Digital Clock Drawing Test (dCDT) technology enables the examination of detailed neurocognitive behavior as behavior unfolds in real time; a capability that cannot be obtained using a traditional pen and paper testing format.
Objective:
Parameters obtained from the dCDT were used to investigate neurocognitive constructs related to higher-order neurocognitive decision making and information processing speed. The current research sought to determine the effect of age as related to combined motor and non-motor components of drawing, and higher-order decision making latencies.
Methods:
A large group of stroke- and dementia- free Framingham Heart Study participants were administered the dCDT to command and copy with hands set for “10 after 11”. Six age groups (age range 28–98) were constructed.
Results:
Differences between age groups were found for total time to completion, total pen stroke count, and higher-order decision making latencies in both command and copy test conditions.
Conclusion:
Longer age-related decision making latencies may reflect a greater need for working memory and increased self-monitoring in older subjects. These latency measures have potential to serve as neurocognitive biomarkers of Alzheimer’s disease and other insidious neurodegenerative disorders.
LibonDJ, KaplanE, SwensonR, PenneyDL (2010) Clock Drawing. In The Encyclopedia of Clinical Neuropsychology, KreutzerJ, DeLucaJ, CaplanB, eds. Springer, New York.
2.
CosentinoS, JeffersonAJ, ChuteDL, KaplanE, LibonDL (2004) Clock drawing errors in dementia: Neuropsychological and neuroanatomic considerations. Cogn Behav Neurol17, 74–83.
3.
ShulmanKI (2000) Clock-drawing: Is it the ideal cognitive screening test?. Int J Geriatr Psychiatry15, 548–561.
4.
FreedmanM, LeachL, KaplanE, WinocurG, ShulmanKI, DelisD (1994) Clock drawing: A neuropsychological analysis. Oxford University Press, New York.
5.
LibonDJ, MalamutBL, SwensonR, SandsLP, CloudBS (1996) Further analysis of clock drawings among demented and nondemented older subjects. Arch Clin Neuropsychol11, 193–205.
ShulmanK, ShedletskyR, SilverI (1986) The challenge of time: Clock-drawing and cognitive function in the elderly. Int J Geriatr Psychiatry1, 135–140.
8.
BrodatyH, MooreCM (1997) The Clock Drawing Test for dementia of the Alzheimer’s type: A comparison of three scoring methods in a memory disorders clinic. Int J Geriatr Psychiatry12, 619–627.
JorgensenK, KristensenMK, WaldemarG, VogelA (2015) The six-item Clock Drawing Test –reliability and validity in mild Alzheimer’s disease. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn22, 301–311.
11.
LibonDJ, SwensonR, BarnoskiE, SandsLP (1993) Clock drawing as an assessment tool for dementia. Arch Clin Neuropsychol8, 405–416.
12.
SeichepineDR, NeargarderS, DavidsdottirS, ReynoldsGO, Cronin-GolombA (2015) Side and type of initial motor symptom influences visuospatial functioning in Parkinson’s disease. J Parkinsons Dis5, 75–83.
13.
SallamK, AmrM (2013) The use of the Mini-Mental State Examination and the Clock-Drawing Test for dementia in a tertiary hospital. J Clin Diagn Res7, 484–488.
14.
PriceCC, CunninghamH, CoronadoN, FreedlandA, CosentinoS, PenneyDL, PenisiA, BowersD, OkunMS, LibonDJ (2011) Clock drawing in the Montreal Cognitive Assessment: Recommendations for dementia assessment. Dement Geriatr Cogn Disord31, 179–187.
15.
De PandisMF, GalliM, VimercatiS, CimolinV, De AngelisMV, AlbertiniG (2010) A new approach for the quantitative evaluation of the Clock Drawing Test: Preliminary results on subjects with Parkinson’s disease. Neurol Res Int2010, 283890.
16.
DavisR, PenneyDL (2014) U.S. Patent No. 8,740,819. U.S. Patent And Trademark Office, Washington, DC.
17.
SalthouseTA (1996) The processing-speed theory of adult age differences in cognition. Psychol Rev103, 403–428.
18.
DavisR, LibonD, AuR, PitmanD, PenneyDL (2014) THink: Inferring Cognitive Status from Subtle Behaviors. Proceedings of the Conference on Innovative Applications of Artificial Intelligence, Québec City, Québec, Canada; 2014, pp. 2898–2905.
19.
CohenJ, PenneyDL, DavisR, LibonDJ, SwensonRA, AjiloreO, KumarA, LamarM (2014) Digital Clock Drawing: Differentiating “thinking” versus “doing” in younger and older adults with depression. J Int Neuropsychol Soc20, 920–928.
20.
LibonDJ, PenneyDL, LamarM, PriceCC, SwensonR, EppigJ, NievesC, GarrettKD, DavisR (2011) Assessing constructional decision making and response latencies to differentiate patients with dementia and mild cognitive impairment (MCI) using new digital technology. In Neuropsychology and Vascular Cognitive Impairment: Combining Neuropsychological Assessment, Digital Technology, and Brain Imaging to Differentiate Between Dementia, Depression, and Mild Cognitive Impairment, LibonDJ, ed. Symposium Presented at the 5th Biannual Meeting of The International Society of Vascular Behavioural and Cognitive Disorders (VAS-COG), Lille, France.
21.
LibonDJ, PenneyDL, DavisR, TabbyDS, EppigJ, NievesC, BlochA, DonohueJB, BrennanL, RifeKL, WicasG, LamarM, PriceCC, AuR, SwensonR, GarrettKD (2014) on behalf of the Clock Sketch Consortium. Deficits in processing speed and decision making in relapsing-remitting multiple sclerosis: The Digit Clock Drawing Test (dCDT). J Mult Scler1, 1–8.
22.
PenneyDL, LibonDJ, AuR, LamarM, PriceCC, SwensonR, MacaulayC, GarrettKD, DevineS, Delano-WoodL, ScalaS, FlanaganA, DavisR (2014) Working harder but producing less: The DigitalClock Drawing Test (dCDT) differentiates amnestic mild cognitiveimpairment and Alzheimer’s disease. Abstract presented at the 42ndannual meeting of the International Neuropsychological Society, Seattle, Washington.
23.
KannelWB, McGeeDL (1979) Diabetes and cardiovascular risk factors: The Framingham Study. Circulation59, 8–13.
24.
SplanskyGL, CoreyD, YangQ, AtwoodLD, CupplesLA, BenjaminEJ, D’AgostinoRBSr, FoxCS, LarsonMG, MurabitoJM, O’DonnellCJ, VasanRS, WolfPA, LevyD (2007) The third generation cohort of the National Heart, Lung, and Blood Institute’s Framingham Heart Study: Design, recruitment, and initial examination. Am J Epidemiol165, 1328–1335.
25.
BentonA, TranelD (1993) Visuoperceptual, visuospatial, and visuoconstructional disorders. In Clinical neuropsychology (3rd edition), HeilmanKM, ValenstienE, eds. Oxford University Press, New York.
26.
KaplanE (1988) A process approach to neuropsychological assessment. In Clinical neuropsychology and brain function: Research, measurement, and practice, BollT, BryantBK, eds. American Psychological Association, Washington, DC.
27.
KaplanE (1990) The process approach to neuropsychological assessment of psychiatric patients. J Neuropsychiatry Clin Neurosci2, 72–87.
28.
EhrekeL, LuckT, LuppaM, KönigHH, VillringerA, Riedel-HellerSG (2011) Clock drawing test - screening utility formild cognitive impairment according to different scoring systems:Results of the Leipzig Longitudinal Study of the Aged (LEILA 75+). Int Psychogeriatr23, 1592–1601.
29.
KatoY, NarumotoJ, MatsuokaT, OkamuraA, KoumiH, KishikawaY, TerashimaS, FukuiK (2013) Diagnostic performance of a combination of Mini-Mental State Examination and Clock Drawing Test in detecting Alzheimer’s disease. Neuropsychiatr Dis Treat9, 581–586.
30.
NessetM, KerstenH, UlsteinID (2014) Brief Tests such as the Clock Drawing Test or Cognistat can be useful predictors of conversion from MCI to dementia in the clinical assessment of outpatients. Dement Geriatr Cogn Dis Extra4, 263–270.
31.
Souillard-MandarW, DavisR, RudinC, AuR, LibonDJ, SwensonR, PriceCC, LamarM, PenneyDL (2016) Learning classification models of cognitive conditions from subtle behaviors in the Digital Clock Drawing Test. Mach Learn102, 393–441.
32.
HenriksenK, O’BryantSE, HampelH, TrojanowskiJQ, MontineTJ, JerominA, BlennowK, LonneborgA, Wyss-CorayT, SoaresH, BazenetC, SjogrenM, HUW, LovestoneS, KarsdalMA, WeinerMW; Blood-Based Biomarker Interest Group (2014) The future of blood-based biomarkers for Alzheimer’s disease. Alzheimers Dement10, 115–131.
33.
PalmqvistS, HertzeJ, MinthonL, WattmoC, ZetterbergH, BlennowK, LondosE, HanssonO (2012) Comparison of brief cognitive tests and CSF biomarkers in predicting Alzheimer’s disease in mild cognitive impairment: Six-year follow-up study. PLoS One7, e38639.
