Assessing Performance on Digital Clock Drawing Test in Aged Patients With Cerebral Small Vessel Disease

The term small vessel disease (SVD) encompasses all the pathological processes that affect the small vessels of the brain, including small arteries and arterioles but also capillaries and small veins, which can result in multi-domain cognitive deficits. The digital clock drawing test (dCDT) has been proved to be a more useful assessment tool for cognitive disorders compared to traditional clock drawing test DT (tCDT) in many neuropsychological diseases. This study aimed to check whether this tool worked well in capturing some specific aspects of cognitive performance in aged patients with SVD. A total of 20 aged patients with high-burden SVD (severe-SVD), 10 aged patients with low burden SVD (low-SVD), and 10 age-matched (healthy) individuals were grouped according to Fazekas' score. The dCDT and a series of neuropsychological assessments were performed to evaluate the cognitive function of participants. severe-SVD patients showed higher air-time percentage and lower mean handwriting/drawing pressure on surface during drawing compared with low-SVD and healthy subjects. The linear regression analysis adjusted for age, gender and education showed that the air-time percentage during drawing correlated with the choice reaction test (CRT) and the digit symbol substitution test (DSST), and the mean handwriting/drawing pressure on surface showed a limited correlation with DSST. The data indicated that some early manifestations of cognitive deficits in aged patients with SVD could be detected using the dCDT with a brand-new perspective different from the tCDT.