Application of Clock Drawing Test in Evaluating Different Types of Dementias (Alzheimer’s Disease, Vascular Dementia and Fronto-temporal Dementia): A Cross-sectional Observational Study
Introduction: The Clock Drawing Test (CDT) is a highly effective screening tool for assessing cognitive function. It complements the Mental State Examination (MSE) in the early detection of various types of dementia and the evaluation of cognitive functions. Documenting the specific type of...
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| Format: | Article |
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JCDR Research and Publications Private Limited
2023-08-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| author | Sanjukta Mukherjee Subrata Biswas Sudipto Chaudhury Malay Kumar Ghoshal Sandip Pal |
| author_facet | Sanjukta Mukherjee Subrata Biswas Sudipto Chaudhury Malay Kumar Ghoshal Sandip Pal |
| author_sort | Sanjukta Mukherjee |
| collection | DOAJ |
| description | Introduction: The Clock Drawing Test (CDT) is a highly effective
screening tool for assessing cognitive function. It complements
the Mental State Examination (MSE) in the early detection
of various types of dementia and the evaluation of cognitive
functions. Documenting the specific type of error in clock
drawing significantly enhances the clinical evaluation of dementia
patients in an economical manner. The CDT can effectively
detect errors in execution and visuospatial functions associated
with different types of dementia, including Alzheimer’s Disease
(AD), Vascular Dementia (VD), and Frontotemporal Dementia
(FTD). Additionally, it allows for a comparative analysis of the
CDT with the severity of dementia assessed by the Bengal
Mental Status Examination (BMSE) Scale.
Aim: Present study aims to determine the ability of the CDT to
scriminate these three disorders AD, VD, and FTD by analysing
patterns of error in clock drawing.
Materials and Methods: This cross-sectional observational
study was conducted at the Department of Neuromedicine,
Memory Clinic, Medical College, Kolkata, West Bengal, India,
from March 2019 to February 2020. The diagnosis of dementia
was made based on the Diagnostic and Statistical Manual of
Mental Disorders- Fifth Edition (DSM-V) criteria for AD and VD,
and the Rascovsky Criteria for FTD. A total of 80 patients were
included in the study, with 40 in the AD group, 30 in the VD
group, and 10 in the FTD group, considering 80% power and a
5% probability of error. Dementia severity was assessed using
the BMSE [Annexure-III]. The subjects were provided with an
8.5×11-inch blank sheet of paper and a pencil, and were asked
to draw a clock, including all the numbers, and set the hands to
10 minutes past 11. They were also requested to copy a clock
as accurately as possible from a model. The resulting drawings
were then analysed quantitatively by revised scale score and
qualitatively using Rouleau’s qualitative analysis of clock
drawing. Numerical variables were compared between groups
using the Analysis of Variance (ANOVA) test and the Wilcoxon
test, depending on the distribution’s normalcy. All analyses were
two-tailed, and p<0.05 was considered statistically significant.
Results: When comparing the revised quantitative scale, the
CDT score showed a significant difference between the three
groups (AD, VD, and FTD) with mean scores of 2.91, 2.9, and 0.7,
respectively (p=0.01). The size of the drawn clocks also showed
a significant difference (p=0.006) among the AD, VD, and FTD
groups, with sizes of 21.27, 18.63, and 16.7, respectively. The
BMSE score also showed a significant difference between AD
and FTD (p<0.05), as well as between AD and VD (p<0.05). Clock
size was significantly different between AD and VD (p<0.05).
There were no significant differences observed regarding
graphical difficulty, stimulus-bound response, conceptual
deficits, spatial and/or planning deficits, and perseveration
among the three groups.
Conclusion: Qualitative analysis of the CDT contributes to the
identification of different types of dementia by enabling the
description of specific errors. A significant inter-group difference
was found in the BMSE score, but it could not pinpoint the domains
of cognitive deficits, whereas the CDT can detect those. |
| first_indexed | 2024-03-12T01:20:18Z |
| format | Article |
| id | doaj.art-38a04e426ade4442826e55ca56034d62 |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-03-12T01:20:18Z |
| publishDate | 2023-08-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-38a04e426ade4442826e55ca56034d622023-09-13T06:36:27ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2023-08-01178051110.7860/JCDR/2023/62543.18305Application of Clock Drawing Test in Evaluating Different Types of Dementias (Alzheimer’s Disease, Vascular Dementia and Fronto-temporal Dementia): A Cross-sectional Observational StudySanjukta Mukherjee0Subrata Biswas1Sudipto Chaudhury2Malay Kumar Ghoshal3Sandip Pal4Senior Resident, Department of Psychiatry, Burdwan Medical College, Burdwan, West Bengal, India.Assistant Professor, Department of Radiodiagnosis, RG Kar Medical College, Kolkata, West Bengal, IndiaAssociate Professor, Department of Radiodiagnosis, RG Kar Medical College, Kolkata, West Bengal, India.Professor, Department of Psychiatry, Medical College, Kolkata, West Bengal, India.Professor, Department of Neuromedicine, Medical College, Kolkata, West Bengal, India.Introduction: The Clock Drawing Test (CDT) is a highly effective screening tool for assessing cognitive function. It complements the Mental State Examination (MSE) in the early detection of various types of dementia and the evaluation of cognitive functions. Documenting the specific type of error in clock drawing significantly enhances the clinical evaluation of dementia patients in an economical manner. The CDT can effectively detect errors in execution and visuospatial functions associated with different types of dementia, including Alzheimer’s Disease (AD), Vascular Dementia (VD), and Frontotemporal Dementia (FTD). Additionally, it allows for a comparative analysis of the CDT with the severity of dementia assessed by the Bengal Mental Status Examination (BMSE) Scale. Aim: Present study aims to determine the ability of the CDT to scriminate these three disorders AD, VD, and FTD by analysing patterns of error in clock drawing. Materials and Methods: This cross-sectional observational study was conducted at the Department of Neuromedicine, Memory Clinic, Medical College, Kolkata, West Bengal, India, from March 2019 to February 2020. The diagnosis of dementia was made based on the Diagnostic and Statistical Manual of Mental Disorders- Fifth Edition (DSM-V) criteria for AD and VD, and the Rascovsky Criteria for FTD. A total of 80 patients were included in the study, with 40 in the AD group, 30 in the VD group, and 10 in the FTD group, considering 80% power and a 5% probability of error. Dementia severity was assessed using the BMSE [Annexure-III]. The subjects were provided with an 8.5×11-inch blank sheet of paper and a pencil, and were asked to draw a clock, including all the numbers, and set the hands to 10 minutes past 11. They were also requested to copy a clock as accurately as possible from a model. The resulting drawings were then analysed quantitatively by revised scale score and qualitatively using Rouleau’s qualitative analysis of clock drawing. Numerical variables were compared between groups using the Analysis of Variance (ANOVA) test and the Wilcoxon test, depending on the distribution’s normalcy. All analyses were two-tailed, and p<0.05 was considered statistically significant. Results: When comparing the revised quantitative scale, the CDT score showed a significant difference between the three groups (AD, VD, and FTD) with mean scores of 2.91, 2.9, and 0.7, respectively (p=0.01). The size of the drawn clocks also showed a significant difference (p=0.006) among the AD, VD, and FTD groups, with sizes of 21.27, 18.63, and 16.7, respectively. The BMSE score also showed a significant difference between AD and FTD (p<0.05), as well as between AD and VD (p<0.05). Clock size was significantly different between AD and VD (p<0.05). There were no significant differences observed regarding graphical difficulty, stimulus-bound response, conceptual deficits, spatial and/or planning deficits, and perseveration among the three groups. Conclusion: Qualitative analysis of the CDT contributes to the identification of different types of dementia by enabling the description of specific errors. A significant inter-group difference was found in the BMSE score, but it could not pinpoint the domains of cognitive deficits, whereas the CDT can detect those.https://jcdr.net/articles/PDF/18305/62543_CE[Ra1]_F(IS)_PF1(AKA_KM)_PFA(NC)_QC(SD_RDW_IS)_PN(KM).pdfcognitive assessment screening instrumentcognitive disordersdementia testsmental status |
| spellingShingle | Sanjukta Mukherjee Subrata Biswas Sudipto Chaudhury Malay Kumar Ghoshal Sandip Pal Application of Clock Drawing Test in Evaluating Different Types of Dementias (Alzheimer’s Disease, Vascular Dementia and Fronto-temporal Dementia): A Cross-sectional Observational Study Journal of Clinical and Diagnostic Research cognitive assessment screening instrument cognitive disorders dementia tests mental status |
| title | Application of Clock Drawing Test in Evaluating Different Types of Dementias (Alzheimer’s Disease, Vascular Dementia and Fronto-temporal Dementia): A Cross-sectional Observational Study |
| title_full | Application of Clock Drawing Test in Evaluating Different Types of Dementias (Alzheimer’s Disease, Vascular Dementia and Fronto-temporal Dementia): A Cross-sectional Observational Study |
| title_fullStr | Application of Clock Drawing Test in Evaluating Different Types of Dementias (Alzheimer’s Disease, Vascular Dementia and Fronto-temporal Dementia): A Cross-sectional Observational Study |
| title_full_unstemmed | Application of Clock Drawing Test in Evaluating Different Types of Dementias (Alzheimer’s Disease, Vascular Dementia and Fronto-temporal Dementia): A Cross-sectional Observational Study |
| title_short | Application of Clock Drawing Test in Evaluating Different Types of Dementias (Alzheimer’s Disease, Vascular Dementia and Fronto-temporal Dementia): A Cross-sectional Observational Study |
| title_sort | application of clock drawing test in evaluating different types of dementias alzheimer s disease vascular dementia and fronto temporal dementia a cross sectional observational study |
| topic | cognitive assessment screening instrument cognitive disorders dementia tests mental status |
| url | https://jcdr.net/articles/PDF/18305/62543_CE[Ra1]_F(IS)_PF1(AKA_KM)_PFA(NC)_QC(SD_RDW_IS)_PN(KM).pdf |
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