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

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. [ABSTRACT FROM AUTHOR]

Objectives. Methadone maintenance treatment (MMT) patients may achieve up to a 2-week privilege of methadone take-home doses (THD), which is associated with considerable responsibility. MMT patients are characterized as having poor sleep quality and low cognitive states. We studied sleep indices and cognitive status with respect to THD privileges. Methods. A sample of 123 MMT patients stratified by THD groups was studied. Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and the cognitive Clock Drawing Test (CDT) were performed. Results. Thirty-one of 123 patients never had any THD and 92 did (25 had the maximum of 2 weeks). The never THD had history of longer duration of opiate usage and a shorter period in MMT. They had the highest rates of poor sleep (80.6%, PSQI > 5), daily sleepiness ('fall asleep while talking') (41.9%), and impaired cognitive status (58.1%, CDT < 3), while those who had 2-week privileges had the lowest (56, 8, and 28%, respectively). Logistic regression characterized THD patients as no-benzodiazepine and no-cocaine, short opiate usage duration, low ADHD scores, and no cognitive impairment (CDT = 3) and its interaction with treatment duration. Conclusion. Privileges that reflect patients' abstinence and rehabilitation were also expanded to be associated with better cognitive states. These finding confirm the THD dispensing performance. Including CDT as part of the decision for dispensing THD may be considered. [ABSTRACT FROM AUTHOR]

Introduction: The Clock Drawing Test is a frequently used cognitive screening test with several scoring systems in elderly populations. We compare simple and complex scoring systems and evaluate the usefulness of the combination of the Clock Drawing Test with the Mini-Mental State Examination to detect patients with mild cognitive impairment. Method: Patients with amnestic mild cognitive impairment (n = 48) and age- and education-matched controls (n = 48) underwent neuropsychological examinations, including the Clock Drawing Test and the Mini-Mental State Examination. Clock drawings were scored by three blinded raters using one simple (6-point scale) and two complex (17- and 18-point scales) systems. The sensitivity and specificity of these scoring systems used alone and in combination with the Mini-Mental State Examination were determined. Results: Complex scoring systems, but not the simple scoring system, were significant predictors of the amnestic mild cognitive impairment diagnosis in logistic regression analysis. At equal levels of sensitivity (87.5%), the Mini-Mental State Examination showed higher specificity (31.3%, compared with 12.5% for the 17-point Clock Drawing Test scoring scale). The combination of Clock Drawing Test and Mini-Mental State Examination scores increased the area under the curve (0.72; p <.001) and increased specificity (43.8%), but did not increase sensitivity, which remained high (85.4%). Conclusions: A simple 6-point scoring system for the Clock Drawing Test did not differentiate between healthy elderly and patients with amnestic mild cognitive impairment in our sample. Complex scoring systems were slightly more efficient, yet still were characterized by high rates of false-positive results. We found psychometric improvement using combined scores from the Mini-Mental State Examination and the Clock Drawing Test when complex scoring systems were used. The results of this study support the benefit of using combined scores from simple methods. [ABSTRACT FROM AUTHOR]

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

Background: The Institute of Cognitive Neurology (INECO) Frontal Screening (IFS) is a brief neuropsychological tool recently devised for the evaluation of executive dysfunction in neurodegenerative conditions. Objective: In this study we present a cross-cultural validation of the IFS for the Portuguese population, provide normative values from a healthy sample, determine how age and education affect performance, and inspect its clinical utility in the context of Alzheimer's disease (AD). A comparison with the Frontal Assessment Battery (FAB) was undertaken, and correlations with other well-established executive functions measures were examined. Methods: The normative sample included 204 participants varying widely in age (20-85 years) and education (3-21 years). The clinical sample (n = 21) was compared with a sample of age- and education-matched controls (n = 21). Healthy participants completed the IFS and the Mini-Mental State Examination (MMSE). In addition to these, the patients (and matched controls) completed the FAB and a battery of other executive tests. Results: IFS scores were positively affected by education and MMSE, and negatively affected by age. Patients underperformed controls on the IFS, and correlations were found with the Clock Drawing Test, Stroop test, and the Zoo Map and Rule Shift Card tests of the Behavioral Assessment of the Dysexecutive Syndrome. A cut-off of 17 optimally differentiated patients from controls. While 88% of the IFS sub-tests discriminated patients from controls, only 67% of the FAB sub-tests did so. Conclusion: Age and education should be taken into account when interpreting performance on the IFS. The IFS is useful to detect executive dysfunction in AD, showing good discriminant and concurrent validities. [ABSTRACT FROM AUTHOR]

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

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

Background:The aim of the study was to develop the Japanese versions of Executive Interview (J-EXIT25) and Executive Clock Drawing Task (J-CLOX) and to evaluate the aspects of executive function that these two tests will be examining.Methods:The concurrent validity and reliability of J-EXIT25 and J-CLOX were first examined in all participants (n = 201). Next, the relationship between the two tests was examined using receiver operating characteristic (ROC), correlation, and regression analyses in healthy participants (n = 45) and participants with mild cognitive impairment (n = 36) and dementia (n = 95).Results:Satisfactory concurrent validity and reliability of J-EXIT25 and J-CLOX were shown. ROC analysis indicated that J-EXIT25 and J-CLOX1 were superior to the Frontal Assessment Battery, but inferior to the Mini-Mental State Examination (MMSE), in discriminating between non-dementia and dementia. J-EXIT25, J-CLOX1, and J-CLOX2 scores were significantly correlated with age, scores on the MMSE, Instrumental Activities of Daily Living (IADL) and Physical Self-Maintenance Scale (PSMS), and care level. In stepwise regression analyses of IADL scores, MMSE and J-EXIT25 were significantly independent predictors in men, and MMSE, age, and J-CLOX1 were significantly independent predictors in women. J-EXIT25, MMSE, and J-CLOX1 were significantly independent predictors in stepwise regression analysis of PSMS scores, and J-EXIT25 was the only significantly independent predictor in stepwise regression analysis of care level.Conclusions:J-EXIT25 and J-CLOX are valid and reliable instruments for assessment of executive function in older people. The present results suggest that these tests have common and distinct psychometric properties in the assessment of executive function. [ABSTRACT FROM AUTHOR]

Abstract: Background: In Alzheimer's disease (AD) drawing and constructional abilities are impaired and worsen as the disease progresses. Purpose: To examine the feasibility of and develop a method for screening, diagnosis, and staging of dementia that can be quickly administered and interpreted in the clinical setting. Methods: The study aims to describe a scoring mechanism of the intersecting pentagon copying (IPC) task based on the degree of drawing failure and pitted against the Mini-Mental State Examination (MMSE) and the clock drawing test (CDT), which is probably its most likely competitor for a small measure. This is a prospective cohort study of 91 probable dementia patients of the Alzheimer type referred to the geriatrician over a period of 3 years where the suitability of prescribing acetyl cholinesterase inhibitor is investigated. The patients were categorized as follows: 18 (20%) normal, 31 (34%) mild dementia, and 42 (46%) moderate dementia. The copying of the pentagon was part of the MMSE and these drawings were further scrutinized and a 10-point scoring method developed. Each IPC and CDT was blindly and independently rated by two geriatricians. Results: The MMSE and Clinical Dementia Rating were found to have very similar staging results. The IPC had some commonality with these measures for patients defined as normal in that most score 10/10 for the IPC. However, both mild and moderate dementia patients according to other measures have an overlapping range of scores on the IPC scoring method developed. The highest association for the IPC with the CDT was 0.68. IPC had a stronger correlation with the total MMSE than with the two shorter versions. Conclusion: The IPC seems to operate more as a screening tool rather than a dementia staging instrument and assists in identifying normal patients. [Copyright &y& Elsevier]

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Many scoring systems exist for clock drawing task variants. However, none of them are reliable in evaluating longitudinal changes of cognitive function. The purpose of this study is to create a simple yet optimal scoring procedure to evaluate cognitive decline using a clinic-based sample. Methods: Clock-drawings from 121 participants (76 individuals with no dementia and later did not develop dementia after a mean 41.2-month follow-up, 45 individuals with no dementia became demented after a mean 42.3-month follow-up) were analyzed using t-test to determine a new and simplified CDT scoring system. The new scoring method was then compared with other commonly used systems. Results: In the converters, there were only 7 items that are significantly different between the initial visits and the second visits. We propose a new scoring system that includes the seven critical items: numbers are equally spaced (12–3–6–9) (p = 0.031), the other eight numbers are marked (p = 0.022), numbers are clockwise (p = 0.002), all numbers are correct (p = 0.030), distance between numbers is constant (p = 0.016), clock has two hands (p = 0.000), arrows are drawn (p = 0.003). Compared with other traditionally used scoring methods, this based change clock drawing test (BCCDT) has one of the most balanced sensitivities/specificities with a clinic-based sample. Conclusions: The new CDT scoring system provides further evidence in support of a simple and reliable clock-drawing scoring system in follow-up studies to evaluate cognitive decline, which can be used in assessing the efficacy of medicine. [ABSTRACT FROM AUTHOR]

Background: The Clock Drawing Test (CDT) is a widely-used, rapid assessment tool for the screening of cognitive decline though its evaluation and interpretation are still not uniform. The aim of present study was to investigate the difference in sensitivity and specificity of two types of CDTs and to compare the clinical benefits of quantitative and semiquantitative scoring systems. Objective: To investigate the difference in sensitivity and specificity of two types of CDTs and to compare the clinical benefits of quantitative and semiquantitative scoring systems. Methods: Six hundred and ninety-two participants with or without dementia completed 10-item CDTs in nursing homes in two counties in southern Hungary. The dementia was not further subclassified. The results of the two tests, CDT1 (representing five minutes to a quarter to four) and CDT2 (representing ten past five), were evaluated quantitatively and semiquantitatively. Results: In the quantitative evaluation, the sensitivity and the specificity for the diagnosis of dementia at cut-off scores of 7 points were determined: 87.1% and 51.9%, respectively, for CDT1, and 81.7% and 57% for CDT2, respectively. The semiquantitative analysis revealed a sensitivity of 67.3% and a specificity of 65.3% for CDT1, and of 64.6% and 66.6% for CDT2, respectively. Conclusion: The results of CDT tests do not appear to depend on the positions of the clock hands and additionally suggest that the quantitative evaluation method is more sensitive than the semiquantitative method. [ABSTRACT FROM AUTHOR]

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

Background: Cognitive assessment is thought to increase the ability of the physical phenotype of frailty to identify older persons at a higher risk for adverse outcomes. Objective: Data from a cohort of dementia-free community dwellers were used to investigate whether the clock drawing test (CDT), a quick and easy cognitive screening test, is associated with adverse health outcomes independently of the physical phenotype of frailty. Methods: Thiswas a prospective population-based cohort study of 766 dementia-free Italian community dwellers aged 65 years or older. Baseline assessment included the physical phenotype of frailty, 3 different CDT protocols [Sunderland, Shulman, and the clock drawing interpretation scale (CDIS)], and several health confounders. Hazard ratios (HR) and odds ratio (OR) along with their corresponding 95% confidence intervals (CI) from models adjusted for frailty and sociodemographic and health confounders were used to estimate the independent association of the CDT with the 7-year risk of all-cause mortality and the 3-year risk of new and worsening disability, hospitalization, and fractures. Results: After adjustment for confounders, the Sunderland CDT was significantly associated with all-cause mortality independently of the physical phenotype of frailty (HR = 1.44, 95% CI 1.03-2.01, p = 0.031). However, compared to all nonfrail participants with a normal Sunderland CDT, the HR was 1.57 (95% CI 1.09-2.26, p = 0.016) for those with impairment on the Sunderland CDT only, 2.48 (95% CI 1.46-4.20, p = 0.001) for those with frailty only, and 2.52 (95% CI 1.34-4.77, p = 0.004) for those with both frailty and impairment on the Sunderland CDT. Mortality was unrelated to the CDIS CDT (p = 0.359) and the Shulman CDT (p = 0.281). No statistically significant relationship was found between nonlethal outcomes and any CDT protocol, although trends were found for an association of both the Sunderland CDT (p = 0.118) and the CDIS CDT with worsening disability (p = 0.154). Conclusions: In older persons, depending on the scoring system, the CDT may predict the mortality risk independently of the physical phenotype of frailty. However, combining the two measurements does not improve their individual prognostic abilities. © 2013 S. Karger AG, Basel [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 relapsingremitting MS. Methods: In this case-control research done in Isfahan MS association, Iran, 49 women with relapsingremitting 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. [ABSTRACT FROM AUTHOR]

Clostridium difficile causes antibiotic-associated diarrhea and pseudomembranous colitis by the actions of Rho-glucosylating toxins A and B. Recently identified hypervirulent strains, which are associated with increased morbidity and mortality, additionally produce the actin-ADP–ribosylating toxin C. difficile transferase (CDT). CDT depolymerizes actin, causes formation of microtubulebased protrusions, and increases pathogen adherence. Here we show that CDT-induced protrusions allow vesicle traffic and contain endoplasmic reticulum tubules, connected to microtubules via the calcium sensor Stim1. The toxin reroutes Rab11-positive vesicles containing fibronectin, which is involved in bacterial adherence, from basolateral to the apical membrane sides in a microtubule- and Stim1-dependent manner. The data yield a model of C. difficile adherence regulated by actin depolymerization, microtubule restructuring, subsequent Stim1-dependent Ca2+ signaling, vesicle rerouting, and secretion of ECM proteins to increase bacterial adherence. [ABSTRACT FROM AUTHOR]

Clock drawing is recommended by medical and transportation authorities as a screening test for unsafe drivers. The objective of the present study was to assess the usefulness of different clock drawing systems as screening measures of driving performance in 122 healthy and cognitively impaired older drivers. Clock drawing was measured using four different scoring systems. Driving outcomes included global ratings of safety and the error rate on a standardized on-road test. Findings revealed that clock drawing was significantly correlated with the driving score on the road test for each of the scoring systems. However, receiver operator curve analyses showed limited clinical utility for clock drawing as a screening instrument for impaired on-road driving performance with the area under the curve ranging from 0.53 to 0.61. Results from this study indicate that clock drawing has limited utility as a solitary screening measure of on-road driving, even when considering a variety of scoring approaches. [ABSTRACT FROM AUTHOR]

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

Background. Diagnostic evaluations of dementia are often performed in primary health care (PHC). Cognitive evaluation requires validated instruments. Objective. To investigate the diagnostic accuracy and clinical utility of Cognistat in a primary care population. Methods. Participants were recruited from 4 PHC centres; 52 had cognitive symptoms and 29 were presumed cognitively healthy. Participants were tested using the Mini-Mental State Examination (MMSE), the Clock Drawing Test (CDT), and Cognistat. Clinical diagnoses, based on independent neuropsychological examination and a medical consensus discussion in secondary care, were used as criteria for diagnostic accuracy analyses. Results. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.85, 0.79, 0.85, and 0.79, respectively, for Cognistat; 0.59, 0.91, 0.90, and 0.61 for MMSE; 0.26, 0.88, 0.75, and 0.46 for CDT; 0.70, 0.79, 0.82, and 0.65 for MMSE and CDT combined. The area under the receiver operating characteristic curve was 0.82 for Cognistat, 0.75 for MMSE, 0.57 for CDT, and 0.74 for MMSE and CDT combined. Conclusions. The diagnostic accuracy and clinical utility of Cognistat was better than the other tests alone or combined. Cognistat is well adapted for cognitive evaluations in PHC and can help the general practitioner to decide which patients should be referred to secondary care. [ABSTRACT FROM AUTHOR]

A prospective cohort, noncomparative, multicenter trial was conducted to explore the potential of a phytotherapeutic compound, available as a dietary supplement and containing extracts of Bacopa monnieri and Haematococcus pluvialis (astaxanthin) plus phosphatidylserine and vitamin E, in improving cognition in subjects diagnosed with mild cognitive impairment. Enrolled subjects (n=104) were aged 71.2±9.9 years and had a mini-mental state examination score of 26.0±2.0 (mean ± standard deviation). They underwent the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) test and the clock drawing test at baseline and upon completion of a 60-day period of dietary supplementation with one tablet daily of the tested compound. In 102 assessable subjects, total ADAS-cog scores improved from 13.7±5.8 at baseline to 9.7±4.9 on day 60, and the clock drawing test scores improved from 8.5±2.3 to 9.1±1.9. Both changes were statistically significant (P,0.001). Memory tasks were the individual components of ADAS-cog showing the largest improvements. In a multivariate analysis, larger improvements in total ADAS-cog score were associated with less compromised baseline mini-mental state examination scores. Perceived efficacy was rated as excellent or good by 62% of study subjects. The tested compound was well tolerated; one nonserious adverse event was reported in the overall study population, and perceived tolerability was rated excellent or good by 99% of the subjects. In conclusion, dietary supplementation with the tested compound shows potential for counteracting cognitive impairment in subjects with mild cognitive impairment and warrants further investigation in adequately controlled, longer-term studies. [ABSTRACT FROM AUTHOR]

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

The clock drawing (CDT) and verbal fluency tests (VF) is a simple application widely used in neuropsychological evaluations aimed to investigate dementia in elderly. The diagnosis of Alzheimer's disease is clinical, but the cognitive tests are of great help during the anamnesis. The objective this study was to evaluate the correlation between the tests of verbal fluency and clock drawing test and other cognitive tests used in Alzheimer's disease screening. Cross-sectional study with 130 elderly, evaluated by the instruments: Cambridge cognitive examination (Camcog), mini mental state exam (MMSE), VF and CDT. Alzheimer's disease criteria were based on National Institute for Communicative Disorders and Stroke -- Alzheimer's Disease and Related Disorders Association (Nincds-ADRDA). Normal control group was formed considering subjects did not fill the criteria for dementia syndrome. The results showed a significant and moderate correlation between the instruments used. It can be concluded that the tests may be used in combination showing a good correlation for this population. [ABSTRACT FROM AUTHOR]