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Clock Drawing Test: Types of Errors and Accuracy in Early Cognitive Screening.

Karolina Sejunaite1, Frederic Gaucher1, Claudia Lanza1

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Summary

The Clock Drawing Test (CDT) shows limited use for very mild cognitive deficits, especially in early Alzheimer's disease (AD) and depressive disorder (DD) screening. Itemized scoring offers better discrimination than Shulman scoring for mild impairment.

Keywords:
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Area of Science:

  • Neurology
  • Geriatrics
  • Cognitive Science

Background:

  • The Clock Drawing Test (CDT) is a widely used screening tool for cognitive disorders.
  • Its ease of use is contrasted by poor predictive value in mild cognitive impairment cases.

Purpose of the Study:

  • To evaluate the Clock Drawing Test (CDT) for screening early-stage cognitive impairment.
  • Focus on biomarker-verified Alzheimer's disease (AD) and depressive disorder (DD).

Main Methods:

  • Analysis of CDT performance in 172 AD patients, 70 DD patients, and 58 healthy adults.
  • CDT scoring utilized both semi-quantitative (Shulman) and itemized (Mendez) criteria.
  • Logistic regression analyzed predictive variables based on Mini-Mental State Examination (MMSE) scores.

Main Results:

  • Uneven number spacing was a significant predictor for both DD and AD patients with high MMSE scores.
  • As MMSE scores declined (24-26), errors in setting clock hands became predictive.
  • CDT demonstrated acceptable discrimination for AD and DD in low MMSE conditions (AUCs ranging from 0.739 to 0.827).
  • Itemized scoring showed acceptable discrimination in high MMSE conditions, while Shulman scoring performed poorly for both AD and DD.

Conclusions:

  • The CDT has limited utility for screening very mild cognitive deficits, particularly when cognitive performance is only slightly below the healthy range.
  • Modern diagnostics should ideally precede significant cognitive decline for effective intervention.
  • Itemized CDT scoring may offer superior discrimination in early-stage cognitive impairment compared to Shulman scoring.