Department of Psychiatry, Kahramanmaras State Hospital, Turkey.
Compr Psychiatry. 2012 Jan;53(1):81-6. doi: 10.1016/j.comppsych.2011.02.001. Epub 2011 May 14.
The objective of the study was to assess the validity and reliability of the clock drawing test (CDT) in comparison with the Mini-Mental State Examination (MMSE) as a screening tool for cognitive impairment in patients with fibromyalgia (FM).
Fifty female patients with FM and 51 healthy female controls were enrolled in the study. Cognitive functioning of the subjects was evaluated by the CDT and the MMSE. Each CDT was scored according to 3 different clock scoring methods (Shulman, Sunderland, and Watson). Two experienced clinicians scored the CDTs to evaluate the interrater reliability. Validity, sensitivity, specificity, and predictive accuracy of each clock scoring method were analyzed.
The Shulman score had the highest correlation with the MMSE score (r =0.65, P < .01). The Shulman and Sunderland methods had significantly the largest areas under the receiver operating characteristic curve (0.82 and 0.81, respectively; P = .000). They also had the highest sensitivity (68.8% and 65.5%, respectively) and specificity (84.2%, and 84.1%, respectively). The interrater correlation coefficients were high for all 3 clock scoring methods.
The CDT has been proven to be a valid and reliable tool for screening cognitive impairment in FM patients. The Shulman or Sunderland scoring methods are more appropriate than the Watson scoring method. Further studies are needed for using the CDT to detect cognitive impairment in patients with FM.
本研究旨在评估画钟测验（CDT）与简易精神状态检查（MMSE）相比作为纤维肌痛（FM）患者认知障碍筛查工具的有效性和可靠性。
研究纳入了 50 名女性 FM 患者和 51 名健康女性对照者。采用 CDT 和 MMSE 评估受试者的认知功能。根据 3 种不同的时钟评分方法（Shulman、Sunderland 和 Watson）对每个 CDT 进行评分。两位经验丰富的临床医生对 CDT 进行评分，以评估评分者间的可靠性。分析了每种时钟评分方法的有效性、敏感性、特异性和预测准确性。
Shulman 评分与 MMSE 评分相关性最高（r=0.65，P<0.01）。Shulman 和 Sunderland 方法的受试者工作特征曲线下面积显著较大（分别为 0.82 和 0.81，P=0.000）。它们的敏感性（分别为 68.8%和 65.5%）和特异性（分别为 84.2%和 84.1%）也最高。所有 3 种时钟评分方法的评分者间相关性系数均较高。
CDT 已被证明是一种有效的、可靠的工具，可用于筛查 FM 患者的认知障碍。Shulman 或 Sunderland 评分方法比 Watson 评分方法更合适。需要进一步研究 CDT 用于检测 FM 患者的认知障碍。
