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Clock Drawing Test – screening utility for mild cognitive impairment according to different scoring systems: results of the Leipzig Longitudinal Study of the Aged (LEILA 75+)

Published online by Cambridge University Press:  04 August 2011

Lena Ehreke ,
Tobias Luck ,
Melanie Luppa ,
Hans-Helmut König ,
Arno Villringer  and
Steffi G. Riedel-Heller
Lena Ehreke*
Affiliation:
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
Tobias Luck
Affiliation:
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany LIFE – Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
Melanie Luppa
Affiliation:
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
Hans-Helmut König
Affiliation:
Department of Medical Sociology and Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Arno Villringer
Affiliation:
Max Planck Institute for Human Cognitive and Brain Sciences and Day Clinic of Cognitive Neurology, University of Leipzig, Leipzig, Germany
Steffi G. Riedel-Heller
Affiliation:
Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
*
Correspondence should be addressed to: Lena Ehreke, Institute of Social Medicine, Occupational Health and Public Health, Philipp-Rosenthal-Straße 55, D-04103 Leipzig, Germany. Phone +49-341-9724591; Fax +49-341-9724569. Email: [email protected].
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Abstract

Background: There is a strong demand for screening instruments for mild cognitive impairment (MCI), as a pre-stage of dementia. The clock drawing test (CDT) is widely used to screen for dementia, but the utility in screening for MCI remains uncertain. In particular, it is still questionable which scoring system is the best in order to screen for MCI. We therefore aimed to compare the utility of different CDT scoring systems for screening for MCI.

Methods: In a sample of 428 subjects of the Leipzig Longitudinal Study of the Aged (LEILA 75+) study, CDT scores of different scoring systems were compared between subjects with and without MCI. Comparison of receiver operating characteristic (ROC; area under the curve, sensitivity, specificity) was performed and inter-rater reliability was calculated.

Results: The CDT scores differed significantly between MCI and non-MCI subjects according to all scoring systems applied. However, ROC of the CDT scores was not adequate.

Conclusions: None of the present CDT scoring systems has sufficient utility to screen reliably for MCI. The clinical value of the CDT could be improved by using semi-quantitative scoring, having a wider score range and focusing on specific details of the clock (e.g. the hands and numbers).

Keywords

Clock Drawing Testscoring systemdementiaMCI
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 10 , December 2011 , pp. 1592 - 1601
Copyright
Copyright © International Psychogeriatric Association 2011

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References

Babins, L., Slater, M. E., Whitehead, V. and Chertkow, H. (2008). Can an 18-point clock-drawing scoring system predict dementia in elderly individuals with mild cognitive impairment? Journal of Clinical and Experimental Neuropsychology, 30, 173–186.CrossRefGoogle ScholarPubMed
Blake, H., McKinney, M., Treece, K., Lee, E. and Lincoln, N. B. (2002). An evaluation of screening measures for cognitive impairment after stroke. Age and Ageing, 31, 451–456.CrossRefGoogle ScholarPubMed
Brauns, H. and Steinmann, S. (1999). Educational reform in France, West-Germany and the United Kingdom. Zuma-Nachrichten, 44, 7–44.Google Scholar
Busse, A., Hensel, A., Guhne, U., Angermeyer, M. C. and Riedel-Heller, S. G. (2006). Mild cognitive impairment: long-term course of four clinical subtypes. Neurology, 67, 2176–2185.CrossRefGoogle ScholarPubMed
Chiu, Y. C., Li, C. L., Lin, K. N., Chiu, Y. F. and Liu, H. C. (2008). Sensitivity and specificity of the Clock Drawing Test, incorporating Rouleau scoring system, as a screening instrument for questionable and mild dementia: scale development. International Journal of Nursing Studies, 45, 75–84.CrossRefGoogle ScholarPubMed
DeLong, E. R., DeLong, D. M. and Clarke-Pearson, D. L. (1988). Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics, 44, 837–845.CrossRefGoogle ScholarPubMed
Ehreke, L., Luppa, M., König, H. H. and Riedel-Heller, S. G. (2010). Is the Clock Drawing Test a screening tool for the diagnosis of mild cognitive impairment? A systematic review. International Psychogeriatrics, 22, 56–63.CrossRefGoogle Scholar
Esteban-Santillan, C., Praditsuwan, R., Ueda, H. and Geldmacher, D. S. (1998). Clock drawing test in very mild Alzheimer's disease. Journal of the American Geriatrics Society, 46, 1266–1269.CrossRefGoogle ScholarPubMed
Ferri, C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 2112–2117.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Hotte, S. D., Lankers, D., Kissler, S., Freyberger, H. J. and Schroder, S. G. (2010). [MMSE for survival prognostics in dementia]. Psychiatrische Praxis, 37, 78–83.Google ScholarPubMed
Ihl, R. et al. (2000). [Development and validation of a test for early diagnosis of dementia with differentiation from depression (TFDD)]. Fortschritte der Neurologie - Psychiatrie, 68, 413–422.CrossRefGoogle ScholarPubMed
Jackson, C. E. and Snyder, P. J. (2008). Electroencephalography and event-related potentials as biomarkers of mild cognitive impairment and mild Alzheimer's disease. Alzheimer's and Dementia, 4, S137–S143.CrossRefGoogle ScholarPubMed
Lee, K. S., Kim, E. A., Hong, C. H., Lee, D. W., Oh, B. H. and Cheong, H. K. (2008). Clock drawing test in mild cognitive impairment: quantitative analysis of four scoring methods and qualitative analysis. Dementia and Geriatric Cognitive Disorders, 26, 483–489.CrossRefGoogle ScholarPubMed
Leyhe, T., Milian, M., Muller, S., Eschweiler, G. W. and Saur, R. (2009). The minute hand phenomenon in the Clock Test of patients with early Alzheimer disease. Journal of Geriatric Psychiatry and Neurology, 22, 119–129.CrossRefGoogle ScholarPubMed
Lin, K. N. et al. (2003). The three-item clock-drawing test: a simplified screening test for Alzheimer's disease. European Neurology, 49, 53–58.CrossRefGoogle Scholar
Lonie, J. A., Tierney, K. M. and Ebmeier, K. P. (2009). Screening for mild cognitive impairment: a systematic review. International Journal of Geriatric Psychiatry, 24, 902–915.CrossRefGoogle ScholarPubMed
Luck, T. et al. (2007a). Mild cognitive impairment in general practice: age-specific prevalence and correlate results from the German study on ageing, cognition and dementia in primary care patients (AgeCoDe). Dementia and Geriatric Cognitive Disorders, 24, 307–316.CrossRefGoogle Scholar
Luck, T., Zaudig, M., Wiese, B. and Riedel-Heller, S. G. (2007b). SIDAM: Alters- und bildungsspezifische Normen des kognitiven Leistungsteiles nach der neuen CASMIN-Bildungsklassifikation. Zeitschrift für Gerontopsychologie & -psychiatrie, 20, 31–38.CrossRefGoogle Scholar
Mattis, S. (1988). Dementia Rating Scale Professional Manual. Odessa: Psychological Assessment Resources.Google Scholar
Mendez, M. F., Ala, T. and Underwood, K. L. (1992). Development of scoring criteria for the clock drawing task in Alzheimer's disease. Journal of the American Geriatrics Society, 40, 1095–1099.CrossRefGoogle ScholarPubMed
Middleton, L. E. and Yaffe, K. (2009). Promising strategies for the prevention of dementia. Archives of Neurology, 66, 1210–1215.CrossRefGoogle ScholarPubMed
Pentzek, M., Fuchs, A., Wiese, B. and Abholz, H. H. (2010). [Which information do GPs use to rate the cognitive status of elderly non-demented patients?]. Psychiatrische Praxis, 37, 377–383.CrossRefGoogle ScholarPubMed
Petersen, R. C. and Negash, S. (2008). Mild cognitive impairment: an overview. CNS Spectrums, 13, 45–53.CrossRefGoogle ScholarPubMed
Pinto, E. and Peters, R. (2009). Literature review of the Clock Drawing Test as a tool for cognitive screening. Dementia and Geriatric Cognitive Disorders, 27, 201–213.CrossRefGoogle ScholarPubMed
Qiu, C., Kivipelto, M. and von Strauss, E. (2009). Epidemiology of Alzheimer's disease: occurrence, determinants, and strategies toward intervention. Dialogues in Clinical Neuroscience, 11, 111–128.CrossRefGoogle ScholarPubMed
Quentin, W., Riedel-Heller, S. G., Luppa, M., Rudolph, A. and Konig, H. H. (2010). Cost-of-illness studies of dementia: a systematic review focusing on stage dependency of costs. Acta Psychiatrica Scandinavica, 121, 243–259.CrossRefGoogle ScholarPubMed
Riedel-Heller, S. G., Schork, A., Matschinger, H. and Angermeyer, M. C. (2000). Recruitment procedures and their impact on the prevalence of dementia: results from the Leipzig Longitudinal Study of the Aged (LEILA75+). Neuroepidemiology, 19, 130–140.CrossRefGoogle ScholarPubMed
Riedel-Heller, S. G., Busse, A., Aurich, C., Matschinger, H. and Angermeyer, M. C. (2001). Prevalence of dementia according to DSM-III-R and ICD-10: results of the Leipzig Longitudinal Study of the Aged (LEILA75+) Part 1. British Journal of Psychiatry, 179, 250–254.CrossRefGoogle ScholarPubMed
Ries, M. L. et al. (2008). Magnetic resonance imaging characterization of brain structure and function in mild cognitive impairment: a review. Journal of the American Geriatrics Society, 56, 920–934.CrossRefGoogle ScholarPubMed
Rouleau, I., Salmon, D. P., Butters, N., Kennedy, C. and Mcguire, K. (1992). Quantitative and qualitative analyses of clock drawings in Alzheimer's and Huntington's disease. Brain and Cognition, 18, 70–87.CrossRefGoogle ScholarPubMed
Shulman, K. I. (2000). Clock-drawing: is it the ideal cognitive screening test? International Journal of Geriatric Psychiatry, 15, 548–561.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Shulman, K. I., Gold, D. P., Cohen, C. A. and Zucchero, C. A. (1993). Clock-drawing and dementia in the community: a longitudinal-study. International Journal of Geriatric Psychiatry, 8, 487–496.CrossRefGoogle Scholar
Sunderland, T. et al. (1989). Clock drawing in Alzheimer's disease. A novel measure of dementia severity. Journal of the American Geriatrics Society, 37, 725–729.CrossRefGoogle ScholarPubMed
Wancata, J., Musalek, M., Alexandrowicz, R. and Krautgartner, M. (2003). Number of dementia sufferers in Europe between the years 2000 and 2050. European Psychiatry, 18, 306–313.CrossRefGoogle ScholarPubMed
Winblad, B. et al. (2004). Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240–246.CrossRefGoogle Scholar
Yamamoto, S. et al. (2004). The clock drawing test as a valid screening method for mild cognitive impairment. Dementia and Geriatric Cognitive Disorders, 18, 172–179.CrossRefGoogle ScholarPubMed
Youden, W. J. (1950). Index for rating diagnostic tests. Cancer, 3, 32–35.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Zanetti, M., Ballabio, C., Abbate, C., Cutaia, C., Vergani, C. and Bergamaschini, L. (2006). Mild cognitive impairment subtypes and vascular dementia in community-dwelling elderly people: a 3-year follow-up study. Journal of the American Geriatrics Society, 54, 580–586.CrossRefGoogle ScholarPubMed
Zaudig, M. and Hiller, W. (1996). SIDAM-Handbuch. Strukturiertes Interview für die Diagnose einer Demenz vom Alzheimer Typ, der Multiinfarkt- (oder vaskulären) Demenz und Demenzen anderer Ätiologie nach DSM-III-R, DSM-IV und ICD-10. Bern: Huber.Google Scholar
Zaudig, M. et al. (1991). SIDAM: a structured interview for the diagnosis of dementia of the Alzheimer type, multi-infarct dementia and dementias of other aetiology according to ICD-10 and DSM-III-R. Psychological Medicine, 21, 225–236.CrossRefGoogle ScholarPubMed