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

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

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

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

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

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

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

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

Introduction: This study compared the Turkish version of Test Your Memory (TYM) MMSE (Mini-Mental State Examination) and CDT (Clock Drawing Test) in patients with neurocognitive disorder. Methods: After a thorough medical workup, patients with a diagnosis of neurocognitive disorder were enrolled. A cross-sectional design was used to compare the TYM results with those of MMSE and CDT. Results: This study was conducted on 100 patients, including 46 males and 54 females, aged 52 to 86. The majority of patients were diagnosed with vascular neurocognitive disorder. The z-score of TYM-TR was significantly lower in the domains of registration, recall, visuospatial, and total score. The same results were achieved when CDT was added to MMSE. The same pattern was observed separately for those who were diagnosed with a mild or major neurocognitive disorder. Conclusion: Patients’ cognitive deficits might be more evident when measured by the TYM-TR compared to the MMSE.

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

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

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

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

Aim Despite the widespread use of the clock-drawing test (CDT), normative data and information regarding the influence of sociodemographic factors on test performance by adult and elderly Israeli Arabs are lacking. The current study aimed to establish normative data for this population group by exploring the impact of sociodemographic factors such as age, education, and gender on CDT performance. In addition, this study examined the association between CDT performance and Mini-Mental State Examination (MMSE) scores. Methods The sample consisted of 295 community-dwelling healthy adult and elderly Israeli Arabs, aged 20-86 years, with a MMSE score ≥24. The MMSE and the CDT were administered to participants. Results Statistical analyses revealed that age had a negative effect on CDT performance, which was most pronounced in the 60-86 age group, but education and occupation (academic vs non-academic) had a positive effect. Gender and place of residence (urban vs rural) had no effect. CDT performance predicted the MMSE score. Conclusions The present study provides preliminary normative data on adult and elderly Israeli Arabs. The CDT appears to be applicable to Israeli Arabs, while the normative data might help interpret cognitive function results in this population.

Introduction Overlapping and evolving symptoms lead to ambiguity in the diagnosis of dementia. Visuospatial function relies on parietal lobe function, which may be affected in the early stages of Alzheimer's disease (AD). This review evaluates visuospatial dysfunction in patients with AD, frontotemporal dementia, dementia with Lewy bodies, and vascular dementia to determine the diagnostic and prognostic potential of visuospatial tasks in AD. Methods A systematic search of studies (1960–2016) investigating visuospatial dysfunction in dementia was conducted. Results Tests measuring construction, specifically Block Design and Clock Drawing Test, and visual memory, specifically Rey-Osterrieth Complex Figure recall and topographical tasks, show the greatest diagnostic potential in dementia. The Benton visual retention, Doors and People, and topographical memory tests show potential as prognostic markers. Discussion Tests of visuospatial function demonstrate significant diagnostic and prognostic potential in dementia. Further studies with larger samples of pathologically confirmed cases are required to verify clinical utility., Highlights • Memory deficits have been demonstrated in Alzheimer's and non-Alzheimer's dementias. • Parietal lobes are uniquely affected in the early stages of Alzheimer's disease. • Visuospatial tasks demonstrate significant diagnostic and prognostic potential. • Computerized test protocols have been developed to test aspects of visuospatial function and memory. • Novel topographical memory tasks demonstrated the greatest prognostic potential.

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.

Objective Mini-mental state examination, a nonspecific measure of global cognitive function, and the clock drawing test, a very concise and specific measure of cognitive function, are among the most widely used screening tests for cognitive dysfunction. The present research aimed to examine the correspondence between MMSE and CDT scores.Methods A total of 70 older adults (mean(SD) age=69.70(6.41) y) were selected by convenience sampling method from two local health centers from the same civil servant area in Mashhad City, Iran. They completed MMSE and CDT tests. Mann–Whitney U test and Spearman correlation were used for analyzing the data.Results Results showed a significant correlation between CDT and MMSE total score. Also the older adults’ performance on MMSE and CDT were significantly related to their level of education and gender, but not age.Conclusion The correlation between the MMSE and CDT test scores was high. Although one test cannot be replaced for the other, the CDT is a simple test that can be used for fast initial screening of cognitive performance among the elderly.

Objective: The Clock Drawing Test (CDT) is widely used as a cognitive screening tool. The purpose of this study was to investigate the influence of gender, age, and education on CDT scores ...

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.

The present study evaluated the metabolic syndrome (MetS) as independent predictor of 1-year longitudinal changes in cognitive function.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.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.MetS as an entity predicted accelerated 1-year decline in cognitive function, assessed by CDT, in a sample of older hypertensive subjects.

The Clock Drawing Test (CDT) is a brief cognitive screening tool for dementia. Several different presentation formats and scoring methods for the CDT are available in the literature.In this study we aimed to compare performance on the free-drawn and "incomplete-copy" versions of the CDT using the same short scoring method in Mild Cognitive Impairment (MCI) and dementia patients, and healthy elderly participants.90 participants (controlled for age, sex and education) subdivided into control group (n=20), MCI group (n=30) and dementia group (n=40) (Alzheimer's disease - AD=20; Vascular Dementia - VD=20) were recruited for this study. The participants performed the two CDT versions at different times and a blinded neuropsychologist scored the CDTs using the same scoring system.The scores on the free-drawn version were significantly lower than the incomplete-copy version for all groups. The dementia group had significantly lower scores on the incomplete-copy version of the CDT than the control group. MCI patients did not differ significantly from the dementia or control groups. Performance on the free-drawn copy differed significantly among all groups.The free-drawn CDT version is more cognitively demanding and sensitive for detecting mild/early cognitive impairment. Further evaluation of the diagnostic value (accuracy) of the free-drawn CDT in Brazilian MCI patients is needed.O Teste do Desenho do Relógio (TDR) é um instrumento breve de triagem cognitiva para demência. A literatura apresenta diferentes formas de aplicação deste instrumento, assim como diferentes métodos de escore.O objetivo deste estudo foi comparar a performance da versão desenho-livre do TDR com a versão cópia-incompleta, utilizando o mesmo método breve de escore, no Comprometimento Cognitivo Leve (CCL), em pacientes com demência e em participantes idosos saudáveis.foram recrutados para este estudo 90 participantes subdivididos em grupo controle (n=20), grupo CCL (n=30) e grupo demência (n=40) (Doença de Alzheimer - DA=20; Demência Vascular - DV=20), controlados para a idade, sexo e educação. Os participantes realizaram as duas versões do TDR em diferentes momentos e um neuropsicólogo cego para o estudo realizou o escore utilizando o mesmo método de escore.Os escores da versão desenho-livre foram significativamente inferiores que os da versão cópia-incompleta em todos os grupos. O grupo demência apresentou escores significativamente inferiores que o grupo controle na versão cópia-incompleta. Os participantes com CCL não diferiram dos com demência e do grupo controle. A versão desenho-livre foi significativamente diferente entre todos os grupos estudados.A versão desenho-livre do TDR é mais cognitivamente exigente e sensível para detectar prejuízo cognitivo leve ou precoce. São necessárias avaliações adicionais a respeito do valor diagnóstico (acurácia) do TDR versão desenho-livre, em pacientes Brasileiros com CCL.

[Purpose] This study examined the clinical usefulness of the clock drawing test applying Rasch analysis for predicting the level of cognitive impairment. [Subjects and Methods] A total of 187 stroke patients with cognitive impairment were enrolled in this study. The 187 patients were evaluated by the clock drawing test developed through Rasch analysis along with the mini-mental state examination of cognitive evaluation tool. An analysis of the variance was performed to examine the significance of the mini-mental state examination and the clock drawing test according to the general characteristics of the subjects. Receiver operating characteristic analysis was performed to determine the cutoff point for cognitive impairment and to calculate the sensitivity and specificity values. [Results] The results of comparison of the clock drawing test with the mini-mental state showed significant differences in according to gender, age, education, and affected side. A total CDT of 10.5, which was selected as the cutoff point to identify cognitive impairement, showed a sensitivity, specificity, Youden index, positive predictive, and negative predicive values of 86.4%, 91.5%, 0.8, 95%, and 88.2%. [Conclusion] The clock drawing test is believed to be useful in assessments and interventions based on its excellent ability to identify cognitive disorders.

OBJECTIVES: The aim of this study was to analyze the psychometric and diagnostic properties of the Clock Drawing Test (CDT), scored according to the Babins, Rouleau, and Cahn scoring systems, for Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD) screening, and develop corresponding cutoff scores. Additionally, we assessed the construct validity of the CDT through exploratory and confirmatory factor analysis. METHODS: We developed a cross-sectional study of ambulatory MCI and AD patients, divided in two clinical groups (450 MCI and 250 mild AD patients) and a normal control group (N = 400). All participants were assessed with the CDT, Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) for convergent validity. RESULTS: The selected scoring systems presented adequate validity and reliability values. The proposed cutoff scores showed 60 to 65% sensitivity and 58 to 62% specificity to identify MCI patients. The corresponding values for AD were 84 to 90% sensitivity and 76 to 78% specificity. Exploratory and confirmatory factor analysis revealed that the Babins scoring system had good construct validity and allowed us to propose a three-factor model for this system. CONCLUSIONS: Our results confirmed the complexity of the CDT and support it as a cognitive screening instrument particularly sensitive to AD. The use of the CDT with MCI patients should be interpreted with more caution due to the lower sensitivity and specificity for milder forms of cognitive impairment. info:eu-repo/semantics/publishedVersion

The Clock Drawing Test (CDT) is a frequently employed screening tool with different scoring systems. Quantitative and semi-quantitative scoring systems, such as Sunderland’s et al. (1989), do not discriminate different error patterns. Thus, the same score can represent a number of different neuropsychological profiles. Therefore, the use of a scoring method that emphasizes qualitative aspects to determine specific error patterns is fundamental. Objective: To use a qualitative scale to analyze error patterns in the CDTs of older adults who scored 5 in a previous study. Methods: 49 CDTs with score of 5 were analyzed using the qualitative scale. Linear regression and hierarchical and non-hierarchical cluster analyses were performed. Results: The linear regression showed a significant association between the total score and all the error patterns of the qualitative scale. The hierarchical cluster yielded three groups. However, due to the heterogeneity observed among the groups, a non-hierarchical cluster analysis was performed to better understand the results. Three groups were determined with different neuropsychological profiles and patterns of errors. Conclusion: The qualitative scoring of the CDT is important when examining and analyzing specific neuropsychological domains in older adults, especially executive functions. Resumo O Teste do Desenho do Relógio (TDR) está entre os instrumentos de rastreio mais utilizados e apresenta diversos métodos de correção e pontuação. Sistemas de pontuação quantitativos e semiquantitativos não discriminam diferentes padrões de erros, como é o caso do método de Sunderland et al. (1989). Dessa feita, uma mesma pontuação pode reunir diferentes perfis neuropsicológicos. Assim, o uso de métodos de correção com ênfase nos aspectos qualitativos, para verificar padrões mais específicos de erro, tornou-se fundamental. Objetivo: Analisar através de escala qualitativa os padrões de erros no TDR dos idosos cuja pontuação foi 5 em estudo anterior. Métodos: 49 TDR com pontuação 5 foram analisados pela escala qualitativa. Uma regressão linear e análises de cluster hierárquica e não-hierárquicas foram realizadas. Resultados: A regressão linear mostrou associação significativa entre o resultado total e todos os padrões de erro da escala qualitativa. O cluster hierárquico gerou três grupos. Entretanto devido a heterogeneidade observada entre os grupos, uma análise de cluster não hierárquico foi realizada para melhor entender os resultados. Três grupos foram formados com diferentes perfis neuropsicológicos e padrão de erros. Conclusão: A pontuação qualitativa do TDR é importante para examinar e analisar domínios neuropsicológicos específicos em idosos, principalmente funções executivas.

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

The Clock Drawing Test (CDT) is an important instrument for screening individuals suspected of having cognitive impairment.To determine the influence of education on the performance of healthy adults on the CDT.A total of 121 drawings by healthy adults without neurological complaints or impairments were analysed. Participants were stratified by educational level into 4 subgroups: 27 illiterate adults, 34 individuals with 1-4 years of formal education, 30 with 5-11 years, and 30 adults with11 years' formal education. Scores on the CDT were analyzed based on a scale of 1-10 points according to the criteria of Sunderland et al. (1989).¹ The Kruskal-Wallis test was applied to compare the different education groups. Tukey's multiple comparisons test was used when a significant factor was found.Although scores were higher with greater education, statistically significant differences on the CDT were found only between the illiterate and other educated groups.The CDT proved especially difficult for illiterate individuals, who had lower scores. These results suggest that this screening test is suitable for assessing mainly visuoconstructional praxis and providing an overall impression of cognitive function among individuals, independently of years of education.O Teste do Desenho do Relógio (TDR) é um instrumento importante para rastrear indivíduos com suspeita de alterações cognitivas.Verificar a influência da variável sociodemográfica escolaridade no desempenho de adultos saudáveis no TDR.Foram analisados os desenhos de 121 adultos saudáveis sem queixas e/ou alterações neurológicas, distribuídos em 4 subgrupos, a partir de quatro níveis de escolaridade: 27 adultos analfabetos, 34 adultos com 1-4 anos de estudo formal, 30 adultos com 5-11 anos de estudo formal, 30 adultos com11 anos de estudo formal. Os desenhos obtidos foram analisados segundo os critérios propostos por Sunderland et all (1989),¹ com uma escala que variou de 1 a 10 pontos. A comparação dos grupos segundo a escolaridade foi feita utilizando-se o teste de Kruskal-Wallis seguido do teste de comparações múltiplas de Tukey para verificar onde as diferenças se deram.Apesar dos escores terem aumentado conforme a escolaridade, foram observadas diferenças estatisticamente significantes apenas entre analfabetos e os demais grupos no TDR.O desempenho dos indivíduos melhorou de acordo com a escolaridade, porém o TDR não sofreu forte influência da escolaridade em sua aplicação, exceto para indivíduos analfabetos, que apresentaram escores diminuídos. Deste modo, acredita-se que o teste pode ser utilizado na avaliação da praxia visuo-construtiva em indivíduos independentemente dos anos de escolarização.

Research was conducted to identify a series of neuropsychological tests to assess the ability to drive. Driving performance of young and old UK drivers was modeled through multiple linear regression and univariate logistic regression tools. The UFOV3 test (i.e. the third subtest of the UFOV test) had comparatively high discriminating ability in separating poor-drivers from not-poor-drivers, with 92.86% of the drivers correctly classified; the UFOV3 test resulted in a Sensitivity of 62.5%. Age and a composite cognitive measure were also found to be sound discriminators of poor-drivers and not-poor-drivers with 91.07% and 89.28% of the drivers correctly classified respectively; both age and the composite cognitive measure resulted in a Sensitivity of 50%. It was found that the commonly recommended Clock Drawing Test and the Trail Making-B test were insignificant predictors of driving ability. Results suggest that for a score greater than 220 on the UFOV3 test, the driver may be further evaluated by a driving specialist to ascertain questionable driving behavior. Also, drivers above the age of 77 were more susceptible to exhibiting unusual driving behavior; if such drivers have UFOV3 scores greater than 220 it would be more appropriate to evaluate driving behavior through a driving specialist.

Background The Japanese version of the Rapid Dementia Screening Test (RDST-J) and the clock-drawing test (CDT) are both brief psychometric screening tools used to detect the severity of Alzheimer's disease. It remains unclear, however, which is more effective when screening for mild Alzheimer's disease. Methods We administered the RDST-J and CDT to 250 patients with very mild to severe Alzheimer's disease and to 49 healthy volunteers. Patients with a Mini-Mental State Examination score of 12–26 had Clinical Dementia Rating (CDR) scores from 0.5 to 3. Patients were divided into four groups according to CDR score. We performed one-way factorial anova between the four groups and control subjects based on the CDT and RDST-J scores. Results Data analysis revealed that RDST-J could distinguish patients with CDR 0.5 from the controls, but CDT could not. Furthermore, the sensitivity of a RDST-J score ≥8 was 57.1%, with a specificity of 81.0%, and the sensitivity of a RDST-J score ≥9 was 79.6%, with a specificity of 55.1% for discriminating CDR 0.5 from controls. Conclusions RDST-J is a more effective tool than CDT for distinguishing CDR 0.5 from controls.

Delirium is common neuropsychiatric condition among elderly inpatients. The clock drawing test (CDT) has been used widely as bedside screening tool in assessing cognitive impairment in elderly people. Previous studies which evaluate its usefulness in delirium reported conflicting results. The objective of this study was to evaluate the utility of CDT to detect delirium in elderly medical patients.Prospective, observational, longitudinal study. All acute medical admissions 70 years of age and above were approached within 72 hours of admission for recruitment. Patients eligible for inclusion were assessed four times, twice weekly during admission. Assessment included Confusion Assessment Method (CAM), Delirium Rating Scale (DRS-98R), Montreal Cognitive Assessment (MoCA), Acute Physiology and Chronic Health Evaluation II (APACHE) II, and CDT. Data was analysed using a linear mixed effect model.Three hundred and twenty-three assessments with the CDT were performed on 200 subjects (50% male, mean age 81.13; standard deviation: 6.45). The overall rate of delirium (CAM+) during hospitalisation was 23%. There was a significant negative correlation between the CDT and DRS-R98 scores (Pearson correlation r = -0.618, p0.001), CDT and CAM (Spearman's rho = -0.402, p0.001) and CDT and total MoCA score (Pearson's r = 0.767, p0.001). However, when the data were analysed longitudinally controlling for all the factors, we found that cognitive function and age were significant factors associated with CDT scores (p.0001): neither the presence nor the severity of delirium had an additional significant effect on the CDT.CDT score reflects cognitive impairment, independently of the presence or severity of delirium. The CDT is not a suitable test for delirium in hospitalised elderly patients.

OBJECTIVE: To evaluate apraxia in healthy elderly and in patients diagnosed with Alzheimer's disease (AD) and Mild cognitive impairment (MCI). METHODS: We evaluated 136 subjects with an average age of 75.74 years (minimum 60 years old, maximum 92 years old) and average schooling of 9 years (minimum of 7 and a maximum of 12 years), using the Mini-Mental State examination (MMSE), Cambridge Cognitive Examination (CAMCOG) and the Clock Drawing Test. For the analysis of the presence of apraxia, eight subitems from the CAMCOG were selected: the drawings of the pentagon, spiral, house, clock; and the tasks of putting a piece of paper in an envelope; the correct one hand waiving "Goodbye" movements; paper cutting using scissors; and brushing teeth. RESULTS: Elder controls had an average score of 11.51, compared to MCI (11.13), and AD patients, whose average apraxia test scores were the lowest (10.23). Apraxia scores proved able to differentiate the three groups studied (p=0.001). In addition, a negative correlation was observed between apraxia and MMSE scores. CONCLUSION: We conclude that testing for the presence of apraxia is important in the evaluation of patients with cognitive impairments and may help to differentiate elderly controls, MCI and AD. OBJETIVO: Avaliar apraxia em idosos saudáveis, com diagnóstico de doença de Alzheimer (DA) e Comprometimento Cognitivo Leve (CCL). MÉTODOS: Foram avaliados 136 indivíduos com uma idade média de 75,74 anos (mínimo de 60 anos de idade, máximo 92 anos) e escolaridade média de 9 anos (mínimo de 7 e máximo de 12 anos), por meio do Mini-exame do Estado Mental (MEEM), Cambridge Cognitive Examination (CAMCOG) e o teste do relógio. Para analisar a presença de apraxia, foram selecionados oito subitens do CAMCOG: os desenhos do Pentágono, da espiral, da casa, do relógio, e também a tarefa de colocar um pedaço de papel em um envelope e os movimentos corretos com uma mão para dar "adeus", cortar papel com uma tesoura e escovar os dentes. RESULTADOS: Idosos saudáveis sem alterações cognitivas apresentaram média de 11,51, em comparação com CCL (11,13), e DA o qual apresentou pior média no teste de apraxia (10.23). O subteste de apraxia diferenciou os três grupos diagnósticos (p=0,001). Observou-se uma correlação negativa entre os escores de apraxia e os do MEEM. CONCLUSÃO: Conclui-se que a investigação da presença de apraxia é importante na avaliação cognitiva de pacientes com comprometimento cognitivo e pode ser útil em diferenciar controles idosos, indivíduos com CCL e com DA.

The Clock Drawing Test (CDT) is a simple neuropsychological screening instrument that is well accepted by patients and has solid psychometric properties. Several different CDT scoring methods have been developed, but no consensus has been reached regarding which scoring method is the most accurate. This article reviews the literature on these scoring systems and the changes they have undergone over the years. Historically, different types of scoring systems emerged. Initially, the focus was on screening for dementia, and the methods were both quantitative and semi-quantitative. Later, the need for an early diagnosis called for a scoring system that can detect subtle errors, especially those related to executive function. Therefore, qualitative analyses began to be used for both differential and early diagnoses of dementia. A widely used qualitative method was proposed by Rouleau et al. (1992). Tracing the historical path of these scoring methods is important for developing additional scoring systems and furthering dementia prevention research.O Teste do Desenho do Relógio (TDR) é um instrumento de rastreio neuropsicológico simples bem aceito pelos pacientes e com sólidas propriedades psicométricas. Em meio aos métodos de pontuação, não existe consenso com relação aos que tenham maior acurácia. Esse artigo tem como objetivo realizar uma revisão histórica sobre os sistemas de pontuação mais utilizados e as mudanças ocorridas com os mesmos ao longo dos anos. No decorrer do caminho histórico, diferentes tipos de sistemas de pontuação surgiram. Inicialmente, o foco era no rastreio de demência e os métodos utilizados eram quantitativos e semi-quantitativos. Contudo, em um segundo momento, a necessidade de diagnóstico precoce demandou o uso de um sistema de pontuação que pudesse especificar erros sutis especialmente aqueles relacionados a funções executivas. Assim, análise qualitativa começou a ser mais usada em ambos no diagnóstico diferencial e precoce de demência. Um método qualitativo amplamente utilizado é o de Rouleau et al. (1992). O caminho histórico é importante para o desenvolvimento dos sistemas de pontuação e também para as pesquisas de prevenção de demência.

Aim The aim of this study was to evaluate the accuracy of the clock drawing test and to compare its scoring methods. Background Dementia refers to a symptom where an adult demonstrates memory disorder and cognitive impairment. Early diagnosis of dementia is very important for medication management and prognosis. The clock drawing test is one of the most used cognitive screening tools for dementia. However, due to its scoring system, the accuracy of the clock drawing test remains a topic of debate. Design A systematic review with meta-analysis following Cochrane's methods and the guidelines of the Agency for Healthcare Research and Quality. Data sources A literature search was carried out in the OVID-MEDLINE, OVID-EMBASE and OVID-PsycINFO databases (27 October 2015). Review method The quality assessment of diagnostic accuracy studies (QUADAS-2) tool was employed for this review. We used hierarchical regression models to pool the values of diagnostic accuracy in a random effects model. Results A total of 18 studies with 5,531 participants were identified for this review. Fifteen of these studies were included for meta-analysis according to each scoring system. The pooled sensitivity and specificity of the clock drawing test using the Shulman system were 82% and 75.7% respectively. In the Sunderland system, these were 72.6% and 87.9% respectively. Conclusions The findings indicate that the accuracy of the clock drawing test using the Shulman system was the most studied and highly sensitive. After gaining a better understanding of the clock drawing test through this study, we recommend it for widespread use in the diagnosis of dementia.

The purpose of this study was to develop and evaluate a brief cognitive screen for possible Mild Cognitive Impairment (MCI) and other neurocognitive impairment in a sample of general medical patients. Two hundred community-dwelling general medical patients aged 65 or older participated in this study. Age and education corrected scores from the Rey Auditory Verbal Learning Test and Mattis Dementia Rating Scale were used to classify participants into three groups: MCI, neurocognitive disorder, cognitively intact. Groups were then compared on an independent set of measures: the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery, Mini-Mental State Examination, and Clock Drawing Test. The MCI group constituted 9% of the sample, while 10.5% of the sample was classified into the neurocognitive disorder group. The CERAD Verbal Category Fluency and CERAD Word List Memory Test Delayed Recall measures were individually and collectively the most effective in differentiating cognitively intact elders from persons in both the MCI and neurocognitive disorder groups. We conclude that these two brief measures appear to be effective for detecting possible MCI or neurocognitive disorder, thereby facilitating identification of candidates who would benefit from more detailed neuropsychological assessment.

Bu çalışmanın amacı şizofreni hastaları ile sağlıklı kontrol grubunun saat çizimtesti performanslarını karşılaştırmaktır. 50 şizofreni hastası - cinsiyet – eşleştirilmişsağlıklı kontrol ile karşılaştırıldı. Saat Çizim Testi ve Mini Mental Test (MMT) tümkatılımcılara uygulandı. Şizofreni hastalarının semptom şiddeti Pozitif ve NegatifSendrom Ölçeği (PANSS) ve Kısa Psikiyatrik Değerlendirme Ölçeği (BPRS) iledeğerlendirildi. Şizofreni hastaların, kontrol grubuna göre saat çizim testiperformansının istatistiksel olarak anlamlı düşük skorlara sahip olduğu tespit edildi.MMT skorları ve eğitim seviyesi ortak değişken olarak alındığında da, iki gruparasındaki farkın önemli derecede olduğu tespit edildi. Niteleyici saat analizindeşizofreni grubu frontal (ön) süreçlere ilişkin belirli hatalar çizdi: numaraları doğru yereyerleştirmede güçlük, dakika hedeflerini belirtmede başarısızlık, yelkovanı dakikanumaralarından kaydırmak (yelkovanla sayıyı eşleştirememek gibi) ve yelkovançizimde başarısızlık gibi. Hastaların genel psikopatoloji testinden aldıkları puanla saatçizme testi performansları arasında anlamlı ve ters yönde ilişki bulundu. Sonuç olarak;saat çizim testinin şizofrenide kognitif bozukluğun doğasını tespit etmek için yeterincehassas olduğu ve bu testteki performans düşüklüğünün genel hastalık şiddeti ile orantılıolduğu tespit edildi. Bu sonuçlar saat çizme testinin şizofrenide bilişsel durumunudeğerlendirirken kullanılabilecek pratik ve yararlı bir test olduğunu düşündürmektedir. The aim of this study is to compare the performance of the time-drawing test ofschizophrenia patients with the healthy control group. 50 schizophrenic patients -compared with sex-matched healthy controls. The clock drawing test and Mini MentalTest (MMT) were applied to all participants. Symptom severity of schizophreniapatients was assessed by Positive and Negative Syndrome Scale (PANSS) and BriefPsychiatric Rating Scale (BPRS). The schizophrenia patients were found to havestatistically significant lower scores on the performance of the clock drawing test thanthe control group. When the MMT scores and education level were taken as a covariate,the difference between the two groups was found to be significant. In the qualitativeclock analysis, the schizophrenia group made certain mistakes about the frontalprocesses: difficulty in positioning numbers correctly, failing to specify minute targets,shifting the minute hand from minute numbers (such as not counting with the minutehand and numbering) and failing in minute hand drawing. There was a significant andinverse correlation between the scores of the patients psychopathology test and thescores of the scratch test. As a result; Hour drawing test was sufficiently sensitive todetect the nature of schizophrenia cognitive impairment and that the performanceimpairment in this test was proportional to the overall disease severity. These resultssuggest that the time-lapse test is a practical and useful test that can be used to assessthe cognitive status of schizophrenia. 88

Objectives: The clock drawing test (CDT) is one of the worldwide most used screening tests for Alzheimer’s disease (AD). MRI studies have identified temporo-parietal regions being involved in CDT impairment. However, the contributions of specific hippocampal subfields and adjacent extrahippocampal structures to CDT performance in AD and mild cognitive impairment (MCI) have not been investigated so far. It is unclear whether morphological alterations or CDT score, or a combination of both, are able to predict AD. Methods: 38 AD patients, 38 MCI individuals and 31 healthy controls underwent neuropsychological assessment and MRI at 3 Tesla. FreeSurfer 5.3 was used to perform hippocampal parcellation. We used a collection of statistical methods to better understand the relationship between CDT and hippocampal formation. We also tested the clinical feasibility of this relationship when predicting AD. Results: Impaired CDT performance in AD was associated with widespread atrophy of the cornu ammonis, presubiculum, and subiculum, whereas MCI subjects showed CDT-related alterations of the CA4-dentate gyrus and subiculum. CDT correlates in AD and MCI showed regional and quantitative overlap. Importantly, CDT score was the best predictor of AD. Conclusions: Our findings lend support for an involvement of different hippocampal subfields in impaired CDT performance in AD and MCI. CDT seems to be more efficient than subfield imaging for predicting AD.

Clinicians often wonder if the single sentence from the Folstein Mini-Mental Status Exam (MMSE) offers meaningful information about the patient. We compared single sentences derived from the MMSE generated by 3 groups of participants — hospitalized medically-ill patients with psychiatric comorbidity, hospitalized medically-ill patients without psychiatric comorbidity, and non-hospitalized non-psychiatric participants. These sentences were analyzed for themes using manual thematic coding and a semi-automatic computerized method, the Meaning Extraction Method (MEM). We found that thematic content obtained from as little as a single sentence could differentiate between participant groups using both methods. Specifically, psychiatric patients used more power themes, focused on states other than the present, and were less interpersonally engaged than the other groups. Thematic content also indicated cognitive status through scores on the Clock Drawing Test (CDT) and MMSE. Our findings suggest that a single sentence can provide meaningful information about patients with medical and psychiatric comorbidity.