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OBJECTIVE: To investigate the diagnostic value of brief cognitive tests in differentiating vascular dementia (VaD) from Alzheimer's disease (AD). METHOD: Fifteen patients with mild VaD, 15 patients with mild probable AD and 30 healthy controls, matched for age, education and dementia severity, were submitted to the following cognitive tests: clock drawing (free drawing and copy), category and letter fluency, delayed recall test of figures and the EXIT 25 battery. RESULTS: VaD patients performed worse than AD patients in category fluency (p=0.014), letter fluency (p=0.043) and CLOX 2 (p=0.023), while AD cases performed worse than VaD patients in delayed recall (p=0.013). However, ROC curves for these tests displayed low sensitivity and specificity for the differential diagnosis between VaD and AD. CONCLUSION: Although the performance of VaD and AD patients was significantly different in some cognitive tests, the value of such instruments in differentiating VaD from AD proved to be very limited.OBJETIVO: Investigar o valor diagnóstico de testes cognitivos breves na diferenciação de demência vascular (DV) e doença de Alzheimer (DA). MÉTODO: Quinze pacientes com DV, 15 com DA provável e 30 controles saudáveis, pareados em relação à idade, escolaridade e gravidade da demência, foram submetidos aos seguintes testes: desenho do relógio espontâneo e cópia, fluência verbal semântica e fonêmica, teste de evocação de memória de figuras e a bateria EXIT25. RESULTADOS: Pacientes com DV apresentaram pior desempenho na fluência verbal semântica (p=0,014), fonêmica (p=0,043), e no CLOX 2 (p=0,023). O grupo com DA obteve pior desempenho no teste de evocação tardia (p=0,013). As curvas ROC aplicadas a esses testes mostraram baixa sensibilidade e especificidade para o diagnóstico diferencial entre DV e DA. CONCLUSÃO: Embora o desempenho dos pacientes tenha sido diferente em alguns testes, o valor desses instrumentos para o diagnóstico diferencial entre DV e DA parece ser muito limitado.

Alzheimer's disease is the most common degenerative disease of brain. Nowadays, the most common treatment being used to slow down disease progression, include Donepezil , Rivastigmine and Galantamine, which all of them act as inhibitors of acetyl cholinesterase. General purpose of our study was to show effects of treatment with Donepezil and Rivastigmine, as two drugs that commonly used for treatment of AD in Iran and to compare these effects between two drugs. Samples selected from patients who had Alzheimer` disease with DSM IV criteria and were candidate of receiving Donepezil or Rivastigmine, as treatment of AD, for the first time. We used four neuropsychological tests including MMSE, NPI, Clock and Bender to assess patient's cognitive and behavioral changes during treatment with two drugs. Patients divided to two groups (each group 35 cases); Patients with plan of taking Donepezil entered into one of the groups and patients with plan of taking Rivastigmine entered into another. The four tests were completed once before starting treatment and then, 1 month, 3 months and 6 months after treatment with Donepezil and Rivastigmine. MMSE, 6 months after treatment with Donepezil, improved from 20.63 before treatment to 21.83, which is statistically significant (P = 0.04). Also, MMSE, 6 months after treatment with Rivastigmine, improved from 20.03 before treatment to 22.71, which was statistically significant (P = 0.007). About Clock test, there was a significant improvement from 5.74 before treatment to 6.4 after 6 months of treatment with Rivastigmine; while this significant improvement was not seen in patients receiving Donepezil. In two other tests, no significant differences were seen before and after treatment. Also, No significant difference was detected between two groups and so no different effects on these tests between Donepezil and Rivastigmine in 6 months period of treatment.

Objectives: This study was aimed to assess the usefulness of the quantitative assessment of clock drawing test (CDT) combined with the Mini-Mental State Examination (MMSE) compared to that of the Montreal Cognitive Assessment (MoCA) or the MMSE alone for screening of dementia in Parkinson disease (PD) in patients with a low educational level. Methods: A representative sample of 91 PD patients was administered MMSE, MoCA and CDT. The discriminative validity of the MMSE, MoCA, and a MMSE+CDT combination for dementia screening was determined by estimating the sensitivity and specificity of each test and by testing integrated discrimination improvement (IDI). Results: The mean age and educational years were 69.0 (years) and 7.3 in the study population. The best screening cut-off points for the MMSE, MoCA, and MMSE+CDT were 25/26, 21/22 and 41/42. In a group of patients with educational years ≤6, the sensitivity and specificity of the MMSE+CDT were 94.4 and 54.8 with area under the curve (AUC) 0.806 (95% confidence interval, 0.686-0.925), whereas those of the MMSE and MoCA were 94.4 and 45.2 with AUC 0.767 (0.635-0.899), and 83.3 and 35.5 with AUC 0.773 (0.634-0.913), respectively. Compared with the MMSE alone, the IDI of the MMSE+CDT showed a significant improvement in the low-educational level group whereas the IDI of the MoCA did not show such an improvement in this group. Conclusions: In low educational level population, a combination of the quantitative CDT and MMSE is a good screening tool for dementia in PD. [ABSTRACT FROM AUTHOR]

Objective: The Clock Drawing Test (CDT) is widely used as a screening tool for discriminating cognitively normal individuals from patients with mild dementia. The aim of present study was to provide normative values for a 10-point quantitative scoring system proposed by Rouleau and colleagues (1992), including CDT total score and subscales score assessing representation of clock face (RC), layout of numbers (LN), and position of hands (PH), in a large sample of Italian healthy individuals. Method: Eight hundred and seventy-two Italian healthy participants (483 women; age range 20-94 years) with educational level from primary school to university underwent CDT and Mini Mental State Examination (MMSE). Results: Multiple linear regression analysis revealed that age and education significantly influenced CDT total score and its subscale scores. Moreover, a significant effect of gender was found only in RC subscale. From the derived linear equation, a correction grid for raw scores was built. Inferential cut-off values were estimated using a non-parametric technique and equivalent scores (ES) were computed. Correlation analysis showed a weakly significant correlation between adjusted CDT total score and adjusted MMSE scores. Conclusions: The present study provided normative data for the Rouleau and colleagues version of CDT in an Italian sample, useful for clinical and research purposes. [ABSTRACT FROM AUTHOR]

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

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

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

Background: Alzheimer's disease dementia (ADD) has become an important health problem in the world. Visuospatial deficits are considered to be an early symptom besides memory disorder.Objectives: The gesture imitation test was devised to detect ADD and amnestic mild cognitive impairment (aMCI).Methods: A total of 117 patients with ADD, 118 with aMCI, and 95 normal controls were included in this study. All participants were administered our gesture imitation test, the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Clock Drawing Test (CDT), and the Clinical Dementia Rating Scale (CDR).Results: Patients with ADD performed worse than normal controls on global scores and had a lower success rate on every item (p < 0.001). The area under the curve (AUC) for the global scores when comparing the ADD and control groups was 0.869 (p < 0.001). Item 4 was a better discriminator with a sensitivity of 84.62% and a specificity of 67.37%. The AUC for the global scores decreased to 0.621 when applied to the aMCI and control groups (p = 0.002). After controlling for age and education, the gesture imitation test scores were positively correlated with the MMSE (r = 0.637, p < 0.001), the MoCA (r = 0.572, p < 0.001), and the CDT (r = 0.514, p < 0.001) and were negatively correlated with the CDR scores (r = -0.558, p < 0.001).Conclusions: The gesture imitation test is an easy, rapid tool for detecting ADD, and is suitable for the patients suspected of mild ADD and aMCI in outpatient clinics. [ABSTRACT FROM AUTHOR]

Objectives: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. Method: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. Results: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 correlationr= −0.618,p< 0.001), CDT and CAM (Spearman's rho = −0.402,p< 0.001) and CDT and total MoCA score (Pearson'sr= 0.767,p< 0.001). 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. Conclusion: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. [ABSTRACT FROM PUBLISHER]

Aim: The Clock Drawing Test (CDT) is a popular screening test to detect of dementia. The aim of the present research was to determine the role of the test in diagnosing early stages of Alzheimer‘s disease (AD). Patients and methods: The Mini-Mental State Examination (MMSE) and the CDT with three times 11:10, 23:20 and 5:40 were examined in 77 cognitively normal seniors (NOS) and in 77 patients diagnosed with early AD according to NIA-AA criteria. All CDTs were scored according to the instructions in the Addenbrooke´s and Montreal cognitive tests (ACE, MoCA), Shulman´s system and by our newly developed BaJa system with fi ve dichotomous questions and 0-5 scale. Results: MMSE and CDT scores with any of the three times (11:10, 23:20, 5:40) assessed by any system were signifi cantly lower for the early AD patients than for the NOS group (p < 0.01). The 23:20 was signifi cantly more diffi cult than 11:10 for all participants (p = 0.003). A comparison of patients and NOS for three times of the CDT showed a cut-off score for BaJa ≤ 4 points, sensitivity 54-65%, specifi city of 59-75% and the area under the receiver operating curve (AUC) around 0.7. The MMSE cut-off score ≤ 27 points was associated with higher sensitivity of 86%, specifi city 96% and AUC 0.96. There were no diff erences between the four CDT scoring systems with respect to AUCs. Conclusion: Although the CDT with 23:20 is more diffi cult than the other times, the CDT in general is not useful for early detection of AD due to its low sensitivity and specifi city, regardless of what time or scoring system is used. [ABSTRACT FROM AUTHOR]

many studies sustained that the clock drawing test (CDT) was not able to accurately detect people with CDR = 0.5. Other researchers have promoted the use of scoring approaches with multiple scales that rate quantitative and qualitative features of the production. Nevertheless, these scoring systems are complex and time-consuming. We propose a new brief CDT' scoring system in order to find a good measure for mild cognitive decline which is at the same time easy to administer. we enrolled 719 subjects: n. 181 with mild Alzheimer's disease (AD); n. 200 with amnesic mild cognitive impairment (MCI) and n. 338 healthy elderly subjects (C). our CDT-three-cluster scoring system demonstrated a good sensitivity and an excellent specificity to discriminate MCI subjects from normal elderly (76 and 84 %, respectively) and an excellent sensitivity and specificity to discriminate patients affected by mild Alzheimer disease (CDR: 1) from normal elderly (91 and 90 %, respectively). We found that CDT' score = 1.30 discriminate people with MCI, whereas a score = 4.38 discriminate AD patients. The three-cluster-scoring-system demonstrated a good diagnostic accuracy, taking into account those error-items more predictive of cognitive decline: omission of numbers or hands, writing numbers or hands in a wrong position and writing numbers or hands in a different code. Our CDT' scoring system is very short and easy method which can be used also by non-specialist. [ABSTRACT FROM AUTHOR]

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

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

Diarrheagenic and uropathogenic E. coli types are mainly characterized by the expression of distinctive bacterial virulent factors. stx1, stx2 (Shiga toxins), and cdt (cytolethal distending toxin) genes have been acquired by horizontal gene transfer. Some virulent genes such as espP (serine protease), etpD (part of secretion pathway), and katP (catalase-peroxidase), or sfpA gene (Sfp fimbriae), are on plasmids and the others like fliC (flagellin) and the fimH gene (fimbriae type-I) are located on chromosome. Genomic pathogenicity islands (PAIs) carry some virulent genes such as hly gene. To determine the existence of virulence genes in cdt clinical isolates, genes including stx1, stx2, cdt, hly, espP, katP, sfpA, etpD, fliC, and fimH were assessed by Polymerase Chain Reaction (PCR). The most prevalent isolates for etpD and katP genes were 85.7% in cdtII. katP gene was also observed 83.3% in cdtI. However, in 42.85% of cdtIII isolates, espP gene was the most detected. Moreover, hly gene was also the most prominent gene in cdtIII (71.42%). sfpA gene was observed in 66.6% of cdtV. stx1 gene was detected in 100% of cdtII, cdtIV, and cdtV types. Presence and pattern of virulence genes were considered among cdt positive isotypes and used for their clustering and profiling. [ABSTRACT FROM AUTHOR]

The Clock Drawing Test-a simple pencil and paper test-has been used for more than 50 years as a screening tool to differentiate normal individuals from those with cognitive impairment, and has proven useful in helping to diagnose cognitive dysfunction associated with neurological disorders such as Alzheimer's disease, Parkinson's disease, and other dementias and conditions. We have been administering the test using a digitizing ballpoint pen that reports its position with considerable spatial and temporal precision, making available far more detailed data about the subject's performance. Using pen stroke data from these drawings categorized by our software, we designed and computed a large collection of features, then explored the tradeoffs in performance and interpretability in classifiers built using a number of different subsets of these features and a variety of different machine learning techniques. We used traditional machine learning methods to build prediction models that achieve high accuracy. We operationalized widely used manual scoring systems so that we could use them as benchmarks for our models. We worked with clinicians to define guidelines for model interpretability, and constructed sparse linear models and rule lists designed to be as easy to use as scoring systems currently used by clinicians, but more accurate. While our models will require additional testing for validation, they offer the possibility of substantial improvement in detecting cognitive impairment earlier than currently possible, a development with considerable potential impact in practice. [ABSTRACT FROM AUTHOR]

Clock Drawing Test performance was examined alongside other neuropsychological tests in mild cognitive impairment (MCI). We tested the hypothesis that clock-drawing errors are related to executive impairment. The current research examined 86 patients with MCI for whom, in prior research, cluster analysis was used to sort patients into dysexecutive (dMCI,n = 22), amnestic (aMCI,n = 13), and multidomain (mMCI,n = 51) subtypes. First, principal components analysis (PCA) and linear regression examined relations between clock-drawing errors and neuropsychological test performance independent of MCI subtype. Second, between-group differences were assessed with analysis of variance (ANOVA) where MCI subgroups were compared to normal controls (NC). PCA yielded a 3-group solution. Contrary to expectations, clock-drawing errors loaded with lower performance on naming/lexical retrieval, rather than with executive tests. Regression analyses found increasing clock-drawing errors to command were associated with worse performance only on naming/lexical retrieval tests. ANOVAs revealed no differences in clock-drawing errors between dMCI versus mMCI or aMCI versus NCs. Both the dMCI and mMCI groups generated more clock-drawing errors than the aMCI and NC groups in the command condition. In MCI, language-related skills contribute to clock-drawing impairment. [ABSTRACT FROM PUBLISHER]

Introduction: The study aimed to determine the prevalence and documentation of delirium among the elderly and if the Clock Drawing Test (CDT) can be used to predict which patients had delirium on admission and those who may develop delirium during their stay in acute medical wards.Methods: A single researcher performed the Mini-Mental State Examination (MMSE) and CDT on admission and discharge of 57 elderly adults at the National University Hospital, Singapore. Delirium was defined as a ≥ 3-point improvement or ≥ 2-point decline in MMSE scores from admission to discharge, where a fall denotes development of delirium and a rise denotes resolution. The case notes of the same patients were reviewed for documentation of delirium. All inpatients from two acute medical wards were examined. One CDT score and a pair of MMSE scores were collected from each patient.Results: A total of 57 patients (28 male, 29 female) were involved in the study. Their mean age was 76.0 ± 8.7 years. The prevalence of delirium based on MMSE scores was 40.4%; 16 patients had delirium on admission while seven developed delirium during their inpatient stay. However, delirium was documented in the case notes of only 7 (30%) of the 23 patients. CDT score was better than baseline MMSE score at predicting a decline in MMSE score.Conclusion: The prevalence of delirium in the acute medical setting is high but underdiagnosed. The CDT may be a good screening tool to identify patients at risk of delirium during their inpatient stay. Baseline cognition screening should be performed in every elderly patient admitted to hospital. [ABSTRACT FROM AUTHOR]

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

Many clock drawing test (CDT) scoring systems focus on drawing results and lack drawing process assessments. This study created a CDT scoring procedure with drawing process assessment and explored its diagnostic value in screening for mild cognitive impairment (MCI) and early Alzheimer's disease (AD) from normal control (NC). We used logistic regression and receiver operating characteristic (ROC) curves to determine a new, sensitive scoring system for AD and MCI patients in a derivation cohort. The new scoring method was then compared to two common scoring systems and externally validated in a second cohort. We developed a new scoring system named CDT5, which contained one process assessment item: remember setting time without asking. Compared with two published scoring systems, CDT5 had better discriminatory power in distinguishing AD patients from NCs in derivation (area under the ROC curve [area under the curve, AUC] = .890) and validation (AUC = .867) cohorts. Three scoring systems had poor diagnostic accuracy at discriminating MCI patients from controls, with CDT5 being the most sensitive (78.57%). Adding the drawing process in CDT helps accurately detect patients with early AD, but its role in identifying patients with MCI needs to be further explored.

Background: Visuospatial dysfunction and cognitive impairment are common in Parkinson's disease (PD), which draw increasing attention in the current literature. But clinicians still lack rapid, effective and unified cognitive battery for visuospatial assessment., Objective: A new approach was studied to explore the feasibility of using mobile application software (APP) to evaluate visuospatial dysfunction in patients with PD and compared with traditional assessment tools. We aimed to verify the threshold score of the APP for early diagnosis., Materials and Methods: A total of 41 patients with PD underwent assessments using several test modules including Digit Symbol Test (DST), Visual Organization Test (VOT), Facial Recognition Test (FRT), Vocabulary Memory Test (VMT) of this APP, as well as Clock Drawing Test (CDT), Cube Copying Test (CCT) and the Mini-Mental State Examination (MMSE) for comparison. Among the 41 PD patients, 30 individuals were found to have visuospatial dysfunction based on CDT score < 5 and CCT score of<18 while the remaining 11 patients served as control., Results: There were statistically significant differences in DST, VOT, and FRT scores (all p  ≤ 0.001 for group comparisons). DST, VOT, and FRT-1 were significantly correlated with MMSE, CDT and CCT and the correlations were moderate or fairly strong. For visuospatial dysfunction diagnosis, all the areas under curves (AUC) of DST, VOT, and FRT-1 were statistically significant ( p  < 0.0001, p  = 0.0002, and p  = 0.0002, respectively). The estimates and 95% confidence intervals of AUC were 0.8303 (0.6868, 0.9739), 0.8045 (0.6423, 0.9668), and 0.7833 (0.6344, 0.9322), respectively. Their cut-off points for visuospatial dysfunction were 26, 17, and 19, respectively. After dichotomization by the cut-off points, DST had high sensitivity of 96.67% while VOT and FRT-1 had high specificity of 81.82 and 90.91%., Conclusion: This study demonstrated that visuospatial disorders was highly prevalent in PD patients, and the APP used in study could be a practical clinical screening tool for visuospatial ability assessment with high sensitivity and specificity., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Shao, Wang, Zhang, Zhen, Dong, Tian and Yu.)

The clock-drawing test (CDT) is widely used in clinical practice to diagnose and distinguish patients with dementia. It remains unclear, however, whether the CDT can distinguish among the early-onset dementias. Accordingly, we examined the ability of both quantitative and qualitative CDT analyses to distinguish behavioral variant frontotemporal dementia (bvFTD) and early-onset Alzheimer disease (eAD), the 2 most common neurodegenerative dementias with onset <65 years of age. We hypothesized that executive aspects of the CDT would discriminate between these 2 disorders. The study compared 15 patients with bvFTD and 16 patients with eAD on the CDT using 2 different scales and correlated the findings with neuropsychological testing and magnetic resonance imaging. The total CDT scores did not discriminate bvFTD and eAD; however, specific analysis of executive hand placement items successfully distinguished the groups, with eAD exhibiting greater errors than bvFTD. The performance on those executive hand placement items correlated with measures of naming as well as visuospatial and executive function. On tensor-based morphometry of the magnetic resonance images, executive hand placement correlated with right frontal volume. These findings suggest that lower performance on executive hand placement items occurs with involvement of the right dorsolateral frontal-parietal network for executive control in eAD, a network disproportionately affected in AD of early onset. Rather than the total performance on the clock task, the analysis of specific errors, such as executive hand placement, may be useful for early differentiation of eAD, bvFTD, and other conditions. [ABSTRACT FROM AUTHOR]

To compare clock test deficits in elderly patients with early onset depression (EOD) and late onset depression (LOD), we assessed 32 elderly healthy controls (HCs), 26 patients with EOD, and 27 patients with LOD with the clock drawing test (CDT), clock setting test, clock reading test, and the Tübingen Clock Questionnaire testing semantic memory about clock times. There was no significant difference in depression severity between patients with EOD and LOD. Patients with LOD had significantly lower scores on the CDT than patients with EOD and HCs. Semantic memory impairment concerning minute hand functionality was highly correlated with CDT performance and was significantly different between the EOD and the LOD groups. It can be suggested that significant differences in cognitive impairment severity between patients with EOD and LOD can be detected with CDT. Semantic memory impairment concerning minute hand functionality might affect CDT test results in elderly patients with depression. [ABSTRACT FROM AUTHOR]

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

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

The digital clock drawing test is a fielded application that provides a major advance over existing neuropsychological testing technology. It captures and analyzes high-precision information about both outcome and process, opening up the possibility of detecting subtle cognitive impairment even when test results appear superficially normal. We describe the design and development of the test, document the role of AI in its capabilities, and report on its use over the past seven years. We outline its potential implications for earlier detection and treatment of neurological disorders. We set the work in the larger context of the THink project, which is exploring multiple approaches to determining cognitive status through the detection and analysis of subtle behaviors. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) are in best position to suspect dementia. Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) are widely used. Additional neurological tests may increase the accuracy of diagnosis. We aimed to evaluate diagnostic ability to detect dementia with a Short Smell Test (SST) and Palmo-Mental Reflex (PMR) in patients whose MMSE and CDT are normal, but who show signs of cognitive dysfunction. Methods: This was a 3.5-year cross-sectional observational study in the Memory Clinic of the University Department of Geriatrics in Bern, Switzerland. Participating patients with normal MMSE (>26 points) and CDT (>5 points) were referred by GPs because they suspected dementia. All were examined according to a standardized protocol. Diagnosis of dementia was based on DSM-IV TR criteria. We used SST and PMR to determine if they accurately detected dementia. Results: In our cohort, 154 patients suspected of dementia had normal MMSE and CDT test results. Of these, 17 (11 %) were demented. If SST or PMR were abnormal, sensitivity was 71 % (95 % CI 44-90 %), and specificity 64 % (95 % CI 55-72 %) for detecting dementia. If both tests were abnormal, sensitivity was 24 % (95 % CI 7-50 %), but specificity increased to 93 % (95 % CI 88-97 %). Conclusion: Patients suspected of dementia, but with normal MMSE and CDT results, may benefit if SST and PMR are added as diagnostic tools. If both SST and PMR are abnormal, this is a red flag to investigate these patients further, even though their negative neuropsychological screening results. [ABSTRACT FROM AUTHOR]

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

Identification of individuals who will eventually develop dementia is critical for early intervention, treatment, and care planning. The clock drawing test (CDT) is a widely used cognitive screening tool that has been well accepted among clinicians and patients for its ease of use and short administration time. This review explores the value of the CDT for predicting the later development of dementia in cognitively intact older adults and patients with mild cognitive impairment (MCI). Additionally, we reviewed studies that examined the ability of the CDT to monitor declines in cognitive functioning over time. A PubMed literature search for articles that included a longitudinal analysis of the CDT was conducted. The search included articles published up to June 2013 and manual cross-referencing of bibliographies. Relevant studies were categorized, summarized, and critiqued. The consensus from the studies reviewed suggests that the CDT is a useful measure of cognitive decline over time. Conceptual clock drawing errors (eg, misrepresentation of time) detected this decline most effectively. In addition, the CDT appears to differentiate at baseline between cognitively intact older adults who will develop dementia up to 2 years postbaseline. Finally, the CDT has been found to differentiate between patients with MCI who will progress to dementia up to 6 years postbaseline. The CDT appears useful for the longitudinal assessment of cognitive impairment and together with other validated measures may be helpful for predicting conversion to dementia. Cost-effective and practical ways of predicting risk of dementia will become increasingly critical as we develop disease-modifying treatments. [ABSTRACT FROM AUTHOR]