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The Clock Drawing Test is a valuable cognitive screening tool. Comparing scoring systems like Montreal Cognitive Assessment and Mini-Cog revealed score correlations but also discrepancies, highlighting the importance of rater reliability in clinical settings.

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Area of Science:

  • Cognitive Neuroscience
  • Geriatric Medicine
  • Anesthesiology

Background:

  • The Clock Drawing Test (CDT) is increasingly used for cognitive screening in the perioperative setting.
  • Accurate cognitive assessment is crucial for patient safety and management during surgery.
  • Several scoring systems exist for the CDT, each with potential variations in application.

Purpose of the Study:

  • To compare the interrater and intrarater reliability of three common Clock Drawing Test scoring systems.
  • To evaluate the correlation and discrepancies between the Montreal Cognitive Assessment, Mini-Cog, and Libon scale in scoring preoperative clock drawings.
  • To inform the optimal implementation of CDT scoring in clinical practice.

Main Methods:

  • Three novice raters were trained to assess interrater and intrarater reliability for each scoring system.
  • A total of 738 preoperative clock drawings were scored using the Montreal Cognitive Assessment, Mini-Cog, and Libon scale.
  • Statistical analysis was performed to compare the reliability and correlation of the final scores.

Main Results:

  • All three scoring systems demonstrated some level of interrater and intrarater reliability among novice raters.
  • Final scores obtained from the three systems showed correlation but also exhibited notable discrepancies.
  • The Libon scale and Mini-Cog showed comparable reliability, while the Montreal Cognitive Assessment had slightly lower scores.

Conclusions:

  • While the Clock Drawing Test is a useful cognitive screening tool, discrepancies exist between common scoring systems.
  • Ensuring high interrater and intrarater reliability is essential for consistent and accurate cognitive assessment in the perioperative environment.
  • Clinical implementation of any CDT scoring system requires careful consideration of its reliability and potential for varied interpretation.