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Computerized kinematic analysis of the clock drawing task in elderly people with mild Major Depressive Disorder: an exploratory study

Published online by Cambridge University Press:  30 November 2009

Jeremia Heinik*
Affiliation:
Margoletz Psychogeriatric Center, Ichilov Hospital, Tel Aviv, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Perla Werner
Affiliation:
Department of Gerontology, University of Haifa, Haifa, Israel
Tal Dekel
Affiliation:
Department of Gerontology, University of Haifa, Haifa, Israel
Ilya Gurevitz
Affiliation:
Margoletz Psychogeriatric Center, Ichilov Hospital, Tel Aviv, Israel
Sara Rosenblum
Affiliation:
Department of Occupational Therapy, University of Haifa, Haifa, Israel
*
Correspondence should be addressed to: Jeremia Heinik, Margoletz Psychogeriatric Center, Ichilov Hospital, 6 Weizman Street, Tel Aviv, Israel64239. Phone: +972–3-6973325; Fax. +972–3-6974658. Email: [email protected].

Abstract

Background: Developments in data collection technology enable evaluation of kinematic characteristics of the drawing process. We examined the clock drawing task in elderly patients with mild Major Depressive Disorder (MDD), assessed the relative importance of kinematic measures that differentiate the groups and analyzed associations between computerized measures, and the cognitive and depression status of the study groups.

Methods: The participants comprised 20 elderly people with mild MDD and 20 matched controls. Both groups performed a clock drawing task using a computerized system. Kinematic measures included: number of segments drawn, performance time, pressure implemented towards the drawing surface, and pen azimuth. Three representative spatial characteristics were analyzed per segments drawn on the paper: height, width and length. The clock drawing tasks were blindly scored with Freedman's method. Cognitive state was quantified using the Mini-mental State Examination (MMSE) and depression with the Geriatric Depression Scale (GDS).

Results: Freedman's method found no between-group differences. Pressure and azimuth measures and spatial measures of segments height, width and length were significantly lower in the mild MDD group, while the number of paper segments and performance time did not differ. The azimuth measure correlated with the GDS score, and pressure with the MMSE and the GDS scores. Spatial measures did not correlate with either the MMSE or GDS. Pressure, segment width and length, azimuth and segment height allowed correct classification of 81.1% of the participants.

Conclusions: A computerized system focusing on the clock drawing task might be sensitive to altered performance among elderly people with mild MDD.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2009

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References

American Psychiatric Association (APA) (1994). Diagnostic and Statistical Manual of Mental Disorders (4th edn). Washington, DC: American Psychiatric Association.Google Scholar
Berger, A. K., Fahlander, K., Wahlin, A. and Bäckman, L. (2002). Negligible effects of depression on verbal and spatial performance in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 13, 17.CrossRefGoogle ScholarPubMed
Bodner, T., Delazer, M., Kemmler, G., Gurka, P., Marksteiner, J. and Fleischhacker, W. W. (2004). Clock drawing, clock reading, clock setting, and judgment of clock faces in elderly people with dementia and depression. Journal of the American Geriatrics Society, 52, 11461150.CrossRefGoogle ScholarPubMed
Butters, M. A. et al. (2000). Changes in cognitive functioning following treatment of late-life depression. American Journal of Psychiatry, 157, 19491954.CrossRefGoogle ScholarPubMed
Cheng, S. T. and Chan, A. C. (2007). Withdrawal, apathy and lack of vigor in late life depression: factorial validity and relationship to diagnosis. Aging and Mental Health, 11, 532537.CrossRefGoogle ScholarPubMed
Cullen, B., O'Neill, B., Evans, J. J., Coen, R. F. and Lawlor, B. A. (2007). A review of screening tests for cognitive impairment. Journal of Neurology, Neurosurgery and Psychiatry, 78, 790799.CrossRefGoogle ScholarPubMed
Dantchev, N., and Widlöcher, D. J. (1998). The measurement of retardation in depression. Journal of Clinical Psychiatry, 59 (Suppl. 14), 1925.Google ScholarPubMed
Fischer, C. et al. (2008). Neurocognitive profiles in older adults with and without major depression. International Journal of Geriatric Psychiatry, 23, 851856.CrossRefGoogle ScholarPubMed
Freedman, M., Leach, L., Kaplan, E., Winocur, G., Shulman, K. I. and Delis, D. C. (1994). Clock Drawing. A Neuropsychological Analysis. Oxford: Oxford University Press,Google Scholar
Hart, R. P., Kwentus, J. A., Taylor, J. R. and Harkins, S. W. (1987). Rate of forgetting in dementia and depression. Journal of Consulting and Clinical Psychology, 55, 101105.CrossRefGoogle ScholarPubMed
Heinik, J. et al. (2004). Clock Drawing Test-Modified and Integrated Approach (CDT-MIA): description and preliminary examination of its validity and reliability in dementia patients referred to a specialized psychogeriatric setting. Journal of Geriatric Psychiatry and Neurology, 17, 7380.CrossRefGoogle ScholarPubMed
Herrmann, N. et al. (1998). Clock tests in depression, Alzheimer's disease, and elderly controls. International Journal of Psychiatry in Medicine, 28, 437–47.CrossRefGoogle ScholarPubMed
Kirby, M., Denihan, A., Bruce, I., Coakley, D. and Lawlor, B. A. (2001). The clock drawing test in primary care: sensitivity in dementia detection and specificity against normal and depressed elderly. International Journal of Geriatric Psychiatry, 16, 935940.CrossRefGoogle ScholarPubMed
Lesser, I. M., Boone, K. B., Mehringer, C. M., Wohl, M. A., Miller, B. L. and Berman, N. G. (1996). Cognition and white matter hyperintensities in older depressed patients. American Journal of Psychiatry, 153, 12801287.Google ScholarPubMed
Mattingley, J. B., Phillips, J. G. and Bradshaw, J. L. (1994). Impairments of movement execution in unilateral neglect: a kinematic analysis of directional bradykinesia. Neuropsychologia, 32, 1111–34.CrossRefGoogle ScholarPubMed
Mergl, R. et al. (2004). Kinematical analysis of handwriting movements in depressed patients. Acta Psychiatrica Scandinavica, 109, 383391.CrossRefGoogle ScholarPubMed
Pier, M. P. B., Hustijn, W. and Sabbe, B. G. C. (2004). Differential patterns of psychomotor functioning in unmedicated melancholic and nonmelancholic depressed patients. Journal of Psychiatric Research, 38, 425435.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, 201213.CrossRefGoogle ScholarPubMed
Rosenblum, S. and Werner, P. (2006). Assessing the handwriting process in healthy elderly persons using a computerized system. Aging: Clinical and Experimental Research, 18, 433439.Google ScholarPubMed
Rosenblum, S., Parush, S. and Weiss, P. L. (2003). Computerized temporal handwriting characteristics of proficient and poor handwriters. American Journal of Occupational Therapy, 57, 129–38.CrossRefGoogle Scholar
Rosenblum, S., Dekel, T., Gurevitz, I. and Heinik, J. (2010). Handwriting process variables among elderly people with mild Major Depressive Disorder: a preliminary study. Aging: Clinical and Experimental Research. In press.Google Scholar
Royall, D. R., Cordes, J. A. and Polk, M. (1998). CLOX: an executive clock drawing task. Journal of Neurology Neurosurgery and Psychiatry, 64, 588594.CrossRefGoogle ScholarPubMed
Sabbe, B., Hulstijn, W., van Hoff, J. J. M. and Zitman, F. G. (1996). Fine motor retardation and depression. Journal of Psychiatric Research, 30, 295306.CrossRefGoogle ScholarPubMed
Schröter, A., Mergl, R., Bürger, K., Hampel, H., Möller, H. J. and Hegerl, U. (2003). Kinematic analysis of handwriting movements in patients with Alzheimer's disease, mild cognitive impairment, depression and healthy subjects. Dementia and Geriatric Cognitive Disorders, 15, 132142.CrossRefGoogle ScholarPubMed
Sheline, Y. I. et al. (2006). Cognitive function in late life depression: relationships to depression severity, cerebrovascular risk factors and processing speed. Biological Psychiatry, 60, 5865.CrossRefGoogle ScholarPubMed
Shulman, K. I. (2000). Clock-drawing: is it the ideal cognitive screening test? International Journal of Geriatric Psychiatry, 15, 548561.3.0.CO;2-U>CrossRefGoogle ScholarPubMed
Shulman, K. I. et al. (2006). IPA survey of brief cognitive screening instruments. International Psychogeriatrics, 18, 281294.CrossRefGoogle ScholarPubMed
Slavin, M. J., Phillips, J. G., Bradshaw, J. L., Hall, K. A. and Presnell, I. (1999). Consistency of handwriting movements in dementia of the Alzheimer's type: a comparison with Huntington's and Parkinson's diseases. Journal of the International Neuropsychological Society, 5, 2055.CrossRefGoogle ScholarPubMed
Smith, A. D. (2009). On the use of drawing tasks in neuropsychological assessment. Neuropsychology, 23, 231239.CrossRefGoogle ScholarPubMed
Taft, R. (1967). Extraversion, neuroticism, and expressive behavior: an application of Wallach's moderator effect to handwriting analysis. Journal of Personality, 35, 570584.CrossRefGoogle ScholarPubMed
van Gemmert, A. W. A., Teulings, H. L. and Stelamch, G. E. (2001). Parkinsonian patients reduce their stroke size with increased processing demands. Brain and Cognition, 47, 504512.CrossRefGoogle ScholarPubMed
Werner, P., Heinik, J. and Mendel, A. (1999). Examining the reliability and validity of the Hebrew version of the Mini-mental State Examination. Aging: Clinical and Experimental Research, 11, 329334.Google ScholarPubMed
Werner, P., Rosenblum, S., Bar-On, G., Heinik, J. and Korczyn, A. (2006). Handwriting process variables discriminating mild Alzheimer's disease and mild cognitive impairment. Journals of Gerontology: Series B, Psychological Sciences and Social Sciences, 61 (B), 228236.CrossRefGoogle ScholarPubMed
Woo, B. K., Rice, V. A., Legendre, S. A., Salmon, D. P., Jeste, D. V. and Sewell, D. D. (2004). The clock drawing test as a measure of executive dysfunction in elderly depressed patients. Journal of Geriatric Psychiatry and Neurology, 17, 190194.CrossRefGoogle ScholarPubMed
Yanagita, M. et al. (2006). Disability and depression: investigating a complex relation using physical performance measures. American Journal of Geriatric Psychiatry, 14, 10601068.CrossRefGoogle ScholarPubMed
Yesavage, J. A. et al. (1983). Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research, 17, 3749.CrossRefGoogle Scholar