equally qualify for assistance. Dentures, however, can be cleaned quickly and efficiently independently of patient compliance; therefore, cleaning the patients' dentures should be part of nursing personnel's daily care routine for every patient. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study is to examine the association of the clock drawing test (CDT) with incident dementia, cardiovascular events and mortality in very elderly hypertensive patients. Method All participants were hypertensive and aged 80 years and over. The CDT was administered at baseline and annually thereafter. Data on incident cardiovascular, fatal events and dementia were collected over follow-up. Results There were 3845 participants recruited and followed up for a mean of 2.1 years. Of these, 2701 completed a CDT with 2259 available at baseline. Of this group, 6.6% had a cardiovascular event, 6.1% died, and 10% were diagnosed with dementia. There was no relationship between baseline CDT score and subsequent cardiovascular events or mortality. For incident dementia, the hazard ratio was 0.88 (95% confidence intervals 0.83-0.94) suggesting that better performance on the baseline CDT was associated with a lower risk of dementia. Conclusion These results provide tentative support for the CDT alongside other cognitive screening tools in a hypertensive elderly population. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective We aimed to validate the Freund Clock Drawing Test (CDT), with its predefined cutoff score of ≤4, as a screening tool to detect elderly cancer patients in need of a more in-depth cognitive evaluation within a comprehensive geriatric assessment (CGA). Methods Patients aged 70 years or older with a histologically confirmed diagnosis of cancer were evaluated with a full CGA, including CDT and Folstein Mini Mental State Examination (MMSE) as gold standard. Validation of the Freund CDT was defined in terms of diagnostic accuracy of the test through receiver operating characteristics (ROC)-analysis. To accept the Freund CDT as a screening tool, we estimated that the area under the ROC curve (AUC) had to differ significantly from 0.70 with an AUC of at least 0.85. Results Two hundred elderly cancer patients with a mean age of 79.0 years were included. Four patients were excluded from the analyses because of invalid results. Potential cognitive impairment (MMSE ≤23) was observed in 27.0% of patients. Based on of the AUC ± SE, the Freund CDT showed excellent diagnostic performance (0.95 ± 0.17). Furthermore, it provided excellent sensitivity (94.3%) and high specificity (87.4%). Conclusions Our results indicate that the Freund CDT can be used as an initial screening tool to detect elderly cancer patients in need of a more in-depth cognitive assessment within CGA, instead of the MMSE. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: In this study, we evaluated the effect on cognitive function of memantine, behavioral and psychological symptoms of dementia, and the care burden, in patients with moderate-to-severe Alzheimer’s disease (AD). Furthermore, with near-infrared spectroscopy (NIRS), we examined the association between effect of memantine and brain blood flow. Methods: We evaluated the effect of memantine administration from baseline on Clinical Global Impression-Improvement scale, mini mental state examination (MMSE), Clock Drawing Test (CDT), Neuropsychiatric Inventory (NPI), Japanese version of the Zarit Burden Interview (J-ZBI) and NIRS in two groups, donepezil administration memantine combination group (combination group, n = 19) donepezil administration memantine non-administration group (control group, n = 18) were assessed at weeks 0, 4, 12, and 24. Results: Significant difference was found between the combination group and the control group in the score variation of Clinical Global Impression-Improvement scale, MMSE, CDT, NPI, and J-ZBI. In the NIRS measurements, trend oxyhemoglobin reduced suppression was observed in some channels centered on the superior frontal gyrus. A significant correlation was observed in the scores of MMSE, CDT, NPI, and J-ZBI. In addition, a significant positive correlation was also observed between the number of words in NIRS and scores of MMSE and CDT. Conclusions: In this study, by administering memantine in AD patients that inhibit the reduction of cerebral blood flow in the prefrontal area and improve clinical symptoms overall cognitive function, behavioral and psychological symptoms of dementia, thereby reducing the care burden of caregivers was suggested. [ABSTRACT FROM AUTHOR]

Objective Earlier studies have demonstrated that a disintegrin and metallopeptidase 10 (ADAM10) levels are reduced in Alzheimer's disease (AD) patients compared with healthy subjects. The objective of this study was to evaluate whether platelet ADAM10 levels correlates with the clock drawing test (CDT) scores, which is a simple and a reliable measure of visuospatial ability and executive function in AD patients. Methods Thirty elderly patients with probable AD and 25 healthy patients forming the control group, matched by age, gender, and educational level, were evaluated. Platelet proteins were analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis, and ADAM10 was identified by western blotting. The Spearman's correlation coefficient between ADAM10 and CDT was obtained for each group. The areas under the curves were used to compare the receiver operating characteristic curves. Results The CDT scores and platelet ADAM10 expression were significantly different between patients with AD and controls and also along the disease's progression. In AD patients, there was a positive correlation between ADAM10 expression and CDT scores. Among non-AD subjects, no correlation was found. The combination of ADAM10 and CDT was significantly better to confirm the AD diagnosis than the AUCs of ADAM10 and CDT separately. Conclusions The association of blood-based biomarkers, such as ADAM10, and cognitive tests may be helpful for a more reliable AD diagnosis. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective The clock drawing test (CDT) is a widely used cognitive screening tool that has been well accepted among clinicians and patients for its ease of use and short administration time. Although there is ample interest in the CDT as a screening instrument, there remains a range of CDT administration and scoring systems with no consensus on which system produces the most valid results while remaining user friendly. The aims of this review are to synthesize the available evidence on CDT scoring systems' effectiveness and to recommend which system is best suited for use at the clinical frontlines. Design A Pubmed literature search was carried out from 2000 to 2013 including manual cross-referencing of bibliographies in order to capture studies published after Shulman's comprehensive review published in 2000. A brief summary of all original scoring systems is included, as well as a review of relevant comparative studies. Results The consensus from multiple comparison studies suggests that increasing the complexity of CDT scoring systems does little to enhance the test's ability to identify significant cognitive impairment. Moreover, increased complexity in scoring adds to the administration time, thereby reducing the test's utility in clinical settings. Conclusions In comparing scoring systems, no system emerged as consistently superior in terms of predictive validity. The authors conclude that when scoring the CDT as a screening instrument in a primary/general medicine/community setting, simpler is better, and perhaps qualitative assessment of 'normal' versus 'abnormal' may be sufficient for screening purposes and the establishment of a baseline for follow-up. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective. The aim of our study was to investigate the frequency and pattern of cognitive impairment in patients with clinically isolated syndromes and definite diagnosis of multiple sclerosis within the last 2 years. Methods. We assessed the cognitive status of 46 patients aged 18-49 years with clinically isolated syndromes or definite diagnosis of multiple sclerosis who have onset of their symptoms within the last 2 years. Patients were matched with 40 healthy participants for age, sex, and educational level. Neuropsychological assessment was performed by stroop test, paced auditory serial addition test (PASAT), controlled oral word association test (CÖWAT), clock drawing test, trail making test (TMT), faces symbol test (FST). Hamilton Depression Scale and Modified Fatigue Impact Scale were used to quantify the severity of any depression and fatigue the subjects might suffer. Results. 19.6% of early MS/CIS group failed at 4 and more tests and had significant cognitive impairment focused on attention, executive functions, memory, and learning. No significant relationship was found between cognitive impairment and disability and fatigue scores. Discussion. Cognitive impairment can be present from the earliest stage of multiple sclerosis. It should be considered among the main manifestations of MS even in the earliest stages of the disease. [ABSTRACT FROM AUTHOR]

Objective: Earlier studies have demonstrated that a disintegrin and metallopeptidase 10 (ADAM10) levels are reduced in Alzheimer’s disease (AD) patients compared with healthy subjects. The objective of this study was to evaluate whether platelet ADAM10 levels correlates with the clock drawing test (CDT) scores, which is a simple and a reliable measure of visuospatial ability and executive function in AD patients. Methods: Thirty elderly patients with probable AD and 25 healthy patients forming the control group, matched by age, gender, and educational level, were evaluated. Platelet proteins were analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis, and ADAM10 was identified by western blotting. The Spearman’s correlation coefficient between ADAM10 and CDT was obtained for each group. The areas under the curves were used to compare the receiver operating characteristic curves. Results: The CDT scores and platelet ADAM10 expression were significantly different between patients with AD and controls and also along the disease’s progression. In AD patients, there was a positive correlation between ADAM10 expression and CDT scores. Among non-AD subjects, no correlation was found. The combination of ADAM10 and CDT was significantly better to confirm the AD diagnosis than the AUCs of ADAM10 and CDT separately. Conclusions: The association of blood-based biomarkers, such as ADAM10, and cognitive tests may be helpful for a more reliable AD diagnosis. [ABSTRACT FROM AUTHOR]

Clock drawings produced by right-brain-damaged (RBD) individuals with spatial neglect often contain an abundance of empty space on the left while numbers and hands are placed on the right. However, the clock perimeter is rarely compromised in neglect patients' drawings. By analysing clock drawings produced by 71 RBD and 40 healthy adults, this study investigated whether the geometric characteristics of the clock perimeter reveal novel insights to understanding spatial neglect. Neglect participants drew smaller clocks than either healthy or non-neglect RBD participants. While healthy participants' clock perimeter was close to circular, RBD participants drew radially extended ellipses. The mechanisms for these phenomena were investigated by examining the relation between clock-drawing characteristics and performance on six subtests of the Behavioral Inattention Test (BIT). The findings indicated that the clock shape was independent of any BIT subtest or the drawing placement on the test sheet and that the clock size was significantly predicted by one BIT subtest: the poorer the figure and shape copying, the smaller the clock perimeter. Further analyses revealed that in all participants, clocks decreased in size as they were placed farther from the centre of the paper. However, even when neglect participants placed their clocks towards the centre of the page, they were smaller than those produced by healthy or non-neglect RBD participants. These results suggest a neglect-specific reduction in the subjectively available workspace for graphic production from memory, consistent with the hypothesis that neglect patients are impaired in the ability to enlarge the attentional aperture. [ABSTRACT FROM AUTHOR]

Background/aim: The aim of this study was to explore the relationships between clock drawing ability following stroke, and key clinical variables including cognition, functional independence, side and type of stroke, educational level and age. Methods: One hundred and ninety-seven people with stroke were recruited from 12 hospital and rehabilitation facilities. The participants’ scores from the Clock Drawing Test in the Occupational Therapy Adult Perceptual Screening Test were the dependent variables and were entered into logistic regression with Functional Independence Measure motor scores, side of stroke, Oxfordshire Classification System of Stroke, educational level and age as independent variables. Correlation with the Mini-Mental State Examination was analysed independently, due to its strong correlation with other variables. Results: The Mini-Mental State Examination correlated significantly with the Clock Drawing Test ( Exp (B ) = 0.826, P  < 0.001). In the multivariate analysis, a significant relationship was found with age (Exp ( B ) = 1.052, P  < 0.001), Functional Independence Measure — motor (Exp (B ) = 0.984, P  = 0.030) and side of stroke (Exp (B ) = 0.384, P  = 0.003). Age demonstrated the strongest correlation with the Clock Drawing Test ability and the greatest decline was from approximately 70 years of age. Conclusions: The Clock Drawing Test may be a useful and quick screen of cognitive impairments following stroke. Age-related decline must be considered and it is essential that clinicians use this only as a strategy to determine whether a more comprehensive assessment is required. [ABSTRACT FROM AUTHOR]

Background The CAMCOG is a brief neuropsychological battery designed to assess global cognitive function and ascertain the impairments that are required for the diagnosis of dementia. To date, the cut-off scores for mild cognitive impairment (MCI) have not been determined. Given the need for an earlier diagnosis of mild dementia, new cut-off values are also necessary, taking into account cultural and educational effects. Methods One hundred and fifty-seven older adults (mean age: 69.6 ± 7.4 years) with 8 or more years of formal education (mean years of schooling 14.2 ± 3.8) attending a memory clinic at the Institute of Psychiatry University of Sao Paulo were included. Subjects were divided into three groups according to their cognitive status, established through clinical and neuropsychological assessment: normal controls, n = 62; MCI, n = 65; and mild or moderate dementia, n = 30. ROC curve analyses were performed for dementia vs controls, MCI vs controls and MCI vs dementia. Results The cut-off values were: 92/93 for dementia vs controls (AUC = 0.99: sensitivity: 100%, specificity: 95%); 95/96 for MCI vs controls (AUC = 0.83, sensitivity: 64%, specificity: 88%), and 85/86 for MCI vs dementia (AUC = 0.91, sensitivity: 81%, specificity: 88%). The total CAMCOG score was more accurate than its subtests Mini-mental State Examination, Verbal Fluency Test and Clock Drawing Test when used separately. Conclusions The CAMCOG discriminated controls and MCI from demented patients, but was less accurate to discriminate MCI from controls. The best cut-off value to differentiate controls and demented was higher than suggested in the original publication, probably because only cases of mild to moderate dementia were included. This is important given the need for a diagnostic at earlier stages of Alzheimer's disease. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective To determine the validity of the Clock Drawing Test (CDT) and the Mini-Mental State Examination (MMSE) respectively or in combination for differentiating Vascular Cognitive Impairment No Dementia (V-CIND) from normal subjects. Methods Eighty V-CIND patients and 80 healthy control subjects were blindly evaluated with MMSE, CDT, and additional neuropsychological tests. CDT was scored according to the Rouleau method and AD Cooperative Study method. Sensitivities and specificities of the two CDT measures and MMSE for identifying V-CIND patients were determined. The Areas Under the Receiver Operating Characteristic Curve (AUCs) were compared, and the sensitivity of the combination of CDT with MMSE calculated. Results V-CIND group performed worse than controls on both MMSE (p < 0.0001) and the two CDTs (p < 0.0001). In differentiating V-CIND patients from normal subjects, the two CDT measures provided sensitivities of 68.7% and 65.0%, and specificities of 78.7% and 86.2% respectively at optimal cutoff scores, which did no better than MMSE (sensitivity 80%, specificity 70%) (comparison of the AUCs, p = 0.992 and 0.428). The sensitivity of MMSE was marginally higher than that of CDT scored with AD Cooperative Study method (p = 0.053). By combining the two CDT measures with MMSE, the sensitivity was improved to 93.7% and 92.5% respectively. Conclusions Compared with MMSE, CDT is of only similar or even weaker ability for identifying V-CIND. MMSE at a cutoff of 28 may be of some value in detecting V-CIND patients. CDT and MMSE in combination provide a valid instrument for V-CIND screening. Copyright © 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim: To investigate the associations of Clock-Drawing Test (CDT) score with neuropsychological test scores and regional cerebral blood flow. Method: Twenty-five patients (normal aging, n = 2; mild cognitive impairment, n = 7; Alzheimer's disease [AD], n = 16) participated in this study. Their average age was 74.8 years. Results: CDT score correlated well with the neuropsychological test scores of Mini-Mental State Examination, Clinical Dementia Rating, immediate visual memory, delayed visual memory, and IQ evaluated by Koh's block design. CDT score also had a statistically significant correlation with the regional blood flow in the left hippocampal region as evaluated on 3-D stereotaxic region-of-interest template analysisapplied to single-photon emission computed tomography images. Using a cut-off point of 8/9 in the CDT, the high-CDT group had significantly higher delayed visual memory and IQ scores than the low-CDT group. Moreover, the high-CDT group had significantly higher regional blood flows in the left parietal, left angular and bilateral hippocampal regions than the low-CDT group. Conclusion: CDT score correlates well with regional cerebral blood flow that is decreased in the early stage of AD. [ABSTRACT FROM AUTHOR]

Presents several studies related to risk factors of hypertension. "The Effect of Glucose Metabolism on the Incidence of Erectile Dysfunction in Hypertensive Subjects," by Nikolaos Alexopoulos et al; "Coronary Events in a Health Centre: How Were These Patients Being Controlled?," by Augusto Anguita et al; "Patients With Multiple Risk Factors and Hypertension: What About Their Control?," by Ricardo Cabrera-Sole et al.

ObjectivesIn order to evaluate the suitability of the clock drawing test (CDT) for the detection of questionable dementia (QD), we assessed the inter–rater reliabilities and intercorrelations of four common scoring methods of the CDT in a sample of non-demented subjects and determined the concurrent validity. MethodsThe study sample consisted of 253 discharged general hospital patients, aged between 65 and 85 years. Subjects were screened for cognitive impairment during their hospital stay. Four to six weeks after discharge each non-demented patient was visited at home and interviewed by a trained psychologist. The interview procedure included a cognitive test battery incorporating the CDT, the Mini-Mental State Examination (MMSE), the Syndrome Short Test (SKT), and a verbal fluency test (VF). The criteria of the Clinical Dementia Rating (CDR) were used to differentiate between cognitively normal subjects and those with QD. Clock drawings were scored independently and blindly by two raters according to four different methods. The agreement between raters was assessed, as well as the agreement between the different scoring methods. The association of gender, education, age, test performance and CDR-rating with CDT scores was examined. Accuracy of the CDT for the detection of QD was calculated. ResultsInter–rater reliabilities were high for all four scoring methods. However, substantial differences among the scoring methods were observed, the proportion of abnormal test results varying between 9% and 50%. The CDT correlated significantly with MMSE, SKT and VF, but correlation coefficients were low (r = 0.13 to r = 0.32). Furthermore, CDT scores were influenced by age, gender, and education. Sensitivity of the CDT for QD was 66%, specificity was 65%; the negative predictive value was 73%, the positive predictive value 58%. ConclusionIn a sample of non-demented elderly, the reliability of the CDT was sufficiently high, but the different scoring methods were not equivalent. When established cut-off scores were used, the proportion of abnormal CDTs were significantly different. Concurrent validity with other common cognitive tests was unsatisfactory. The CDT lacks sufficient sensitivity and specificity for the identification of QD and should not be used alone to screen for possible prodromal stages of dementing illnesses. The association of age, gender and level of education with CDT scores should be taken into account by clinicians using the CDT. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ObjectiveTo evaluate five different scoring methods of the Clock Drawing Test (CDT) and to examine whether a combination of Mini Mental State Examination (MMSE) or Short Performance Test (Syndrom Kurz Test, SKT), respectively, with CDT can be used for cognitive screening. MethodsRetrospective blinded analysis of clock drawing performance using five scoring methods (Shulman et al . (1986), Sunderland et al . (1989), Wolf-Klein et al . (1989), Watson et al . (1997), Manos (1997)). A Memory Clinic at an academic psychiatric hospital (University of Frankfurt am Main, Germany). 123 consecutive patients (79 dementia patients, 44 controls). Inter-rater reliability and correlation of five different scoring methods of the CDT with established psychometric tests. Sensitivity and specificity of all five CDT's using the original and modified cut-off scores. Sensitivity, specificity and positive and negative predictive value of a combination of the CDT with MMSE and SKT, respectively. ResultsAll scoring methods of the CDT showed a highly significant interrater reliability (0.82 to 0.94). Correlation with the MMSE and the SKT was also significant (p < 0.01) for all five CDTs. Highest sensitivity was achieved by the Shulman scoring method (81% sensitivity, specificity 79%). Sensitivity of all scoring methods could be improved up to 89% by modifying the originally proposed cut-off scores at the cost of lower specificity. By combining the CDT with the MMSE or the SKT, respectively, the sensitivity of each of the tests could be improved to 92% (SKT and Shulman scale). In patients with mild dementia (GDS 3), a combination of the Shulman Scale with the SKT (92%) and the MMSE (75%) achieved the highest sensitivity. ConclusionsThe CDT in combination with the MMSE or SKT is an easily administered, non threatening and highly sensitive screening test for dementia in the setting of a memory clinic. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

AbstractThe clock drawing test (CDT) is a useful tool for screening cognitive impairment. Previous neuropsychological studies have revealed that CDT performance requires several cognitive functions including semantic memory, visuospatial function and executive function. However, the neural substrates involved remain to be elucidated. The aim of the present study was to identify the brain regions responsible for CDT performance in patients with Alzheimer's disease (AD). Twenty-six patients satisfying the National Institute of Neurological and Communicative Disease and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable AD underwent the CDT and the Mini-Mental State Examination (MMSE), together with a N-isopropyl-p-[123 I] iodoamphetamine (IMP) single photon emission computed tomography measurements of the resting regional cerebral blood flow (rCBF). The CDT score correlated significantly with the MMSE score (r = 0.582; P < 0.05). Stepwise multiple regression analysis revealed that the MMSE score and the left posterior temporal rCBF were major predictors of CDT score. These findings suggest that the CDT score may reflect the severity of dementia, and that it has a close relationship with the left posterior temporal function. Our findings provide the first functional neuroimaging evidence for the neural substrates involved in CDT performance. [ABSTRACT FROM AUTHOR]

Compares the scoring protocols on the clock drawing tests in elation to ease of use. Correlation of the Mini-Mental State Examination (MMSE); Details on the score and related memory real scores; Relations of MMSE-brief to screening.

The Clock Drawing Test (CDT) is a recognized and accepted instrument for the early diagnosis of dementia in the elderly. In a prospective study we evaluated the association between the results of this test and a broad range of clinical, functional and sociodemographic variables. The study was conducted on elderly patients hospitalized for rehabilitation following stroke or hip fracture (HF) in the geriatric ward of a university hospital in southern Israel. The administration of the CDT and its scoring system were adapted from Sunderland et al . and Wolfe-Klein et al . The study was conducted on all 425 elderly patients who were hospitalized during the study period and who were capable of completing the test. Stepwise multiple regression was used to evaluate the association between the results of the CDT and the other variables. The mean CDT score (±SD) for the entire study population was 7.8±2.5 and 145 patients (34%) had scores of 6 or below. Of the 41 variables that were tested, significant associations with the CDT were found for the following four variables only: the Folstein minimental test (β=0.447, p <0.0001), the cognition value from the admission FIM (β=0.252, p <0.0001), years of education (β=0.183, p =0.0001), and the patient's age (β=-0.075, p =0.037). The total variance of the CDT explained by these four variables (Adjusted R [sup 2] ) was 0.554. We conclude that in the study population there was a significant proportion of patients with low CDT scores. This score, in this population, is influenced in particular by two other measures of cognitive function and by the formal level of education, together with a weaker effect of age. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

No abstract is available for this article. [ABSTRACT FROM AUTHOR]