Kanchanatawan Buranee, Jitapunkul Sutthichai, Supapitiporn Siriluk, Chansirikarnjana Sirintorn
Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2006 Aug;89(8):1150-6.
The present paper was to study the validity of screening dementia among Thai elderly by clock drawing test (CDT).
The scoring method selected to apply with CDT was Chula clock-drawing scoring system (CCSS) that was originally developed as clinically-based in Thai elderly patients. The 669 elderly subjects gathered from "Rom Klao" community in Bangkok, Thailand were asked to perform CDT and be examined by a neurologist, using NINCDS-ADRDA diagnosis criteria for probable Alzheimer's disease (AD). CDT was scored by psychiatrists using CCSS.
The authors found the demented by clinical diagnosis in 25 cases. Using a CCSS cutoff score of 7, CDT produced positive test results in 191 subjects. Sensitivity was 88%, the specificity was 74% and the area under receiver operation characteristics (ROC) curve was 0.91. The results also showed that comparatively to cutoff point 7, a cutoff point 6 would contribute the higher specificity of 82% and have a similar sensitivity of 88% in this community-based sample.
The present study provided strong support that CDT scoring by CCSS is efficient to screen dementia in the general community with satisfactory sensitivity and specificity. However modifying the CCSS cutoff score from 7 to 6 increases the specificity and is proposed to be applied in the community.
本文旨在研究通过画钟试验（CDT）对泰国老年人进行痴呆筛查的有效性。
选择应用于CDT的评分方法是朱拉画钟评分系统（CCSS），该系统最初是基于泰国老年患者的临床情况开发的。从泰国曼谷“隆考”社区收集的669名老年受试者被要求进行CDT，并由神经科医生根据美国国立神经疾病和中风研究所 - 阿尔茨海默病及相关疾病协会（NINCDS - ADRDA）可能的阿尔茨海默病（AD）诊断标准进行检查。CDT由精神科医生使用CCSS进行评分。
作者通过临床诊断发现25例痴呆患者。使用CCSS临界值7时，CDT在191名受试者中产生了阳性检测结果。敏感性为88%，特异性为74%，受试者操作特征（ROC）曲线下面积为0.91。结果还表明，在这个基于社区的样本中，与临界值7相比，临界值6将使特异性提高到82%，敏感性相似，为88%。
本研究提供了有力支持，即使用CCSS对CDT进行评分在普通社区筛查痴呆方面具有较高的效率，敏感性和特异性令人满意。然而，将CCSS临界值从7改为6可提高特异性，并建议在社区中应用。
