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Original Article
Dementia and Neurocognitive Disorders 2018: 17: 3: 1-10

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Usefulness of the Clock Drawing Test as a Cognitive Screening Instrument for Mild Cognitive Impairment and Mild Dementia: an Evaluation Using Three Scoring Systems
Sangsoon Kim , 1 Seungmin Jahng , 2 Kyung-Ho Yu , 3 Byung-Chul Lee , 3 Yeonwook Kang
1 Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Korea 2 Department of Psychology, Sungkyunkwan University, Seoul, Korea 3 Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea 4 Department of Psychology, Hallym University, Chuncheon, Korea
Usefulness of the Clock Drawing Test as a Cognitive Screening Instrument for Mild Cognitive Impairment and Mild Dementia: an Evaluation Using Three Scoring Systems
Sangsoon Kim , 1 Seungmin Jahng , 2 Kyung-Ho Yu , 3 Byung-Chul Lee , 3 Yeonwook Kang
1 Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Korea 2 Department of Psychology, Sungkyunkwan University, Seoul, Korea 3 Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Korea 4 Department of Psychology, Hallym University, Chuncheon, Korea
Background and Purpose: Although 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.
Methods: Patients 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.
Results: On 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.
Conclusions: The 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.
Key Words: Clock Drawing Test; Mini Mental State Examination; Mild Cognitive Impairment; Alzheimer's Disease; Vascular Dementia
대한치매학회지 (Dementia and Neurocognitive Disorders)