Graduate School, Hebei Medical University , Shijiazhuang, China.
Department of Neurology, Hebei General Hospital , Shijiazhuang, China.
J Clin Exp Neuropsychol. 2020 Aug;42(6):622-633. doi: 10.1080/13803395.2020.1793104. Epub 2020 Jul 22.
The clock-drawing test (CDT) has been used as a screening tool to identify cognitive deficit in patients with dementia. However, it has not been extensively evaluated for categorizing patients with vascular mild cognitive impairment (vMCI). This study aimed to examine the discrimination of vMCI using various CDT scoring methods.
A total of 120 vMCI patients and 119 normal control (NC) subjects were tested using three CDT quantitative scoring systems: the one from the Montreal Cognitive Assessment (MoCA) (CDT3) and the systems of Rouleau (CDT10) and Babins (CDT18). We used a revised scoring method to evaluate the effectiveness in differentiating vMCI patients from NC subjects, which combined the CDT10 quantitative score and three qualitative errors with a significantly higher prevalence in vMCI group (called hereinafter CDTcomb, including CDTcomb13 and CDTcomb16 based on different weights of the three error types). The sensitivity and specificity of the CDT methods were determined by the receiver operating characteristic (ROC) curve. The results of the scoring systems were compared with those of the Mini-Mental State Examination (MMSE).
The results of the ROC analyses with the CDT3, CDT10, and CDT18 systems produced a sensitivity of 71.1%, 81.8%, and 60.3%, and a specificity of 66.12%, 58.68%, and 73.55%, respectively, for the diagnosis of vMCI. Compared with the separate MMSE score, the combination of MMSE with the CDT3, CDT10 and CDT18 scores did not increase the sensitivity and specificity. When three qualitative errors were incorporated into the CDT10 quantitative score, CDTcomb13 and CDTcomb16 provided a sensitivity of 87.6% and 86.78%, and a specificity of 74.79% and 80.67%, respectively, in differentiating vMCI patients from the NC group.
Our findings suggest that the combination of CDT quantitative score with qualitative observations of the clock-drawing errors can provide a better discrimination between vMCI patients and cognitively normal subjects.
画钟测验（CDT）已被用作一种筛查工具，以识别痴呆患者的认知缺陷。然而，它尚未在血管性轻度认知障碍（vMCI）患者的分类中得到广泛评估。本研究旨在使用各种 CDT 评分方法来检验 vMCI 的区分能力。
对 120 名 vMCI 患者和 119 名正常对照组（NC）受试者进行了三种 CDT 定量评分系统的测试：来自蒙特利尔认知评估（MoCA）的 CDT3 和 Rouleau（CDT10）系统和 Babins（CDT18）系统。我们使用一种改进的评分方法来评估区分 vMCI 患者和 NC 受试者的效果，该方法结合了 CDT10 定量评分和三种在 vMCI 组中更为常见的定性错误（以下简称 CDTcomb，包括基于三种错误类型不同权重的 CDTcomb13 和 CDTcomb16）。CDT 方法的敏感性和特异性通过接受者操作特征（ROC）曲线确定。评分系统的结果与简易精神状态检查（MMSE）的结果进行了比较。
CDT3、CDT10 和 CDT18 系统的 ROC 分析结果分别产生了 71.1%、81.8%和 60.3%的敏感性和 66.12%、58.68%和 73.55%的特异性，用于诊断 vMCI。与单独的 MMSE 评分相比，将 MMSE 与 CDT3、CDT10 和 CDT18 评分相结合并未提高敏感性和特异性。当将三种定性错误纳入 CDT10 定量评分中时，CDTcomb13 和 CDTcomb16 分别在区分 vMCI 患者和 NC 组时提供了 87.6%和 86.78%的敏感性和 74.79%和 80.67%的特异性。
我们的研究结果表明，CDT 定量评分与画钟错误的定性观察相结合，可以更好地区分 vMCI 患者和认知正常的受试者。
