Objective: To develop a simple clock drawing score system for patients with Alzheimer's disease, that correlates with the MMSE (Folstein Mini Mental Status Examination).1
Design: A retrospective analysis of 88 patients with the diagnosis of Alzheimer's disease
Setting: Outpatient Memory Disorder Institute of a large community teaching hospital.
Measurements: MMSE score and two different clock drawing ratings. The MMSE and the clock drawing scoring were performed by different raters. We present a “simple clock scoring system” and compared it with a previously published scoring system by Sunderland et al,2 referred to as the standard score system.
Results: There is a strong correlation between the “new score system” and the standard scoring (Pearsons Correlation Coefficient r = 0.91, p < 0.001). However, when both systems were evaluated in a multivariate linear regression analysis, the “ simple score system “ was a significant predictor of Folstein MMSE (P < 0.01), while the standard scoring system was not.
Conclusion: The “simple score system” is an easy to use, accurate predictor of the MMSE score, in patients with the diagnosis of Alzheimer's disease.
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References
1.
1. Folstein MF, Folstein SE, McHugh DR: Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J. Psychiatry Res. 1975; 12: 189-198.
2.
2. Sunderland T, Hill JL, Lellow AM: Clock drawing in Alzheimer's disease: A novel measure of dementia severity. J Am Geriatr Soc. 1989. 37; 725-729.
3.
3. Jody, Corey-Bloom, Douglas Galasko and Leon J: Thal, Chapter 37, p.634 Clinical Features and Natural History of Alzheimer's Disease. Neurodegenerative Diseases.
4.
4. Huff FJ,Becker JT, Belle SH, et al: Cognitive deficit and clinical diagnosis of Alzheimer's disease. Neurology. 1987; 37: 1119-1124.
5.
5. Ojeda VJ, Mastaglia FL, Kakulas BA: Couse of organic dementia: A neuropsy survey of 60 cases. Med JAust. 1986; 145: 69-71.
6.
6. Storandt M, Botwinick J, Danziger WL, et al: Psychometric differentiation of mild senile dementia of the Alzheimer's type. Arch Neurol. 1984; 41: 497-499.
7.
7. McKhann G, Drachman D, Folstein M, et al: 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. 1983; 34: 939-944.
8.
8. Neary D, Snowden JS, Bowen DM, et al: Cerebral biopsy in the investigation of presenile dementia due to cerebral atrophy. JNeurol Neurosurg Psychiatry. 1986; 49: 157-162.
9.
9. Martin EM, Wilson RS, Penn RD, et al: Cortical biopsy results in Alzheimer's disease: Correlation with cognitive deficits. Neurology. 1987; 37: 1201-1204.
10.
10. Watson YI, Arfken CL, Birge SJ: Clock Completion: An objective Screening test for Dementia. J Am Geriatrtr Soc. 1993; 41: 1235-1240.
11.
11. Nina K. Ainslie, MD, and Robert A.Murden, MD. Effect of Education on the Clock-Drawing Dementia Screen in Non Demented Elderly Persons. JAGS. 1993; 41: 249-252.
12.
12. H Tuokko, PhD, T Hadjistavropoulos, PhD, JA Miller, PhD, BL Beattie, MD: The Clock Test: A Sensitive Measure to Differentiate Normal Elderly from Those with Alzheimer's Disease. JAGS. 1992; 40: 579-584.
13.
13. Brouwers P, Cox C, Martin A, et al: Differential perceptual-spacial impairment in Huntington's and Alzheimer's dementia. Arch Neurol. 1984; 41: 1073-1076.
14.
14. Yasmira I. Watson, MD, Cynthia L. Arfken, PhD, Stanley L.Birge, MD: Clock Completion An Objective Screening Test for Dementia. JAGS. 1993; 41: 1235-1240.
15.
15. Tierney MC, Fisher RH, Lewis AJ, et al: NINCDS-ADRDA Work Group criteria for the clinical diagnosis of probable Alzheimer's disease: A clinicopathologic study of 57 cases. Neurology. 1988; 38: 359-364.
16.
16. Folstein MF, Anthony JC, et al: Meaning of cognitive impairment in the elderly. JAm Geriatr Soc. 1985; 33(4): 228-235.
17.
17. Spencer MP, Folstein MF: The Mini-Mental State Examination. In: Keller PA, Ritt LG. Innovations in Clinical Practice. A Source Book. 1985; 4: 305-310.
18.
18. Loring DW, Largen JW: Neuropsychological patterns of presenile and senile dementia of the Alzheimer's type. Neuropsychology. 1985; 23: 351-357.
19.
19. Anthony JC, LeResche L, Niaz U, et al: Limits of “Mini-Mental State” as a screening test for dementia and delirium among hospital patients. Psych Med. 1982; 12: 397-408.
20.
20. Murdenn RA, McRae TD, Kaner S, et al: Mini-Mental state exam scores vary with education in blacks and whites. JArn Geriatr Soc. 1991; 39: 149-155.
21.
21. Reuben DB, Yashikawa TT, Besdine RW, et al: Geriatrics Review Syllabus Supplement. 1993-4: Part II; 58s-59s.
22.
22. Benton AL, Hamsher KdeS, Varney NR, Spreen OC: Contributions to Neuropsychological Assessment. New York: Oxford University Press, pp.30-43, 1983.
23.
23. Lezak MI: Complex Figure Test. In: Lezak MI. Neuropsychological Assessment. New York: Oxford University Press, 1983, pp. 39-402, 444-447.
24.
24. Moore V, Wyke MA: Drawing disability in patients with senile dementia. Psychol Med. 1984; 14: 97-105.
25.
25. Kirk A, Kertesz A: On drawing impairment in Alzheimer's disease. Arch Neurol. 1991; 48: 73-77.
27. Grossi, Orsini A, Modafferi A, Liotti M: Visuoimaginal constructional apraxia: On a case of selective deficit of imagery. Brain Cogn. 1986; 5: 255-267.
28.
28. Kirk A, Kertesz A: Hemispheric contributions to drawing. Neuropsychologia. 1989; 27: 881-886.
29.
29. DeRenzi E, Faglionii P: The relationship between visuospatial impairment and constructional apraxia. Cortex. 1967; 3: 327-342.
30.
30. McFie J, Zangwill OL: Visual-constructive disabilities associated with lesions of the left cerebral hemisphere. Brain. 1960; 83: 243-260.
31.
31. Sulman K, Shedletsky R, Silver I: The challenge of time: Clock drawing and cognitive function in the elderly. International Journal of Geriatric Psychiatry. 1986; 1: 135-140.
32.
32. Wolf-Klein G, Silverstone F, Levy A, et al: Screening for Alzheimer's disease by clock drawing.J Am Geriatr Soc. 1989; 37: 730-734.
33.
33. Sunderland T, Hill JL, Mellow AM, et al: Clock drawing in Alzheimer's disease: A novel measure of dementia severity. J Am Geriatr Soc. 1989; 37: 725-729.
34.
34. Erkinjuntti T, Ketonen L, Sulkava R, Sipponen J, Vuorialho M, livanainen M: Do white matter changes on MRI and CT differentiate vascular dementia from Alzheimer's disease?JNeurol Neurosurg Psychiatry. 1987; 50: 37-42.
35.
35. Hachinski VC, Iliff LD, Zilhka L, et al: Cerebral flow in dementia. Arch Neurol. 1975; 32: 632-637.
36.
36. Yesavage JA, Brink TL, Rose TL, et al: Development and validation of a geriatric depression screening scale: A preliminary method for grading the cognitive state of patients for the clinician. J Psychiatry Res. 1975; 12: 189-198.
37.
37. Price S, Birge SJ, Riggs K, Michasel M: Implications of formal assessment of cognition and depresion. Gerontologist. 1990; 30: 225A-225A.
38.
38. Death J, Douglas A, Kenny RA: Comparison of clock drawing with Mini-Mental Status Examination, as a screening test in elderly acute hospital admissions. Postgrad Med J. 1993; Sep 69 (815): 696-700.
