Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-19T05:47:41.104Z Has data issue: false hasContentIssue false
  • English
  • Français

A reduced scoring system for the Clock Drawing Test using a population-based sample

Published online by Cambridge University Press:  01 June 2012

Alexandra Jouk  and
Holly Tuokko
Alexandra Jouk*
Affiliation:
Department of Psychology and Centre on Aging, University of Victoria, Victoria, British Columbia, Canada
Holly Tuokko
Affiliation:
Department of Psychology and Centre on Aging, University of Victoria, Victoria, British Columbia, Canada
*
Correspondence should be addressed to: Alexandra Jouk, Centre on Aging, University of Victoria, PO BOX 1700, STN CSC, Victoria, BC, CanadaV8W 2Y2. Phone: +1(250) 532-6361; Fax: +1(250) 721-6499. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Many scoring systems exist for clock drawing task variants, which are common dementia screening measures, but all have been derived from clinical samples. This study evaluates and combines errors from two published scoring systems for the Clock Drawing Test (CDT), the Lessig and Tuokko methods, in order to create a simple yet optimal scoring procedure to screen for dementia using a Canadian population-based sample.

Methods: Clock-drawings from 356 participants (80 with dementia, 276 healthy controls) from the Canadian Study on Health and Aging were analyzed using logistic regression and Receiver Operating Characteristic curves to determine a new, simplified, population-based CDT scoring system. The new Jouk scoring method was then compared to other commonly used systems (e.g. Shulman, Tuokko, Watson, Wolf-Klein).

Results: The Jouk scoring system reduced the Lessig system even further to include five critical errors: missing numbers, repeated numbers, number orientation, extra marks, and number distance, and produced a sensitivity of 81% and a specificity of 68% with a cut-off score of one error. With regard to other traditionally used scoring methods, the Jouk procedure had one of the most balanced sensitivities/specificities when using a population-based sample.

Conclusions: The results from this study improve our current state of knowledge concerning the CDT by validating the simplified scoring system proposed by Lessig and her colleagues in a more representative sample to mimic conditions a general clinician or researcher will encounter when working among a wide-ranging population and not a dementia/memory clinic. The Jouk CDT scoring system provides further evidence in support of a simple and reliable dementia-screening tool that can be used by clinicians and researchers alike.

Keywords

dementiacognitive assessmentdiagnosis and classificationneuropsychological testing
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 11 , November 2012 , pp. 1738 - 1748
Copyright
Copyright © International Psychogeriatric Association 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ainslie, N. K. and Murden, R. A. (1993). Effect of education on the clock-drawing dementia screen in non-demented elderly persons. Journal of the American Geriatrics Society, 41, 249–252.CrossRefGoogle ScholarPubMed
Alzheimer's Association (2007). Alzheimer's Disease Facts and Figures. Available at: http://www.alz.org/national/documents/Report_2007FactsAndFigures.pdf.Google Scholar
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. Washington, DC: American Psychiatric Association.Google Scholar
Bischkopf, J. J., Busse, A. A. and Angermeyer, M. C. (2002). Mild cognitive impairment: a review of prevalence, incidence and outcome according to current approaches. Acta Psychiatrica Scandinavica, 106, 403–414.Google Scholar
Blair, M., Kertesz, A., McGonagle, P., Davidson, W. and Bodi, N. (2006). Quantitative and qualitative analyses of clock drawing in frontotemporal dementia and Alzheimer's disease. Journal of the International Neuropsychological Society, 12, 159–165.CrossRefGoogle ScholarPubMed
CSHA Working Group (1994). Canadian Study of Health and Aging: study methods and prevalence of dementia. Canadian Medical Association Journal, 150, 899–913.Google Scholar
Ehreke, L., Luppa, M., Konig, H. H. and Riedel-Heller, S. G. (2010). Is the Clock Drawing Test a screening tool for the diagnosis of mild cognitive impairment? A systematic review. International Psychogeriatrics, 21, 56–63.CrossRefGoogle Scholar
Essex-Sorlie, D. (1995). Medical Biostatistics and Epidemiology. Norwalk, CT: Appleton and Lange.Google Scholar
Lee, K. S., Kim, E. A., Hong, C. H., Lee, D.-W., Oh, B. H. and Cheong, H.-K. (2008). Clock Drawing Test in mild cognitive impairment: quantitative analysis of four scoring methods and qualitative analysis. Dementia and Geriatric Cognitive Disorders, 26, 483–489.Google Scholar
Lessig, M. C., Scanlan, J. M., Nazemi, H. and Borson, S. (2008). Time that tells: critical clock drawing errors for dementia screening. International Psychogeriatrics, 20, 459–470.CrossRefGoogle ScholarPubMed
Leung, J. C. W., Lui, V. W. C. and Lam, L. C. W. (2005). Screening for early Alzheimer's disease in elderly Chinese patients using the Chinese Clock Drawing Test. Hong Kong Journal of Psychiatry, 15, 14–17.Google Scholar
Lin, K. et al. (2003). The three-item Clock-Drawing Test: a simplified screening test for Alzheimer's disease. European Neurology, 49, 53–58.CrossRefGoogle Scholar
Manos, P. J. (1999). Ten-point clock test sensitivity for Alzheimer's disease in patient with MMSE scores greater than 23. International Journal of Geriatric Psychiatry, 14, 454–458.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Mendez, M. F., Ala, T. and Underwood, K. L. (1992). Development of scoring criteria for the clock drawing task in Alzheimer's disease. Journal of the American Geriatrics Society, 40, 1095–1099.Google Scholar
O'Rourke, N., Tuokko, H., Hayden, S. and Beattie, B. L. (1997). Early identification of dementia: predictive validity of the clock test. Archives of Clinical Neuropsychology, 12, 257–267.CrossRefGoogle ScholarPubMed
Pinto, E. and Peters, R. (2009). Literature review of the Clock Drawing Test as a tool for dementia screening. Dementia and Geriatric Cognitive Disorders, 27, 201–213.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.Google Scholar
Royall, D. R., Cordes, J. A. and Polk, M. (1998). CLOX: an executive clock-drawing task. Journal of Neurology, Neurosurgery, & Psychiatry, 64, 588–594.Google Scholar
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., Sheldetsky, R. and Silver, I. (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
Sliwinski, M., Lipton, R., Buschke, H. and Wasylyshan, C. (2003). Optimizing cognitive test norms for detection. In Petersen, R. C. (ed.), Mild Cognitive Impairment: Aging to Alzheimer's Disease (pp. 89–104). New York: Oxford University Press.Google 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
Tuokko, H., Hadjistavropoulos, T., Miller, J. A. and Beattie, B. L. (1992). The clock test: a sensitive measure to differentiate normal elderly from those with Alzheimer disease. Journal of the American Geriatrics Society, 40, 579–584.Google Scholar
Tuokko, H., Hadjistavropoulos, T., Miller, J. A., Horton, A. and Beattie, B. L. (1995a). The Clock Test: Administration and Scoring Manual. Toronto: Mental Health Systems.Google Scholar
Tuokko, H., Kristjansson, E. and Miller, J. (1995b). Neuropsychological detection of dementia: an overview of the neuropsychological component of the Canadian Study of Health and Aging. Journal of Clinical and Experimental Neuropsychology, 17, 352–373.Google Scholar
Watson, Y. I., Arfken, C. L. and Birge, S. J. (1993). Clock completion: an objective screening test for dementia. Journal of the American Geriatrics Society, 41, 1235–1240.Google Scholar
Wolf-Klein, G. P., Silverstone, F. A., Levy, A. P. and Brod, M. S. (1989). Screening for Alzheimer's disease by clock drawing. Journal of the American Geriatrics Society, 37, 730–734.CrossRefGoogle ScholarPubMed