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Amaç: Saat çizme testi (SÇT) kognitif fonksiyonları değerlendirmede kullanılan kısa, pratik ve güvenli bir testtir. Biz SÇT ile 25-hidroksivitamin D seviyesinin güneşe maruziyet ve yürüme süresi için prediktif olup olmadığını ve SÇT’nin düşük eğitim düzeyli (DE) yaşlılarda güvenilir olup olmadığını araştırmayı amaçladık.Materyal ve Metod: İç hastalıkları kliniğine başvuran 65 yaş üzeri demansı olmayan 185 DE hasta bu çalışmaya dahil edildi. Hastaların demografik verileri, güneş maruziyetleri, yürüme süreleri, koroner kalp hastalığı (KKH) öyküsü ve düşme sayısı kaydedildi. SÇT, Manos skorlama sistemi kullanılarak ölçüldü. Bulgular: Çalışma populasyonu yaş ortalaması 73 ± 6 yıl olan 127 (%68.6) erkek ve yaş ortalaması 70 ± 5 yıl olan 58 (%31.4) kadın hastayı içeriyordu. Manos skorlama sistemine göre, 90 (%48.6) kişinin CDT skoru 0, 70 (%37.9) kişinin CDT skoru 1-9 arası ve 25 (%13.5) kişinin CDT skoru 10 idi. Hastaların ortalama D vitamin düzeyi 18.4 ± 7.3 ng/mL idi. D vitamin seviyesi ve SÇT skorları güneş maruziyeti, yürüme süresi ve düşme sayısı ve KKH için tahmin edici değerdeydi.Sonuç: DE kişilerin SÇT skorları bilinç fonksiyonlarını göstermede güvenilir değildir. Bu çalışma gösterdi ki DE bireylerde D vitamin seviyeleri güneş maruziyeti, yürüme süresi, düşme sayısı ve KKH sıklığını göstermede SÇT skorundan daha güçlüdür.

Purpose: We aimed to investigate whether CDT and 25-hydroxyvitamin D (25OHD) level are predictors for sun exposure and walking duration, and aimed to investigate whether CDT is reliable in low educated (LE) elderly. Material and Methods: A total of 185 LE patients without dementia above the age of 65 who had applied to internal medicine clinic were included in the study. The patients' demographic data, sun exposure, walking duration, a history of coronary artery disease (CAD) and the number of falls were recorded. Clock drawing was measured using Manos scoring system. Results: The study population included 127 (68.6%) males with a mean age of 73 +/- 6 years and 58 (31.4%) females with a mean age of 70 +/- 5 years. According to Manos scoring system a total of 90 (48.6%) subjects had a CDT score of 0, 70 (37.9%) subjects had a CDT score of 1-9 and 25 (13.5%) subjects had a CDT score of 10. The mean vitamin D level of the patients was 18.4 +/- 7.3 ng/mL. Vitamin D levels and CDT scores were predictive for sun exposure, duration of walking, number of falls and CAD. Conclusion: CDT scores of LE subjects were unreliable to demonstrate cognitive functions. This study has shown that vitamin D levels to be more potent predictor than CDT scores to demonstrate sun exposure, walking duration, numbers of falls and the incidence of CAD in LE subjects. [Cukurova Med J 2015; 40(1.000): 6-17]

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. [ABSTRACT FROM AUTHOR]

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

The Gaussian sampler is an integral part in lattice-based cryptography as it has a direct connection to security and efficiency. Although it is theoretically secure to use the Gaussian sampler, the security of its implementation is an open issue. Therefore, researchers have started to investigate the security of the Gaussian sampler against side-channel attacks. Since the performance of the Gaussian sampler directly affects the performance of the overall cryptosystem, countermeasures considering only timing attacks are applied in the literature. In this paper, we propose the first single trace power analysis attack on a constant-time cumulative distribution table (CDT) sampler used in lattice-based cryptosystems. From our analysis, we were able to recover every sampled value in the key generation stage, so that the secret key is recovered by the Gaussian elimination. By applying our attack to the candidates submitted to the National Institute of Standards and Technology (NIST), we were able to recover over 99% of the secret keys. Additionally, we propose a countermeasure based on a look-up table. To validate the efficiency of our countermeasure, we implemented it in Lizard and measure its performance. We demonstrated that the proposed countermeasure does not degrade the performance. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Our aim was to assess cognitive dysfunction, which is common in hemodialysis patients and difficult to diagnose, by an easily applicable test, the Mini Mental State Examination and Clock Drawing Test. MATERIAL and METHODS: Two hundred and sixty six (266, 88.37%) dialysis patients that were followed-up at the Nephrology Clinic of Bursa Specialty Training and Research Hospital and private dialysis centers, and 35 (11.63%) healthy control individuals were involved in our study. Mini Mental State Examination and Clock Drawing Test were applied by a neurologist to the subjects. MMSE and CDT scores of the patients were compared with the control group. RESULTS: Patient and control groups were similar in terms of age, gender, diabetes, and smoking. The rate of hypertension was significantly higher in the dialysis group. Mini Mental State Examination and Clock Drawing Test success rates were significantly higher in the control group. Orientation, attention and language modalities evaluated in the MMSE were observed to be significantly lower in the hemodialysis group. A statistically significant inverse correlation was found between registration memory and recall scores in MMSE, and urea. CONCLUSION: Cognitive performances of hemodialysis patients must be monitored closely. The relationship between record memory and recall scores and urea suggests that uremic toxins may affect memory functions negatively. In addition, cognitive performance can be monitored by Clock Drawing Test in these patients. [ABSTRACT FROM AUTHOR]

Aims: To determine whether the pentagon copying test (PCT) and the clock drawing test (CDT) are associated with nursing home admission or survival in dementia with Lewy bodies (DLB). Methods: The PCT and/or the CDT were retrospectively collected from 103 clinically diagnosed probable DLB patients at a university medical center and general hospital. Patients with high versus low scores on these tests were compared. Results: Kaplan-Meier analysis showed that patients with a low score on the PCT had a shorter time to nursing home admission than patients with a high score (log-rank χ2 = 6.1, p = 0.01). Patients with a low score on the PCT or the CDT had a shorter survival than patients with a high score (log-rank χ2 = 5.4, p = 0.02, and log-rank χ2 = 11.2, p < 0.001, respectively). Cox regression analyses showed the same associations with an HR of 2.2 (95% CI 1.2–4.1) for the PCT and an HR of 2.9 (95% CI 1.6–5.4) for the CDT. Conclusion: The PCT and the CDT may function as prognostic markers in DLB. This finding is clinically relevant as these tests can be applied easily in the clinical setting and can provide valuable prognostic information. Furthermore, it may improve disease management and patient selection for research purposes. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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

Objectives: Patients with Alzheimer’s disease (AD) demonstrate deficits in cross-cortical feature binding distinct from age-related changes in selective attention. This may have consequences for driving performance given its demands on multisensory integration. We examined the relationship of visuospatial search and binding to driving in patients with early AD and elderly controls (EC). Methods: Participants (42 AD; 37 EC) completed search tasks requiring either luminance-motion (L-M) or color-motion (C-M) binding, analogs of within and across visual processing stream binding, respectively. Standardized road test (RIRT) and naturalistic driving data (CDAS) were collected alongside clinical screening measures. Results: Patients performed worse than controls on most cognitive and driving indices. Visual search and clinical measures were differentially related to driving behavior across groups. L-M search and Trail Making Test (TMT-B) were associated with RIRT performance in controls, while C-M binding, TMT-B errors, and Clock Drawing correlated with CDAS performance in patients. After controlling for demographic and clinical predictors, L-M reaction time significantly predicted RIRT performance in controls. In patients, C-M binding made significant contributions to CDAS above and beyond demographic and clinical predictors. RIRT and C-M binding measures accounted for 51% of variance in CDAS performance in patients. Conclusions: Whereas selective attention is associated with driving behavior in EC, cross-cortical binding appears most sensitive to driving in AD. This latter relationship may emerge only in naturalistic settings, which better reflect patients’ driving behavior. Visual integration may offer distinct insights into driving behavior, and thus has important implications for assessing driving competency in early AD. (JINS, 2018, 24, 486–497) [ABSTRACT FROM AUTHOR]

The Clock Drawing Test (CDT) has a known potential for the detection of cognitive impairment in populations with dementia, especially Alzheimer disease (AD). Our aim was to compare the clinical utility of 3 CDT scoring systems (Rouleau, Cahn, and Babins) in several pathologies with cognitive compromise from a tertiary center memory clinic. We selected patients with a clinical diagnosis of mild stage AD, behavioral variant frontotemporal dementia (FTD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and Parkinson disease with dementia (PDD). The results showed significant differences between the several diagnoses with the following pattern of results: AD, DLB < FTD, VaD, PDD. Qualitative analysis of clock drawing errors confirmed the stimulus-bound response as a hallmark of AD, while conceptual deficit was significantly more prevalent in patients with AD and DLB. Our results supported the CDT potential as a cognitive screening measure for mild dementia, particularly sensitive to AD and DLB, especially when we used the Cahn scoring system and its analysis of qualitative errors. [ABSTRACT FROM AUTHOR]

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

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

Objective: To establish a preliminary thermal and mechanical somatosensory profile using a standardized quantitative sensory testing (QST) to investigate site, gender and age differences in healthy Chinese.Materials and Methods: Twenty younger (age: 20-40 years, 10 men, 10 women) and twenty older (age: 41-61 years, 10 men, 10 women) healthy participants completed the study. Cold detection threshold (CDT), warm detection threshold (WDT), cold pain threshold (CPT), heat pain threshold (HPT), mechanical detection threshold (MDT) and mechanical pain threshold (MPT) were measured at five sites: Left hand, bilaterally at the mental area, tip of tongue and the lower lip mucosa. Mixed model ANOVAs with repeated measures were used to analyze the data.Results: MDT(p < .001) and MPT (p < .05) were significantly higher on the hand compared to the mental areas. The CDT ( p = .006) was significantly higher and WDT (p < .001) was significantly lower at the tongue compared to lip mucosa and CDT (p < .001) was higher at the tongue mucosa than at the mental areas. WDT (p < .001) and HPT (p < .05) were significantly higher at the tip of the tongue and the lower lip mucosa compared to the mental areas. Significantly lower sensitivity for WDT (p < .001) and CDT (p = .004) were found in the older group compared to the younger group. Significant gender differences were found with less sensitivity for WDT (p = .024) and MDT (p = .003) in men compared to women.Conclusions: Application of standardized QST can provide valuable information of orofacial somatosensory phenotypes in a Chinese population. Age, gender and site are mandatory to control for. [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]

The present work addresses the identification and qualitative assessment of errors that appear in a free-drawn clock-drawing test representing the time 8:20 in a sample of 455 children and adolescents with neurological diseases and their controls. The authors sought to verify whether the occurrence of particular errors in the clock drawings significantly differentiates the clinical groups. For statistical evaluation of the results, we applied correspondence analysis and cluster analysis. The results of the study showed that three types of errors played an important role in the differentiation of the groups: spatial neglect, mirror reflection, and phonological depletion. [ABSTRACT FROM AUTHOR]

There is a growing incidence of dementia patients in the community, and with this growth, there is need for rapid, valid, and easily administrable tests for the screening of dementia and mild cognitive impairment in the community. This review looks at the two most commonly used tests in dementia screening, namely, the clock drawing test (CDT) and the mini-mental status examination (MMSE). Both these tests have been used in dementia screening over the past three decades and have been the subject of scrutiny of various studies, reviews, and meta-analysis. Both these tests are analyzed on their ability to assess dementia and screen for it in the community, general practice and general hospital settings. The methods of administration and scoring of each test are discussed, and their advantages and disadvantages are explained. There is also a direct comparison made between the MMSE and CDT in dementia screening. Future research needs with these tests are also elucidated. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system in which primary symptoms emerges in adults between the ages of 20 and 40 years. The prevalence of cognitive impairments in patients with MS is 45-65%, depending on the sensitivity and accuracy of neuropsychological measures. During recent past years, dominant approach to screening of cognitive impairments in patients with MS was to develop brief neuropsychological test collections. In this study, Clock Drawing Test was used for screening of cognitive impairments in patients with relapsing-remitting MS. Methods: In this case-control research done in Isfahan MS association, Iran, 49 women with relapsing-remitting MS and 43 age-, education- and intelligence quotient (IQ)-matched women without MS were selected by purposeful sampling. Both groups were tested using Clock Drawing Test. Findings: The multivariate variance analysis (MANOVA) test indicated meaningful difference between patients and controls in both clock (1:45) free-drawn task and clock (3:00) simple copying task (P < 0.001). In addition, patients had shown more errors in clock drawing, placing numbers and handles, and in showing the asked time. The test had 92% of sensitivity and 89% of specificity. Conclusion: According to the study results, patients with MS have more error in clock drawing which probably is because of clock drawing sensitivity in cognitive impairment screening. Thus, it can be used to screen cognitive impairments in patients with MS.

Decline in visuo-spatial skills and memory failures are considered symptoms of Alzheimer’s Disease (AD) and they can be assessed at early stages employing clinical tests. However, performance in a single test is generally not indicative of AD. Functional neuroimaging, such as functional Near Infrared Spectroscopy (fNIRS), may be employed during these tests in an ecological setting to support diagnosis. Indeed, neuroimaging should not alter clinical practice allowing free doctor-patient interaction. However, block-designed paradigms, necessary for standard functional neuroimaging analysis, require tests adaptation. Novel signal analysis procedures (e.g., signal complexity evaluation) may be useful to establish brain signals differences without altering experimental conditions. In this study, we estimated fNIRS complexity (through Sample Entropy metric) in frontal cortex of early AD and controls during three tests that assess visuo-spatial and short-term-memory abilities (Clock Drawing Test, Digit Span Test, Corsi Block Tapping Test). A channel-based analysis of fNIRS complexity during the tests revealed AD-induced changes. Importantly, a multivariate analysis of fNIRS complexity provided good specificity and sensitivity to AD. This outcome was compared to cognitive tests performances that were predictive of AD in only one test. Our results demonstrated the capabilities of fNIRS and complexity metric to support early AD diagnosis.

The Clock Drawing Test (CDT) is a commonly used tool in clinical practice and research for cognitive screening among older adults. The main goal of the present study was to analyze the interrater reliability of three different CDT scoring systems (by Shulman et al., Babins et al., and Cohen et al.). We used a clock with a predrawn circle. The CDT was evaluated by three independent raters based on the normative data set of healthy older and very old adults and patients with nonamnestic mild cognitive impairment (naMCI; N = 438; aged 61-94). We confirmed a high interrater reliability measured by the intraclass correlation coefficients (ICCs): Shulman ICC = .809, Babins ICC = .894, and Cohen ICC = .862, all p < .001. We found that age and education levels have a significant effect on CDT performance, yet there was no influence of gender. Finally, the scoring systems differentiated between naMCI and age- and education-matched controls: Shulman’s area under the receiver operating characteristic curve (AUC) = .84, Cohen AUC = .71, all p < .001; and a slightly lower discriminative ability was shown by Babins: AUC = .65, p = .012. [ABSTRACT FROM AUTHOR]

Purpose: Only a few studies have analyzed the potential link between glaucoma and cognitive function impairment. They have found controversial results. This study aims to perform quick cognitive function assessment with clock drawing test (CDT) using two different scoring systems and compare between normal tension glaucoma (NTG) and cataract patients.Methods: Totally, 30 NTG and 30 patients with cataracts were included in a prospective, pilot study. The predrawn circle was given, and patients were asked to draw the clock showing a time of 11:10. The test was evaluated using two methods - Freund method using a 7-point scoring scale (optimal cutoff ≤4) and Rakusa using a 4-point scoring scale (optimal cutoff ≤3). The level of significance was set at P < 0.05.Results: CDT result was significantly better in cataract group than in NTG group: 3.5 (2) versus 2 (2) by Freund, (P = 0.003) and 6.5 (1) versus 4.5 (2.75) by Rakusa, respectively (P = 0.004). Sixty percent (n = 18) of NTG group and 10% (n = 3) of cataract group patients completed the CDT in the specific picture manner (the short hand on 11 and the long hand between 11 and 12), (P = 0.001).Conclusions: Lower CDT results were seen in NTG patients according to two different scoring systems. NTG patients showed a specific manner of drawing. Further prospective studies are needed to investigate the CDT reliability as fast screening test of cognitive function impairment in glaucoma patients. [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]

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

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

The conventional Clock Drawing Test (cCDT) is a rapid and inexpensive screening tool for detection of moderate and severe dementia. However, its usage is limited due to poor diagnostic accuracy especially in patients with mild cognitive impairment (MCI). The diagnostic value of a newly developed digital Clock Drawing Test (dCDT) was evaluated and compared with the cCDT in 20 patients with early dementia due to AD (eDAT), 30 patients with amnestic MCI (aMCI) and 20 cognitively healthy controls (HCs). Parameters assessed by dCDT were time while transitioning the stylus from one stroke to the next above the surface (i.e., time-in-air), time the stylus produced a visible stroke (i.e., time-on-surface) and total-time during clock drawing. Receiver-operating characteristic (ROC) curves were calculated and logistic regression analyses have been conducted for statistical analysis. Using dCDT, time-in-air was significantly increased in eDAT (70965.8 ms) compared to aMCI (54073.7 ms; p = 0.027) and HC (32315.6 ms; p < 0.001). In addition, time-in-air was significantly longer in patients with aMCI compared to HC (p = 0.003), even in the aMCI group with normal cCDT score (54141.8 ms; p < 0.001). Time-in-air using dCDT allowed discrimination of patients with aMCI from HCs with a sensitivity of 81.3% and a specificity of 72.2% while cCDT scoring revealed a sensitivity of 62.5% and a specificity of 83.3%. Most interestingly, time-in-air allowed even discrimination of aMCI patients with normal cCDT scores (80% from all aMCI patients) from HCs with a clinically relevant sensitivity of 80.8% and a specificity of 77.8%. A combination of dCDT variables and cCDT scores did not improve the discrimination of patients with aMCI from HC. In conclusion, assessment of time-inair using dCDT yielded a higher diagnostic accuracy for discrimination of aMCI patients from HCs than the use of cCDT even in those aMCI patients with normal cCDT scores. Modern digitizing devices offer the opportunity to measure subtle changes of visuoconstructive demands and executive functions that may be used as a fast and easy to perform screening instrument for the early detection of cognitive impairment in primary care. [ABSTRACT FROM AUTHOR]

Assessing the regulation of Clostridium difficile transferase (CDT), is complicated by the presence of a Pathogenicity locus (PaLoc) which encodes Toxins A and B. Here we developed R20291ΔPaLoc model strains and cell-based assays to quantify CDT-mediated virulence. Their application demonstrated that the transcriptional regulator, CdtR, was required for CDT-mediated cytotoxicity. [ABSTRACT FROM AUTHOR]

The objective of this research was to determine the perception of neuropsychologists to the problem of having no normative data for neuropsychological screening tests. An exploratory qualitative design was implemented. Two methods of data collection were used:1) technique semi-structured interview and in-depth analysis of an article on the aspects culturares Neuropsychology: An interview on the "Perception of neuropsychologists on measures of screening MoCa, Drawing and Clock Tests Verbal Fluency nonstandard" The second method of data collection was analysis of the article "Increasing Culturally competent Neuropsychological Services fore Ethnic Minority Populations: A Call to action ". In both methods of data collection, it was found that cultural diversity should be taken into consideration when working with tests neuropsychological screening to ensure that the results of each of these is reliable the. Factors such as language, culture, among others, could affect the outcome thereof. [ABSTRACT FROM AUTHOR]

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

Background: Decline in olfaction may occur after general anesthesia, but the exact incidence and underlying physiopathology remain scarcely investigated. Olfactory dysfunction arises with aging and is known to be linked to cognitive impairment. In this pilot study, we evaluated the incidence of immediate postoperative decline in olfaction and its association with a preoperative cognitive test, performance at Clock Drawing Test (CDT), in a group of older patients., Methods: This pilot study is a sub-analysis of a prospective observational study. Patients ≥ 65 years old and scheduled for elective non-cardiac surgery under sevoflurane-based anesthesia were enrolled. CDT was part of the preoperative evaluation. We assessed olfaction on the day before and the day after surgery (between 16 and 26 h postoperatively) using the Sniffin' Sticks 12-item identification test, which consists of pen-like devices displaying 12 different odors. Postoperative decline in olfaction was defined as a decrease of at least 1 standard deviation in the olfactory score., Results: We included a total of 93 patients, among whom 19 (20.4%) presented a postoperative decline in olfaction. The incidence of postoperative decline in olfaction was higher in the "CDT low-score" (score ≤ 5/8) group (11/34, 32.4%) than in the "CDT high-score" (score ≥ 6/8) group (8/58, 13.6%) (P = 0.030). Despite adjusting for confounding variables, CDT score remained independently associated with immediate postoperative decline in olfactory identification function (OR 0.67, 95% CI 0.48 to 0.94, P = 0.022)., Conclusions: Postoperative decline in olfaction occurred in 20.4% of older patients and was associated with poor preoperative performance at CDT., Trial Registration: This study was retrospectively registered on https://clinicaltrials.gov/ under the NCT04700891 number (principal investigator: Victoria Van Regemorter), in December 2020., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Alzheimer's disease is an incurable disorder that accounts for up to 70% of all dementia cases. While the prevalence of Alzheimer's disease and other types of dementia has increased by more than 160% in the last 30 years, the rates of undetected cases remain critically high. The present work aims to address the underdetection of Alzheimer's disease by proposing four logistic regression models that can be used as a foundation for community-based screening tools that do not require the participation of medical professionals. Our models make use of individual clock drawing errors as well as complementary patient data that is highly available and easily collectible. All models were controlled for age, education, and gender. The discriminative ability of the models was evaluated by area under the receiver operating characteristic curve (AUC), the Hosmer-Lemeshow test, and calibration plots were used to assess calibration. Finally, decision curve analysis was used to quantify clinical utility. We found that among 10 possible CDT errors, only 3 were informative for the detection of Alzheimer's disease. Our base regression model, containing only control variables and clock drawing errors, produced an AUC of 0.825. The other three models were built as extensions of the base model with the step-wise addition of three groups of complementary data, namely cognitive features (semantic fluency score), genetic predisposition (family history of dementia), and cardio-vascular features (BMI, blood pressure). The addition of verbal fluency scores significantly improved the AUC compared to the base model (0.91 AUC). However, further additions did not make a notable difference in discriminatory power. All models showed good calibration. In terms of clinical utility, the derived models scored similarly and greatly outperformed the base model. Our results suggest that the combination of clock symmetry and clock time errors plus verbal fluency scores may be a suitable candidate for developing accessible screening tools for Alzheimer's disease. However, future work should validate our findings in larger and more diverse datasets.

Background: Neurotropism of the hepatitis C virus (HCV) can be the source of subtle neuropsychological symptoms in non-cirrhotic patients. Age is a risk factor for cognitive impairment (CI). Thus, asymptomatic elderly people who carry HCV might be at a greater risk of CI. Education can influence test performance., Objectives: (1) To verify whether elderly people with HCV performed poorer than controls on cognitive tests. (2) To analyze how education affects performance. (3) To verify whether the extent of the effect of education on performance depends on the group (HCV vs. controls) and the type of cognitive test., Methods: Asymptomatic HCV carriers older than 60 years ( n = 41) were matched with 41 corresponding controls. All participants performed the following tests: Mini-Cog, Mini Mental State Examination, clock drawing test (CDT), and verbal fluency., Results: (1) There were no significant differences in cognitive performance between the two groups. (2) Higher education was always associated with better performance. (3) There was a significant group difference in the slopes of the regression lines between years of education and CDT performance. No differences were found for the other three tests., Conclusion: Considering the scores on the CDT, the rate of improvement in performance when schooling increases is higher in HCV carriers.

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

Objectives: Early diagnosis of cognitive disorders in order to initiate new efficient treatments in time is an important task which cannot be fulfilled without proper cognitive screening tools. The Clock Drawing Test (CDT) is a simple inexpensive cognitive screening tool which can be used in primary care settings delivering health services to older people. The aim of this study was to assess validity and reliability of the CDT in Iranian older population. Methods & Materials: In this study the CDT and Mini Mental State Examination (MMSE) were concurrently performed on 74 literate participants aged 60 and over. Participants were recruited from the clients of Iran Alzheimer’s Association (dementia patients and non-demented clients, including other patients or care givers) during a 5 month period. The CDT was performed by two trained raters using Shulman’s six points scoring method. Using SPSS version 20, reliability was assessed measuring kappa statistics as well as ICC. Concurrent validity between CDT and MMSE were statistically analyzed by spearman’s rank correlation coefficient. Results: Mean age of the participants was 72 years in a range of 60 to 90 years with equal numbers 0f male and female participants. Kappa statistics for test retest reliability was 0.554 (P