El test del reloj en la evaluación forense

BackgroundThe Clock Drawing Test (CDT) is commonly used in the detection of cognitive disorder. Easily administered in both clinical and non‐clinical settings and well accepted by patients, this test is a good candidate for use in early detection of dementia with older Aboriginal Australians. This study aimed to: (i) compare three CDT scoring methods and their reliability/validity in detecting mild cognitive impairment (MCI) and dementia in Aboriginal communities; (ii) determine the optimal CDT sensitivity, specificity and cut‐off scores; (iii) investigate the relative and combined performance of the CDT with other cognitive screening tools [Kimberly Indigenous Cognitive Assessment (KICA); Mini Mental State Examination (MMSE); Rowland Universal Dementia Assessment Scale (RUDAS)].MethodA subset of participants (n=153; aged 60‐93) recruited for the Koori Growing Old Well Study completed neurocognitive evaluation as part of a comprehensive medical assessment and were diagnosed by expert consensus as intact, MCI or dementia. CDT responses originally scored as part of the Addenbrooke’s Cognitive Examination Revised (ACE‐R) were rescored using the Mendez and Sunderland methods by an assessor blind to diagnosis.ResultThere were strong positive correlations between all three CDT scoring methods (r s range=.895‐.924). All methods differentiated dementia from MCI and intact participants (p<.001), but not intact from MCI (Mendez p=.712; Sunderland p=.545; ACE‐R p=.094). There was no significant difference between scoring methods in diagnostic validity for dementia (AUC=.739‐.756); however, the simple ACE‐R method had the highest positive and negative predictive values (PPV=0.643; NPV=0.862), with optimal cut‐off score <3.The MMSE outperformed all other screening tests in detecting cognitive impairment (MCI or dementia; AUC=.851) and was superior to both the KICA and CDT in distinguishing MCI from intact participants, but comparable to the RUDAS. Combining the CDT with other screening tools did not significantly improve their diagnostic performance for either cognitive impairment or MCI.ConclusionCDT alone is not an adequate screening tool for MCI; however, has potential for detecting moderate to severe cognitive impairment in older Aboriginal Australians. Relative to other screening tools, the MMSE performed well for detecting both cognitive impairment and MCI; the addition of the CDT did not significantly improve other tests’ performance.

Although cognitive decline in with extracranial atherosclerotic artery stenosis (ECAS) may be improved by carotid revascularization, 1 the effect of stenting on cognitive dysfunction in patients with intracranial atherosclerosis (ICAS) remains unknown. Although stent placement was not effective in improving overall outcomes of patients with ICAS, 2 the value of stenting may have to be reconsidered if the procedure alleviates cognitive dysfunction. We aimed to evaluate changes in cognitive function and perfusion after stent placement in ICAS patients.

Cognitive impairment is common and disabling in Parkinson's disease (PD). Cognitive testing can be time consuming in the clinical setting. One rapid test to detect cognitive impairment in non-PD populations is the Clock Drawing Test (CDT), which calls upon the brain's executive and visuospatial abilities to draw a clock designating a certain time. Test the hypothesis that PD participants would perform worse on CDT compared to controls and that CDT would correlate with other measures of cognition. This study evaluated two independent CDT scoring systems and differences in CDT performance between PD (N = 97) and control (N = 54) participants using a two-sample t-test. Pearson's correlations were conducted between the CDT and tests of sleepiness (Epworth Sleepiness Scale) and vigilance (Psychomotor Vigilance Test); executive function (Trails B-A); and global cognition (Montreal Cognitive Assessment). Receiver operating characteristic curves were used to determine cut points on the CDT that identify individuals who need additional cognitive testing. PD participants had worse performance on CDT compared to controls. The CDT was correlated with executive function (Trails B-A) and global cognition (Montreal Cognitive Assessment). The CDT correlated with vigilance (Psychomotor Vigilance Task) only in healthy controls. However, the CDT was not correlated with measures of sleepiness (Epworth Sleepiness Scale) in either group. A cut point of 9 on the Rouleau scale and 18 on the Mendez scale identified PD participants with cognitive impairment. The CDT is a rapid clinical cognitive assessment that is feasible in PD and correlates with other measures of cognition.

BackgroundThe Digital Clock Test (DCT) is a novel, computerized version of the clock drawing test (CDT). It has been shown to discriminate well between mild cognitive impairment and Alzheimer's disease (AD) dementia and has been associated with AD biomarkers (i.e., amyloid, tau), similar to widely used screening batteries such as the Preclinical Alzheimer's Cognitive Composite (PACC5) and Mini Mental Status Exam (MMSE). As mood symptoms (e.g., anxiety, depression) are common in older adults and can impact cognition, it is important to determine whether such symptoms impact scores on the DCT relative to other measures/batteries. We sought to examine whether mood symptoms are associated with lower DCT scores and/or impaired performance and compare relationships to the MMSE and PACC5.MethodAll participants were older adults (n = 241, mean age=77.60, 80.10% cognitively normal) enrolled in the Harvard Aging Brain Study. Participants completed neuropsychological assessments (i.e., DCT, PACC5, MMSE; lower scores=worse performance) alongside self‐report questionnaires: the 30‐item Geriatric Depression Scale (GDS) and the 20‐item Geriatric Anxiety Inventory (GAI) (higher scores = greater symptoms for both measures). Separate cross‐sectional linear regression models assessed whether GDS/GAI score predicted DCT, MMSE, and PACC5 scores. Separate ordinal regression models were used to determine whether GDS/GAI score predicted impaired DCT (<75), MMSE (<27), and PACC5 (<‐1.5) scores. Analyses controlled for age, sex, and education.ResultHigher GDS scores, but not GAI scores, were associated with lower scores on all cognitive measures (Figure 1). Higher GDS scores were also associated with increased odds of having impaired MMSE and PACC5 scores, but not impaired DCT scores (Table 1). Additionally, higher GAI scores were significantly associated with increased odds of an impaired PACC5 score, but not impaired MMSE or DCT scores (Table 2).ConclusionIn older adults, greater depressive symptoms were associated with worse performance on both the DCT and standard cognitive screens (MMSE, PACC5). In contrast, both depressive and anxiety symptoms were associated with “impaired” scores on PACC5 and/or MMSE, but not on the DCT. This could suggest that the DCT is a sensitive cognitive screen for AD and related dementias in clinical settings where patients present with co‐occurring mood disturbances.

Background: Mild cognitive impairment (MCI) was originally used to describe a transitional state between normal condition and dementia. Revised and extended definition of MCI has been proposed that covers a broader range of cognitive impairment, distinct from normal ageing and from Alzheimer’s disease. Despite the existence of reports regarding analyses of the Clock Drawing test (CDT) in Alzheimer’s disease and vascular dementia, those focusing on MCI subjects are still lacking. The purpose of this study was to assess the characteristics of CDT and compare the results of quantitative and qualitative analyses of CDT performance in patients with MCI. Materials and methods: Five hundred four consecutive patients with MCI (Korean versions of the Mini-Mental State Examination (K-MMSE)>23) were recruited for the study. All participants were examined by the K-MMSE, modified-MMSE (3MS) and the CDT. Quantitative scoring of the CDT was done by the Manos and Wu’s method. Qualitative error types of the CDT were classified as stimulus-bound response (SBR), conceptual deficit (CD), spatial and/or planning deficit (SPD), and perseveration error (PE) by Rouleau’s classification. We divided the subjects into two subgroups by the MMSE scores (lower cognitive function group, MMSE=24~26 vs. higher cognitive function group, MMSE=27~30) and compared the CDT scores and frequency of the error types between them. Results: The total scores in the CDT significantly correlated with the total scores of the K-MMSE, 3MS and the level of education. Of the errors in the CDT, SPD was the most frequent type of error (45.3%) in the total samples. The scores in the K-MMSE and 3MS in the patients having CD errors were lower compared with those of other types of error. The lower cognitive group made more CD error (32.9%) than that of the higher cognitive group (25.5%). Conclusion: Although the CDT cannot be used solely for clinical diagnosis of dementia, it provides useful cognitive information quantitative as well as qualitative ways, estimating the characteristics of MCI patients as a simple screening test.

Background and PurposeAlthough 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.MethodsPatients 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.ResultsOn 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.ConclusionsThe 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.

OBJECTIVE: Goal of the present research was to explore the predictive value of brief neuropsychological tests in driving behavior of PD individuals under low and high traffic conditions on a rural driving environment.METHODS: Nineteen PD individuals (Age:63±11,1years) and forty-two cognitively intact individuals (Age:59,5±8,7years) participated in the study. Participants completed neuropsychological measures, including Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clock Drawing Test (CDT), Frontal Assessment Battery (FAB), Trail Making Test- Trails A & B (TMT A & B), assessing general cognitive ability and executive functions. All individuals underwent a driving simulator experiment, where parameters of driving behavior were measured: average speed, lateral position, average reaction time and headway distance.RESULTS: By applying t-test for independent samples, significant differences were found between PD patients and the control group in average speed (p<0,01) and in average reaction time (p=0,002) under high traffic conditions on rural road. A regression model using PD individuals, with the neuropsychological tests as predictors, explained 38% of the variance in headway distance under high traffic conditions and thus identified the predictive value of CDT, TMT A and TMT B.CONCLUSION: The results of the present study indicate that the driving behavior of PD individuals differed significantly from those of healthy individuals. Neuropsychological tests may have a predictive value. Future studies should include a larger sample size and additional assessments of executive functions.

Alzheimer's disease (AD) is characterized by a heterogeneous course. Predicting a fast rather than a slow decline over time is crucial to both provide a reliable prognosis and elaborate stricter enrolment criteria in clinical trials. Here we searched for independent predictors of cognitive decline rate to assess the risk of fast disease progression already at baseline. Fifty-three subjects with an "in-vivo biomarker confirmed" diagnosis of AD were included. Neuropsychological assessment, plasma neurofilaments (NfL) concentrations and, in a subsample of 23 patients, brain magnetic resonance imaging were available. Patients were labelled FAST or SLOW depending on the Mini-Mental State Examination (MMSE) points lost per year (FAST if more than 3 points). We adopted single logistic regression models to search for independent predictors of FAST progression. At baseline no differences were found between FAST and SLOW subgroups in demographics, MMSE scores, vascular burden and medial temporal lobe atrophy measurements. Higher plasma NfL concentrations and worse scores at semantic verbal fluency (SVF) and clock drawing test (CDT) were independent predictors of FAST decline, after controlling for age, education, sex and baseline disease severity stage. The regression model combining all the predictors correctly classified 80% of patients overall. The risk of FAST decline was 81.2% if all the three predictors were abnormal (i.e., SVF≤21.5, CDT≤5.5, NfL≥22.19). An easily applicable algorithm, including plasma NfL measurement and two neuropsychological tests worldwide adopted in clinical practice (SVF and CDT), may allow clinicians to reliably stratify AD patients in relation to the risk of fast cognitive decline.

P3-151: White matter hyperintensities within cholinergic pathways in Alzheimer's disease affecting the clock drawing test performance

Alzheimer's disease (AD) is the leading cause of dementia in the population. Difficulties in diagnosing AD have served as an incentive for actively studying different current methods that increase the accuracy of diagnosis of the current neurodegenerative process in this disease. One of these areas is the post-processing of magnetic resonance imaging (MRI) data, by exactly calculating the volume of various anatomical formations, namely MRI morphometry.Objective:to determine the possible relationship between the results of evaluating the higher brain functions and the reduction in the hippocampal volume calculated by MRI morphometry in AD patients with mild and moderate dementia and in healthy controls.Patients and methods.Examinations were made in 41 AD patients aged 70.63±8.38 years with mild and moderate dementia and in healthy individuals. All study participants underwent neuropsychological testing that included the Mini-Mental State Examination (MMSE), the frontal lobe dysfunction battery (FLDB); immediate and delayed 12-word recall trials (12-word test); Benton's revised visual retention test; test of literal and categorical associations; clock drawing test; and series number test, Part A. MRI was performed on a Siemens Magnetom Skyra 3T MRI scanner. Statistical Parametric Mapping software was used to convert images and the volume of the hippocampus was estimated by FMRIB Software Library.Results and discussion.A statistically significant decrease in hippocampal volumes was established in patients with AD compared with healthy individuals. No statistically significant differences in hippocampal volumes were found in patients with varying degrees of dementia. Patients with mild and moderate dementia differed in all indicators of neuropsychological tests, with exception for the 12-word test and Benton's test. There was a statistically significant correlation of the total volume of the hippocampi with the indicators of MMSE, FLDB, 12- word test, clock drawing test, and test of categorical associations.Conclusion.Hippocampal MRI morphometry in combination with neuropsychological tests is an informative technique in the diagnosis of AD. There is a relationship between the degree of hippocampal atrophy and the neuropsychological characteristics of patients.

The clock drawing test as a cognitive screening tool for assessment of hypertension-mediated brain damage

P-457 - Dementia in elderly long term inpatients with serious mental illness

Relation between the clock drawing test (CDT) and structural changes of brain in dementia

The aim of the study. To study clinical, psychological and neuroimaging characteristics of chronic tension headache (CTH) in the elderly.Materials and methods. 92 patients with CHTHN (37 men and 55 women aged 55–74 years) were examined. The control group consisted of 53 people (22 men and 31 women of the same age) who did not have neurological complaints, including headache. Pain intensity was assessed on a 10-point visual analogue scale. The severity of neurological symptoms was determined using the NIH-NINDS scale. For the study of cognitive functions, a short scale for assessing mental status was used Mini Mental State Examination (MMSE) and a frontal assessment battery (FAB). Memory was assessed according to the results of the memory subtest MMSE and the 10 words test. The level of attention was studied using the Schulte table, speech fluency – in the «fluency of speech» subtest of the FAB and in the test of verbal associations, visuospatial functions were assessed using the clock drawing test. Memory was assessed by the results of the subtest of memory MMSE and the 10-words test. The level of attention was studied using the Schulte table, the fluency of speech – in the subtest ‘fluency of speech’ FAB and in the verbal association test, visuospatial functions were assessed using the clock drawing test. Magnetic resonance imaging of the head was performed on a Magnetom Impact Expert (Siemens, Germany) tomograph with a magnetic field strength of 1.5 Tesla in T1 and T2 modes. The localization and severity of leukoaraiosis, signs of external and internal atrophy of the brain were determined, the linear dimensions of the anterior horns and central sections of the bodies of the lateral ventricles were measured, and the indices of the anterior horns and bodies of the lateral ventricles were calculated.Results. Patients with chronic tension headache were characterized by clinical and cognitive heterogeneity: frequent «non-standard» characteristics of headache, severe polymorphism of algic manifestations, high frequency of comorbid disorders, cognitive dysfunction and somatic burden, high representation of leukoaraiosis, external and internal hydrocephalus according to MRI study.

BackgroundThe Clock Drawing Test (CDT) and Rey–Osterrieth Complex Figure Test (RCFT) are widely used as a part of neuropsychological test batteries to assess cognitive function. Our objective was to confirm the prediction accuracies of the RCFT-copy and CDT for cognitive impairment (CI) using convolutional neural network algorithms as a screening tool.MethodsThe CDT and RCFT-copy data were obtained from patients aged 60–80 years who had more than 6 years of education. In total, 747 CDT and 980 RCFT-copy figures were utilized. Convolutional neural network algorithms using TensorFlow (ver. 2.3.0) on the Colab cloud platform (www.colab.research.google.com) were used for preprocessing and modeling. We measured the prediction accuracy of each drawing test 10 times using this dataset with the following classes: normal cognition (NC) vs. mildly impaired cognition (MI), NC vs. severely impaired cognition (SI), and NC vs. CI (MI + SI).ResultsThe accuracy of the CDT was better for differentiating MI (CDT, 78.04 ± 2.75; RCFT-copy, not being trained) and SI from NC (CDT, 91.45 ± 0.83; RCFT-copy, 90.27 ± 1.52); however, the RCFT-copy was better at predicting CI (CDT, 77.37 ± 1.77; RCFT, 83.52 ± 1.41). The accuracy for a 3-way classification (NC vs. MI vs. SI) was approximately 71% for both tests; no significant difference was found between them.ConclusionsThe two drawing tests showed good performance for predicting severe impairment of cognition; however, a drawing test alone is not enough to predict overall CI. There are some limitations to our study: the sample size was small, all the participants did not perform both the CDT and RCFT-copy, and only the copy condition of the RCFT was used. Algorithms involving memory performance and longitudinal changes are worth future exploration. These results may contribute to improved home-based healthcare delivery.