C-17 10 Minutes Too Late: Using the Clock Drawing Test in the Era of DSM-5

Objective The Clock Drawing Test (CDT) is among the most researched measures of cognitive functioning and is frequently used by clinicians as a screening instrument for cognitive impairment. Nearly all the existing research on the CDT involves groups of patients diagnosed with a mild cognitive impairment (MCI) or dementia; however, recent updates to the diagnostic system (i.e., DSM-5) saw the creation of the mild and major neurocognitive disorders (NCD), designed to replace MCI and dementia diagnoses. These new diagnoses are similar to their predecessors, however, distinct differences exist that drastically alter the characteristics of these groups. Therefore, this study aimed to examine if qualitative errors on the CDT as described by Rouleau et al. (1992) are consistent with a diagnosis of mild or major NCD according to DSM-5. Method Data was retrospectively collected from a sample of patients seen at an outpatient clinic in eastern Massachusetts. CDTs from 14 healthy controls, 31 patients with mild NCD, and 18 patients with major NCD were made available for analysis. Results Contingency analysis revealed no significant differences in error frequencies when comparing mild NCD to healthy controls. Patients with major NCD committed significantly higher rates of specific stimulus bound (p = 0.021), conceptual (p = 0.026), and spatial/planning (p = 0.037) errors compared to others in the sample. Conclusions While CDT errors do not appear to distinguish mild NCD from healthy controls in our sample, our findings suggest that certain errors may serve as a warning sign to incipient major NCDs. Clinical implications and future directions are discussed.