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The accuracy of the Clock Drawing Test compared to that of standard screening tests for Alzheimer's disease: results from a study of Brazilian elderly with heterogeneous educational backgrounds

Published online by Cambridge University Press:  09 October 2009

Ivan Aprahamian ,
José Eduardo Martinelli ,
Anita Liberalesso Neri  and
Mônica Sanches Yassuda
Ivan Aprahamian*
Affiliation:
Gerontology Division, University of Campinas, São Paulo, Brazil Psychogeriatric Unit, Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
José Eduardo Martinelli
Affiliation:
Gerontology Division, University of Campinas, São Paulo, Brazil Geriatrics Division, Jundiaí Medical School, Jundiaí, Brazil
Anita Liberalesso Neri
Affiliation:
Gerontology Division, University of Campinas, São Paulo, Brazil
Mônica Sanches Yassuda
Affiliation:
Gerontology Division, University of Campinas, São Paulo, Brazil School of Arts, Sciences and Humanities (EACH), University of São Paulo, Brazil
*
Correspondence should be addressed to: Ivan Aprahamian, MD, MSc, Laboratory of Neurosciences – LIM 27, Rua Dr. Ovidio Pires de Campos, 785, 3rd Floor, Cerqueira César, São Paulo, SP, CEP 05403-010, Brazil. Phone: +55 11 3063 5955; Fax: +55 11 3085 5412. Email: ivan.aprahamian@terra.com.br.
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Abstract

Background: Although the Clock Drawing Test (CDT) is the second most used test in the world for the screening of dementia, there is still debate over its sensitivity, specificity, application and interpretation in dementia diagnosis. This study has three main aims: to evaluate the sensitivity and specificity of the CDT in a sample composed of older adults with Alzheimer's disease (AD) and normal controls; to compare CDT accuracy to the that of the Mini-mental State Examination (MMSE) and the Cambridge Cognitive Examination (CAMCOG); and to test whether the association of the MMSE with the CDT leads to higher or comparable accuracy as that reported for the CAMCOG.

Methods: Cross-sectional assessment was carried out for 121 AD and 99 elderly controls with heterogeneous educational levels from a geriatric outpatient clinic who completed the Cambridge Examination for Mental Disorder of the Elderly (CAMDEX). The CDT was evaluated according to the Shulman, Mendez and Sunderland scales.

Results: The CDT showed high sensitivity and specificity. There were significant correlations between the CDT and the MMSE (0.700–0.730; p < 0.001) and between the CDT and the CAMCOG (0.753–0.779; p < 0.001). The combination of the CDT with the MMSE improved sensitivity and specificity (SE = 89.2–90%; SP = 71.7–79.8%). Subgroup analysis indicated that for elderly people with lower education, sensitivity and specificity were both adequate and high.

Conclusions: The CDT is a robust screening test when compared with the MMSE or the CAMCOG, independent of the scale used for its interpretation. The combination with the MMSE improves its performance significantly, becoming equivalent to the CAMCOG.

Keywords

Clock Drawing TestCAMCOGMMSEAlzheimer's diseaseelderly
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Issue 1 , February 2010 , pp. 64 - 71
Copyright
Copyright © International Psychogeriatric Association 2009

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