Dement Neurocogn Disord.  2018 Sep;17(3):100-109. 10.12779/dnd.2018.17.3.100.

Usefulness of the Clock Drawing Test as a Cognitive Screening Instrument for Mild Cognitive Impairment and Mild Dementia: an Evaluation Using Three Scoring Systems

• Kim S
• Jahng S
• Yu KH
• Lee BC
• Kang Y

• KMID: 2442799
• DOI: http://doi.org/10.12779/dnd.2018.17.3.100

Abstract

BACKGROUND AND PURPOSE
Although the clock drawing test (CDT) is a widely used cognitive screening instrument, there have been inconsistent findings regarding its utility with various scoring systems in patients with mild cognitive impairment (MCI) or dementia. The present study aimed to identify whether patients with MCI or dementia exhibited impairment on the CDT using three different scoring systems, and to determine which scoring system is more useful for detecting MCI and mild dementia.
METHODS
Patients with amnestic mild cognitive impairment (aMCI), vascular mild cognitive impairment (VaMCI), mild Alzheimer's disease (AD), mild vascular dementia (VaD), and cognitively normal older adults (CN) were included. All participants were administered the CDT, the Korean-Mini Mental State Examination (K-MMSE), and the Clinical Dementia Rating scale. The CDT was scored using the 3-, 5-, and 15-point scoring systems.
RESULTS
On all three scoring systems, all patient groups demonstrated significantly lower scores than the CN. However, while there were no significant differences among patients with aMCI, VaMCI, and AD, those with VaD exhibited the lowest scores. Area under the Receiver Operating Characteristic curves revealed that the three CDT scoring systems were comparable with the K-MMSE in differentiating aMCI, VaMCI, and VaD from CN. In differentiating AD from CN, however, the CDT using the 15-point scoring system demonstrated the most comparable discriminability with K-MMSE.
CONCLUSIONS
The results demonstrated that the CDT is a useful cognitive screening tool that is comparable with the Mini-Mental State Examination, and that simple CDT scoring systems are sufficient for differentiating patients with MCI and mild dementia from CN.

Keyword

Clock Drawing Test; Mini Mental State Examination; Mild Cognitive Impairment; Alzheimer's Disease; Vascular Dementia

MeSH Terms

Adult
Alzheimer Disease
Dementia*
Dementia, Vascular
Humans
Mass Screening*
Mild Cognitive Impairment*
ROC Curve

Figure

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  Fig. 1 Scoring systems of the clock drawing test. *“O” all of the scoring criteria in the corresponding column must be satisfied in order to assign points in each scoring system.

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  Fig. 2 Receiver operating characteristic curves of CDT and K-MMSE for mild cognitive impairment and dementia patient groups. CDT: clock drawing test, K-MMSE: Korean Mini-Mental State Examination, aMCI: amnestic mild cognitive impairment, VaMCI: vascular mild cognitive impairment, AD: Alzheimer's disease, VaD: vascular dementia.

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