Storey Joella E, Rowland Jeffrey T J, Basic David, Conforti David A
Aged Care Unit, Liverpool Hospital, Sydney, Australia.
Int Psychogeriatr. 2002 Sep;14(3):259-71. doi: 10.1017/s1041610202008463.
To assess the accuracy of clock drawing for detecting dementia in a multicultural, non-English-speaking-background population.
A prospective cohort study.
A general geriatric medical outpatient clinic in southwest Sydney, Australia.
Ninety-three consecutive new patients to the clinic who had a non-English-speaking-background country of birth (mean age 78.0 years).
The clock drawing test was conducted at the beginning of each clinic visit by a blinded investigator. Each patient was then assessed by a geriatrician who collected demographic data, administered the Modified Barthel Index, the Geriatric Depression Scale, and the Folstein Mini-Mental State Examination, and categorized each patient as normal or demented, according to DSM-IV criteria. Interpreters were used for participants who spoke a language other than English or who requested them. Each clock drawing was scored according to the 4-point CERAD scale and the previously published methods of Mendez, Shulman, Sunderland, Watson, and Wolf-Klein. Scoring was evaluated for reliability and predictive accuracy, using receiver operating characteristic (ROC) curve analysis. Logistic regression analysis was used to assess the potential interaction between level of education and each of the clock scoring methods.
Using ROC curve analysis, there was no significant difference between the clock scoring methods (area under the curve varied from 0.60 to 0.72). The most sensitive was the Mendez scoring method (98%), with a specificity of 16%. Specificity above 50% was found only for the Wolf-Klein method, with an intermediate sensitivity of 78%.
There were no significant differences in the clock scoring methods used to detect dementia. Performance of the clock drawing test was modest at best with low levels of specificity across all methods. Scored according to these methods, clock drawing was not a useful predictor of dementia in our multicultural population.
评估在多文化、非英语背景人群中，画钟测试检测痴呆症的准确性。
前瞻性队列研究。
澳大利亚悉尼西南部的一家普通老年医学门诊。
93名连续就诊的新患者，他们出生于非英语背景国家（平均年龄78.0岁）。
在每次门诊就诊开始时，由一名不知情的研究人员进行画钟测试。然后由一名老年病科医生对每位患者进行评估，收集人口统计学数据，进行改良巴氏指数、老年抑郁量表和福林简易精神状态检查表测试，并根据《精神疾病诊断与统计手册》第四版标准将每位患者分类为正常或痴呆。对于说英语以外语言或要求使用翻译的参与者，使用了翻译人员。根据4分制CERAD量表以及先前发表的门德斯、舒尔曼、桑德兰、沃森和沃尔夫 - 克莱因的方法对每幅画钟进行评分。使用受试者工作特征（ROC）曲线分析评估评分的可靠性和预测准确性。采用逻辑回归分析评估教育水平与每种画钟评分方法之间的潜在相互作用。
使用ROC曲线分析，画钟评分方法之间无显著差异（曲线下面积从0.60到(0.72)不等）。最敏感的是门德斯评分方法（98%），特异性为16%。仅沃尔夫 - 克莱因方法的特异性高于50%，中等敏感性为78%。
用于检测痴呆症的画钟评分方法之间无显著差异。画钟测试的表现充其量一般，所有方法的特异性都较低。按照这些方法评分，画钟测试在我们的多文化人群中并非痴呆症的有用预测指标。
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