Effectiveness of the clock drawing test in differentiating various types of dementia

Yıl 2021, Cilt: 46 Sayı: 4, 1703 - 1710, 30.12.2021

Gülcan Göçmez Yılmaz , Aynur Ozge , Mekselina Şahin , Kahraman Kıral

https://doi.org/10.17826/cumj.983409

Öz

Purpose: The aim of this study was to investigate the effectiveness of clock-drawing test (CDT) in differentiating dementia types.
Materials and Methods: 48 Alzheimer's disease (AD), 68 vascular dementia (VaD) and 13 frontotemporal dementia (FTD) patients were included in the study. Clock drawing test (CDT), mini mental state examination (MMSE) and other neurophysiological tests (back and forward numerical range, calculation test, abstraction test, word memory tests, boston naming test, word list recall and recognition tests) were applied to all patients. The scores of CDT and other neurophysiological tests were compared between the AH, VaD and FTD groups. The relationship between CDT and other neurophysiological tests was evaluated.
Results: There was no significant difference in CDT between the dementia groups. MMSE and back numerical range scores were statistically significant among dementia groups. An positive correlation was found especially in AD and VaD patients when MMSE and CDT tests were used together. In addition, a positive correlation was found between CDT and boston naming test for FTD type.
Conclusion: CDT is not a unique predictor to determine primary dementia type. However among the neurophysiological test batteries we used in the study, especially the combined use of MMSE and CDT and combined use of CDT with other tests have an important place in dementia differentiation.

Anahtar Kelimeler

Clock-drawing test, dementia, visuospatial skills, assessment of cognition

Saat çizme testinin çeşitli demans tiplerini ayırt etmedeki etkinliği

Öz

Amaç: Bu çalışmanın amacı, demans tiplerini ayırt etmede saat çizme testinin (SÇT) etkinliğini araştırmaktır.
Gereç ve Yöntem: 48 Alzheimer hastalığı (AH), 68 vasküler demans (VaD) ve 13 frontotemporal demans (FTD) hastası çalışmaya dahil edildi. Tüm hastalara SÇT ile mini mental durum muayenesi (MMSE) ve diğer nörofizyolojik testler (ileri-geri sayım aralık, hesaplama testi, soyutlama testi, kelime hafıza testleri, boston adlandırma testi, kelime listesi hatırlama ve tanıma testleri) uygulandı. SÇT ve diğer nörofizyolojik testlerin skorları AH, VaD ve FTD grupları arasında karşılaştırıldı. SÇT ile diğer nörofizyolojik testler arasındaki ilişki değerlendirildi.
Bulgular: AH, VaD ve FTD grupları arasında SÇT testinin anlamlı bir fark olmadığı görülmüştür. Demans grupları arasında MMSE and geri sayım aralık skorları istatiksel olarak anlamlı bulunmuştur. MMSE ve SÇT testlerinin birlikte kullanımında özellkle AH ve VaD hastalarında pozitif korelasyon saptanmıştır. Ek olarak FTD tipi için SÇT ve boston anlamlandırma testi arasında da pozitif bir ilişki saptanmıştır.
Sonuç: SÇT primer demans tipi belirlemede benzersiz bir öngörücü değildir, ancak çalışmada kullandığımız nörofizyolojik test bataryaları arasında, özellikle MMSE ve SÇT nin birlikte kullanımı ve SÇT’nin diğer testlerle kombine kullanımının demans farklılaşmasında önemli bir yeri vardır.

Anahtar Kelimeler

clock-drawing test, dementia, visuospatial skills, assessment of cognition

Kaynakça

• 1. Tsoi KK, Chan JY, Hirai HW, Wong SY, Kwok TC. Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Intern Med 2015;175(9):1450-1458. (PMID:26052687)
• 2. Grand JH, Caspar S, MacDonald SW. Clinical features and multidisciplinary approaches to dementia care. J Multidiscip Healthc 2011;4:125. (PMID:21655340)
• 3. Paula JJ, Miranda DM, Moraes EN, Malloy-Diniz LF. Mapping the clockworks: what does the Clock Drawing Test assess in normal and pathological aging? Arq Veuro-psiquiatria 2013;71(10):763-768. (PMID:24212511)
• 4. Cosentino S, Jefferson A, Chute DL, Kaplan E, Libon DJ. Clock-drawing errors in dementia: neuropsychological and neuroanatomical considerations. Cog Behav Neurology 2004;17(2): 74-84. PMID:15453515)
• 5. Thomann PA, Toro P, Dos Santos V, Essig M, Schröder J. Clock drawing performance and brain morphology in mild cognitive impairment and Alzheimer’s disease. Brain Cogn 2008;67(1):88-93. (PMID: 18215449)
• 6. Nair AK, Gavett BE, Damman M, Dekker W, Green RC, Mandel A, Auerbach S, Steinberg E, Hubbard EJ, Jefferson A, Stern RA. Clock drawing test ratings by dementia specialists: interrater reliability and diagnostic accuracy. Neuropsychiatry Clin Neurosci 2010;22(1):85-92. (PMID: 20160214)
• 7. Barrows J, Barsuglia J, Paholpak P, Eknoyan D, Sabodash V, J.Lee G, F. Mendez M. Executive abilities as reflected by clock hand placement: frontotemporal dementia versus early-onset Alzheimer Disease. J Geriatr Psychiatry Neurol 2015; 28(4):239-248. (PMID26251109)
• 8. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease Report of the NINCDS‐ADRDA Work Group* under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34(7):939-944. (PMID: 6610841)
• 9. Sachdev PS, Blacker D, Blazer DG, Ganguli M, Jeste DV, Paulsen JS, Petersen RC. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol 2014;10(11):634. (PMID: 25266297)
• 10. Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, Van Swieten JC, Seelaar H, Dopper EG, Onyike CU, Hillis AE. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain 2011;134(9):2456-2477. (PMID: 21810890)
• 11. Román GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JA, Amaducci L, Orgogozo JM, Brun A, Hofman A, Moody DM. Vascular dementia Diagnostic criteria for research studies: report of the NINDS‐AIREN International Workshop. Neurology 1993 1;43(2):250. (PMID: 8094895)
• 12. Güngen C, Ertan T, Eker E, Yaşar R, Engin F. Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population. Turk psikiyatri dergisi. 2002;13(4):273-281. (PMID: 12794644)
• 13. Hoshi Y, Oda I, Wada Y, Ito Y, Yutaka Yamashita, Oda M, Ohta K, Yamada Y, Mamoru Tamura. Visuospatial imagery is a fruitful strategy for the digit span backward task: a study with near-infrared optical tomography. Cognitive brain research. 2000; 1;9(3):339-342. PMID: 10808144)
• 14. Sun X, Zhang X, Chen X, Zhang P, Bao M, Zhang D, Chen J, He S, Hu X. Age-dependent brain activation during forward and backward digit recall revealed by fMRI. Neuroimage. 2005;26(1):36-47. (PMID: 15862203)
• 15. Reynolds JR, Donaldson DI, Wagner AD, Braver TS. Item-and task-level processes in the left inferior prefrontal cortex: positive and negative correlates of encoding. Neuroimage 2004;21(4):1472-1483. (PMID: 15050572)
• 16. Shulman KI. Clock‐drawing: is it the ideal cognitive screening test? Int J Ger Psych 2000;15(6):548-561. (PMID: 10861923)
• 17. Manos PJ, Wu R. The ten-point clock test: a quick screen and grading method for cognitive impairment in medical and surgical patients. Int J Psych Med 1994 24(3):229-244. (PMID: 7890481)
• 18. Kitabayashi Y, Ueda H, Narumoto J, Nakamura K, Kita H, Fukui K. Qualitative analyses of clock drawings in Alzheimer's disease and vascular dementia. Psychiatry Clin Neurosci 2001;55(5):485-491. (PMID:11555344)
• 19. Esteban‐Santillan C, Praditsuwan R, Veda H, Geldmacher DS. Clock-drawing test in very mild Alzheimer's disease. J Am Geriart Soc 1998;46(10):1266-1269. (PMID:9777909)
• 20. Matioli MN, Caramelli P. Limitations in differentiating vascular dementia from Alzheimer's disease with brief cognitive tests. Arq Neuropsiquiatria 2010;68(2):185-188. (PMID: 20464282)
• 21. Sallam K, Mostafa AM. The use of the mini-mental state examination and the clock-drawing test for dementia in a tertiary hospital. JCDR 2013;7(3):484. (PMID: 23634401)
• 22. Lee JH, Oh ES, Jeong SH, Sohn EH, Lee TY, Lee AY. Longitudinal changes in clock drawing test (CDT) performance according to dementia subtypes and severity. Arch Gerontol Geriatr 2011;53(2):e179-182. (PMID: 21035204)
• 23. Yang L, Yan J, Jin X, Jin Y, Yu W, Xu S, Wu H. Screening for dementia in older adults: comparison of Mini-Mental State Examination, Mini-Cog, Clock Drawing test and AD8. PloS One 2016;11(12):e0168949. (PMID: 28006822)
• 24. Wiechmann AR, Hall JR, O'bryant S. The four-point scoring system for the clock drawing test does not differentiate between Alzheimer's disease and vascular dementia. Psychol Rep 2010;106(3):941-948. (PMID: 20712183)