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Is the Clock Drawing Test a screening tool for the diagnosis of mild cognitive impairment? A systematic review

Published online by Cambridge University Press:  20 August 2009

Lena Ehreke ,
Melanie Luppa ,
Hans-Helmut König  and
Steffi G. Riedel-Heller
Lena Ehreke*
Affiliation:
Department of Psychiatry, Public Mental Health Research Unit, University of Leipzig, Leipzig, Germany
Melanie Luppa
Affiliation:
Department of Psychiatry, Public Mental Health Research Unit, University of Leipzig, Leipzig, Germany
Hans-Helmut König
Affiliation:
Department of Psychiatry, Health Economics Research Unit, University of Leipzig, Germany
Steffi G. Riedel-Heller
Affiliation:
Department of Psychiatry, Public Mental Health Research Unit, University of Leipzig, Leipzig, Germany Department of Social Medicine, University of Leipzig, Germany
*
Correspondence should be addressed to: Lena Ehreke, University of Leipzig, Department of Mental Health, Psychiatry and Psychotherapy Clinic, Public Mental Health Research Unit, Semmelweisstraße 10, D-04103 Leipzig, Germany. Phone +49–341-9724591; Fax +49–341-9724539. Email: [email protected].
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Abstract

Background: The clock drawing test (CDT) is a common and widely used cognitive screening instrument for the diagnosis of dementia. However, it has remained unclear whether it is a suitable method to identify mild cognitive impairment (MCI). The aim of this paper is to review systematically the studies concerning the utility of the CDT in diagnosing MCI.

Method: A systematic literature search was conducted. All studies dealing with utility of CDT in diagnosing MCI regardless of the applied CDT scoring system and MCI concept were selected.

Results: Nine relevant studies were identified. The majority of the studies compared average CDT scores of cognitively healthy and mildly impaired subjects, and four of them identified significant mean differences. If reported, sensitivity and specificity have been mostly unsatisfactory.

Conclusion: CDT should not be used for MCI-screening.

Keywords

mild cognitive impairment (MCI)Clock Drawing Testsystematic review
Type
Review Article
Information
International Psychogeriatrics , Volume 22 , Issue 1 , February 2010 , pp. 56 - 63
Copyright
Copyright © International Psychogeriatric Association 2009

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References

Babins, L., Slater, M.-E., Whitehead, V. and Chertkow, H. (2008). Can an 18-point clock-drawing scoring system predict dementia in elderly individuals with mild cognitive impairment? Journal of Clinical and Experimental Neuropsychology, 30, 173–186.CrossRefGoogle ScholarPubMed
Beinhoff, U., Hilbert, V., Bittner, D., Grön, G. and Riepe, M. W. (2005). Screening for cognitive impairment: a triage for outpatient care. Dementia and Geriatric Cognitive Disorders, 20, 278–285.CrossRefGoogle ScholarPubMed
Blake, H., McKinney, M., Treece, K., Lee, E. and Lincoln, N. B. (2002). An evaluation of screening measures for cognitive impairment after stroke. Age and Ageing, 31, 451–456.CrossRefGoogle ScholarPubMed
Brodaty, H., Howarth, G. C., Mant, A. and Kurrle, S. E. (1994). General practice and dementia: a national survey of Australian GPs. Medical Journal of Australia, 160, 10–14.CrossRefGoogle ScholarPubMed
Busse, A., Hensel, A., Gühne, U., Angermeyer, M. C. and Riedel-Heller, S. G. (2006). Mild cognitive impairment: long-term course of four clinical subtypes. Neurology, 67, 2176–2185.CrossRefGoogle ScholarPubMed
Cahn, D. A., Salmon, D. P., Monsch, A. U., Butters, N., Wiederholt, W. C. and Corey-Bloom, J. (1996). Screening for dementia of the Alzheimer type in the community: the utility of the clock drawing test. Archives of Clinical Neuropsychology, 11, 529–539.CrossRefGoogle ScholarPubMed
Chiu, Y.-C., Li, C.-L., Lin, K.-N., Chiu, Y.-F. and Liu, H.-C. (2008). Sensitivity and specificity of the clock drawing test, incorporating Rouleau scoring system, as a screening instrument for questionable and mild dementia: scale development. International Journal of Nursing Studies, 45, 75–84.CrossRefGoogle ScholarPubMed
Crook, T., Bartus, R. T., Ferris, S. H., Whitehouse, P., Cohen, G. D. and Gershon, S. (1986). Age-associated memory impairment: proposed diagnostic criteria and measures of clinical change. Report of a National Institute of Mental Health Work Group. Developmental Neuropsychology, 2, 261–276.CrossRefGoogle Scholar
Donelly, K., Donelly, J. P. and Cory, E. (2008). Primary care screening for cognitive impairment in elderly veterans. American Journal of Alzheimer's Disease and Other Dementias, 23, 218–226.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental-state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Freedman, M., Leach, L., Kaplan, E., Delis, D., Shulman, K. and Winocur, G. (1994). Clock Drawing: A Neuropsychological Analysis. NewYork: Oxford University Press.Google Scholar
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572.CrossRefGoogle ScholarPubMed
Jackson, C. E. and Snyder, P. J. (2008). Electroencephalography and event-related potentials as biomarkers of mild cognitive impairment and mild Alzheimer's disease. Alzheimer's and Dementia, 4, 137–143.CrossRefGoogle ScholarPubMed
Juby, A., Tench, S. and Baker, V. (2002). The value of clock drawing in identifying executive cognitive dysfunction in people with a normal Mini-mental State Examination score. Canadian Medical Association Journal, 167, 859–864.Google ScholarPubMed
Kral, V. A. (1962). Senescent forgetfulness: benign and malignant. Canadian Medical Association Journal, 86, 257–260.Google ScholarPubMed
Levy, R. (1994). Aging-associated cognitive decline. Working Party of the International Psychogeriatric Association in collaboration with the World Health Organization. International Psychogeriatrics, 6, 63–68.Google ScholarPubMed
Luck, T. et al. (2007). Mild cognitive impairment in general practice: age-specific prevalence and correlate results from the German study on Ageing, cognition and dementia in primary care patients (AgeCoDe). Dementia and Geriatric Cognitive Disorders, 24, 307–316.CrossRefGoogle Scholar
Nishiwaki, Y., Breeze, E., Smeeth, L., Bulpitt, C. J., Peters, R. and Fletcher, A. E. (2004). Validity of the clock-drawing test as a screening tool for cognitive impairment in the elderly. American Journal of Epidemiology, 160, 797–807.CrossRefGoogle ScholarPubMed
Nunes, P. V. et al. (2008). CAMCOG as a screening tool for diagnosis of mild cognitive impairment and dementia in a Brazilian clinical sample of moderate to high education. International Journal of Geriatric Psychiatry, 23, 1127–1133.CrossRefGoogle Scholar
Paganini-Hill, A., Clark, L. J., Henderson, V. W. and Birge, S. J. (2001). Clock drawing: analysis in a retirement community. Journal of the American Geriatrics Society, 49, 941–947.CrossRefGoogle Scholar
Panza, F. et al. (2005). Current epidemiology of mild cognitive impairment and other predemtia syndromes. American Journal of Geriatric Psychiatry, 13, 633–644.CrossRefGoogle ScholarPubMed
Petersen, R. C. and Negash, S. (2008). Mild cognitive impairment: an overview. CNS Spectrums, 13, 45–53.CrossRefGoogle ScholarPubMed
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G. and Kokmen, E. (1999). Mild cognitive impairment: clinical characterization and outcome. Archives of Neurology, 56, 303–308.CrossRefGoogle ScholarPubMed
Petersen, R. C. et al. (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 58, 1985–1992.CrossRefGoogle ScholarPubMed
Ravaglia, G. et al. (2005). Screening for mild cognitive impairment in elderly ambulatory patients with cognitive complaints. Aging: Clinical and Experimental Research, 17, 374–379.Google ScholarPubMed
Reisberg, B., Ferris, S. H., De Leon, M. J. and Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google ScholarPubMed
Ries, M. L. et al. (2008). Magnetic resonance imaging characterization of brain structure and function in mild cognitive impairment: a review. Journal of the American Geriatrics Society, 56, 920–934.CrossRefGoogle ScholarPubMed
Roth, M. et al. (1986). CAMDEX: a standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry, 149, 698–709.CrossRefGoogle Scholar
Roth, M., Huppert, F. A., Tym, E. and Mountjoy, C. Q. (1988). CAMDEX: The Cambridge Examination for Mental Disorders of the Elderly. Cambridge: Cambridge University Press.Google Scholar
Rouleau, I., Salmon, D. P., Butters, N., Kennedy, C. and McGuire, K. (1992). Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease. Brain and Cognition, 18, 70–87.CrossRefGoogle ScholarPubMed
Rouleau, I., Salmon, D. P. and Butters, N. (1996). Longitudinal analysis of clock drawing in Alzheimer's disease patients. Brain and Cognition, 31, 17–34.CrossRefGoogle ScholarPubMed
Sager, M. A., Hermann, B. P., La Rue, A. and Woodard, J. L. (2006). Screening for dementia in community-based memory clinics. Wisconsin Medical Journal, 105, 25–29.Google ScholarPubMed
Scanlan, J. M., Brush, M., Quijano, C. and Borson, S. (2002). Comparing clock tests for dementia screening: naive judgments vs formal systems – what is optimal? International Journal of Geriatric Psychiatry, 17, 14–21.CrossRefGoogle ScholarPubMed
Shulman, K. I. (2000). Clock-drawing: Is it the ideal cognitive screening test? International Journal of Geriatric Psychiatry, 15, 548–561.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Shulman, K. I., Shedletsky, R. and Silver, I. L. (1986). The challenge of time: clock drawing and cognitive function in the elderly. International Journal of Geriatric Psychiatry, 1, 135–140.CrossRefGoogle Scholar
Shulman, K. I., Gold, D. P., Cohen, C. A. and Zucchero, C. A. (1993). Clock-drawing and dementia in the community: a longitudinal study. International Journal of Geriatric Psychiatry, 8, 487–496.CrossRefGoogle Scholar
Sunderland, T. et al. (1989). Clock drawing in Alzheimer's disease: a novel measure of dementia severity. Journal of the American Geriatrics Society, 37, 725–729.CrossRefGoogle ScholarPubMed
Thalmann, B., Monsch, A. U., Schneitter, M., Ermini-Fünschilling, D., Spiegel, R. and Stähelin, H. B. (1998). Die CERAD Neuropsychologische Testbatterie. Ein gemeinsames minimales Instrumentarium zur Demenzabklärung. Memory Clinic, Geriatrische Universitätsklinik, Schanzenstrasse 55, CH-4021 Basel.Google Scholar
Thomann, P. A., Toro, P., Dos Santos, V., Essig, M. and Schröder, J. (2008). Clock drawing performance and brain morphology in mild cognitive impairment and Alzheimer's disease. Brain and Cognition, 67, 88–93.CrossRefGoogle ScholarPubMed
Winblad, B. et al. (2004). Mild cognitive impairment: beyond controversies, towards a consensus. Report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.CrossRefGoogle ScholarPubMed
Wolf-Klein, G. P., Silverstone, F. A., Levy, A. P., Brod, M. S. and Breuer, J. (1989). Screening for Alzheimer's disease by clock drawing. Journal of the American Geriatrics Society, 37, 730–734.CrossRefGoogle ScholarPubMed
Yamamoto, S. et al. (2004). The clock drawing test as a valid screening method for mild cognitive impairment. Dementia and Geriatric Cognitive Disorders, 18, 172–179.CrossRefGoogle ScholarPubMed
Zanetti, M., Ballabio, C., Abbate, C., Cutaia, C., Vergani, C. and Bergamaschini, L. (2006). Mild cognitive impairment subtypes and vascular dementia in community-dwelling elderly people: a 3-year follow-up study. Journal of the American Geriatrics Society, 54, 580–586.CrossRefGoogle ScholarPubMed
Zaudig, M. and Hiller, W. (1995). SIDAM: Strukturiertes Interview für die Diagnose einer Demenz vom Alzheimertyp, der Multiinfarkt-Demenz und Demenzen anderer Ätiologie nach DSM-III-R, DSM-IV und ICD-10 [Manual]. 1. Aufl. Bern: Hans Huber Verlag.Google Scholar
Zhou, A. and Jia, J. (2008). The value of the clock drawing test and the Mini-mental State Examination for identifying vascular cognitive impairment no dementia. International Journal of Geriatric Psychiatry, 23, 422–426.CrossRefGoogle ScholarPubMed