Clock drawing and neuroanatomical correlates: A systematic review

Area of Science:

• Neuroscience
• Cognitive Neurology
• Geriatrics

Background:

• The clock drawing test (CDT) is widely used for cognitive screening due to its ease of administration and good psychometric properties.
• Despite its primary use, research has explored the CDT's potential for localizing specific brain lesions or pathologies.

Purpose of the Study:

• To systematically review and summarize existing evidence on the neuroanatomical correlates of the clock drawing test (CDT).

Main Methods:

• A systematic literature search was conducted across six major databases (PubMed, CINAHL, PsychINFO, HealthStar, Embase, Web of Science) up to January 2018.
• Studies were included if they reported correlations between CDT performance and anatomical brain lesions identified via neuroimaging, adhering to PRISMA guidelines.

Main Results:

• Forty-five studies met the inclusion criteria, with 31 identifying various neuroanatomical correlates for CDT performance using different scoring methods and imaging techniques.
• Nine studies linked white matter hyperintensities to lower CDT scores and cognitive deficits, while five focused on cerebrovascular accidents.
• A wide range of brain lesions across all brain areas were associated with CDT abnormalities.

Conclusions:

• The CDT does not demonstrate consistent, specific brain localization across different scoring methods and populations.
• This systematic review supports the continued use of the CDT as a cognitive screening instrument, rather than a tool for localizing brain lesions.