Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-19T06:35:40.317Z Has data issue: false hasContentIssue false
  • English
  • Français

A pilot study of performance among hospitalised elderly patients on a novel test of visuospatial cognition: the letter and shape drawing (LSD) test

Published online by Cambridge University Press:  02 November 2016

D. White ,
O. A. Williams ,
M. Leonard ,
C. Exton ,
D. Adamis ,
A. Hannigan ,
W. Cullen ,
C. P. Dunne  and
D. Meagher
D. White
Affiliation:
University College Hospital, Galway, Ireland
O. A. Williams
Affiliation:
Beaumont Hospital, Dublin, Ireland
C. Exton
Affiliation:
University of Limerick, Castletroy, Limerick, Ireland
D. Adamis
Affiliation:
Sligo Mental Health Services, Ballytivan Road, Sligo, Ireland
A. Hannigan
Affiliation:
Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, Ireland
W. Cullen
Affiliation:
University College Dublin, Belfield, Dublin, Ireland
C. P. Dunne
Affiliation:
Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, Ireland
D. Meagher*
Affiliation:
Graduate Entry Medical School, University of Limerick, Castletroy, Limerick, Ireland
*
*Address for correspondence: Professor D. Meagher, Graduate Entry Medical School, University of Limerick, Ireland. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Conventional bedside tests of visuospatial function such as the clock drawing (CDT) and intersecting pentagons tests (IPT) are subject to considerable inconsistency in their delivery and interpretation. We compared performance on a novel test – the letter and shape drawing (LSD) test – with these conventional tests in hospitalised elderly patients.

Methods

The LSD, IPT, CDT and the Montreal Cognitive Assessment (MoCA) were performed in 40 acute elderly medical inpatients at University Hospital Limerick The correlation between these tests was examined as well as the accuracy of the visuospatial tests to identify significant cognitive impairment on the MoCA.

Results

The patients (mean age 81.0±7.71; 21 female) had a median MoCA score of 15.5 (range=1–29). There was a strong, positive correlation between the LSD and both the CDT (r=0.56) and IPT (r=0.71). The correlation between the LSD and MoCA (r=0.91) was greater than for the CDT and IPT (both 0.67). The LSD correlated highly with all MoCA domains (ranging from 0.54 to 0.86) and especially for the domains of orientation (r=0.86), attention (0.81) and visuospatial function (r=0.73). Two or more errors on the LSD identified 90% (26/29) of those patients with MoCA scores of ⩽20, which was substantially higher than for the CDT (59%) and IPT (55%).

Conclusion

The LSD is a novel test of visuospatial function that is brief, readily administered and easily interpreted. Performance correlates strongly with other tests of visuospatial ability, with favourable ability to identify patients with significant impairment of general cognition.

Keywords

Assessmentcognitionletter and shape drawing testMontreal Cognitive Assessment toolvisuospatial
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 34 , Issue 3 , September 2017 , pp. 169 - 175
Copyright
© College of Psychiatrists of Ireland 2016 

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.)

Footnotes

✠

Deceased.

References

Bellelli, G, Morandi, A, Davis, DHJ, Mazzola, P, Turco, R, Gentile, S, Ryan T, Cash H, Guerini F, Torpilliesi T, Del Santo F, Trabucchi M, Annoni G, MacLullich AM (2014). Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing 43, 496–502.CrossRefGoogle ScholarPubMed
Bender, L (1938). A visual motor gestalt test and its clinical use [Internet]. American Orthopsychiatric Association (http://books.google.ie/books?id=DJstAAAAMAAJ). Accessed 24 June 2014.Google Scholar
Borson, S, Scanlan, JM, Peijun, Chen, Ganguli, M (2003). The Mini-Cog as a screen for dementia: validation in a population-based sample. Journal of the American Geriatrics Society 51, 1451–1454.CrossRefGoogle Scholar
Bourke, J, Castlenden, CM, Stephen, R, Dennis, M (1995). A comparison of clock and pentagons drawing in Alzheimer’s disease. International Journal of Geriatric Psychiatry 10, 703–705.CrossRefGoogle Scholar
Brown, LJ, McGrory, S, McLaren, L, Starr, JM, Deary, IJ, Maclullich, AM (2009). Cognitive visual perceptual deficits in patients with delirium. Journal of Neurology Neurosurgery and Psychiatry 80, 594–599.CrossRefGoogle ScholarPubMed
European Delirium Association, American Delirium Society (2014). The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer. BMC Medicine 12, 141.Google Scholar
Folstein, MF, Folstein, SE, McHugh, PR (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 Scholar
Freedman, M, Leach, L, Kaplan, E, Winocur, G, Shulman, K, Delis, DC (1994). Clock Drawing: A Neuropsychological Analysis. Oxford University Press: New York.Google Scholar
Giannakopoulos, P, Duc, M, Gold, G, Hof, PR, Michel, JP, Bouras, C (1998). Pathologic correlates of apraxia in Alzheimer disease. Archives of Neurology 55, 689–695.Google Scholar
Hanley, JA, McNeil, BJ (1983). A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148, 839–843.CrossRefGoogle ScholarPubMed
Helmes, E (2013). Cognitive screening of older adults: the utility of pentagon drawing. International Psychogeriatrics 25, 413–419.Google Scholar
Hong, YJ, Yoon, B, Shim, YS, Cho, A-H, Lee, E-S, Kim, Y-I, Yang DW (2011). Effect of literacy and education on the visuoconstructional ability of non-demented elderly individuals. Journal of the International Neuropsychology Society 17, 934–939.Google Scholar
Inouye, SK, van Dyck, CH, Alessi, CA, Balkin, S, Siegal, AP, Horwitz, RI (1990). Clarifying Confusion: the confusion assessment method. Annals of Internal Medicine 113, 941–948.CrossRefGoogle ScholarPubMed
Koski, L. (2013). Validity and applications of the montreal cognitive assessment for the assessment of vascular cognitive impairment. Cerebrovascular Disease 36, 6–18.Google Scholar
Lezak, MD, Howieson, DB, Loring, DW (2004). Neuropsychological Assessment. Oxford University Press: New York.Google Scholar
Meagher, DJ, Moran, M, Raju, B, Gibbons, D, Donnelly, S, Saunders, J, Trzepacz, PT (2007). Phenomenology of delirium. Assessment of 100 adult cases using standardised measures. British Journal of Psychiatry 190, 135–141.Google Scholar
Meagher, D, Leonard, M, Donnelly, S, Conroy, M, Saunders, J, Trzepacz, P (2010). Comparison of neuropsychiatric and cognitive profiles in delirium, dementia, comorbid delirium-dementia and cognitively intact controls. Journal of Neurology Neurosurgery and Psychiatry 81, 876–881.CrossRefGoogle ScholarPubMed
Nasreddine, ZS, Phillips, NA, Bédirian, V, Charbonneau, S, Whitehead, V, Collin, I, Cummings JL, Chertkow H (2005). The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society. 53, 695–699.Google Scholar
Pinto, E, Peters, R (2009). Literature review of the clock drawing test as a tool for cognitive screening. Dementia and Geriatric Cognitive Disorders 27, 201–213.CrossRefGoogle ScholarPubMed
Price, CC, Cunningham, H, Coronado, N, Freedland, A, Cosentino, S, Penney, DL, Penisi A, Bowers D, Okun MS, Libon DJ (2011). Clock drawing in the Montreal cognitive assessment: recommendations for dementia assessment. Dementia and Geriatric Cognitive Disorders 31, 179–187.Google Scholar
Robin, X, Turck, N, Hainard, A, Tiberti N, Lisacek F, Sanchez J-C, Müller M (2011). pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics 7, 77.Google Scholar
Shulman, KI (2000). Clock-drawing: is it the ideal cognitive screening test? International Journal of Geriatric Psychiatry 15, 548–561.Google Scholar
Somerville-Ruffalo, J (2004). Visuoconstructional impairment: what are we assessing, and how are we assessing it? Open Access Dissertations. Paper 381 (http://digitalcommons.uri.edu/cgi/viewcontent.cgi?article=1399&context=oa_diss). Accessed 24 June 2014.Google Scholar
Sunderland, T, Hill, JL, Mellow, AM, Lawlor, BA, Gundersheimer, J, Newhouse, PA, Grafman JH (1989). Clock drawing in Alzheimer’s disease. A novel measure of dementia severity. Journal of the American Geriatrics Society 37, 725–729.CrossRefGoogle ScholarPubMed
Waldron-Perrine, B, Axelrod, BN (2012). Determining an appropriate cutting score for indication of impairment on the montreal cognitive assessment. International Journal of Geriatric Psychiatry 27, 1189–1194.Google Scholar
Wei, LA, Fearing, MA, Sternberg, EJ, Inouye, SK (2008). The confusion assessment method: a systematic review of current usage. Journal of the American Geriatrics Society 56, 823–830.Google Scholar
World Medical Association (2004). Declaration of Helsinki: ethical principles for medical research involving human subjects. http://www.wma.net/en/30publications/10policies/b3/.Google Scholar