Durmaz Celik Nazli, Topal Aydan, Kuzu Kumcu Muge, Ozkan Serhat, Tezcan Aydemir Sabiha
Department of Neurology, Osmangazi University Faculty of Medicine, Eskisehir, Türkiye.
Department of Neurology, Samsun Training and Research Hospital, Samsun, Türkiye.
Sisli Etfal Hastan Tip Bul. 2024 Sep 30;58(3):381-388. doi: 10.14744/SEMB.2024.94758. eCollection 2024.
Cognitive impairment is a prevalent non-motor symptom of Parkinson's disease (PD), significantly impacting patient quality of life. The Clock Drawing Test (CDT) evaluates cognitive abilities, including planning, organization, and executive functions such as attention, memory, and visuospatial skills. This study aimed to determine the sensitivity of the CDT in diagnosing cognitive impairment in PD.
We reviewed the records of 44 PD patients (16 female, 28 male) diagnosed with dementia (30 patients) or mild cognitive impairment (14 patients) between 2018 and 2022. These patients were compared to 106 visitors to the neurological outpatient clinic, serving as a control group. A separate researcher assessed the patients' CDT scores, maintaining confidentiality of all other patient data except age and education level.
Among the 44 PD patients, two with mild cognitive impairment were rated as normal, while all PD dementia cases were identified solely through the CDT. In the healthy control group, 72 out of 106 individuals reported no cognitive complaints, whereas 34 individuals (32.1%) reported cognitive complaints as assessed by a blind investigator. The CDT demonstrated a positive predictive value of 55.3% and a negative predictive value of 97.3%. Sensitivity was calculated at 95.5%, and specificity was 67.9%.
The findings suggest that the CDT is sensitive in detecting cognitive impairment in PD patients with cognitive deficits. While the CDT serves as an effective rapid screening tool, high scores indicate the absence of cognitive impairment, but low scores alone are insufficient for a definitive diagnosis of dementia. Comprehensive neurological evaluation and detailed cognitive assessment remain essential for confirming dementia diagnoses.
认知障碍是帕金森病（PD）常见的非运动症状，对患者生活质量有显著影响。画钟试验（CDT）可评估认知能力，包括计划、组织以及诸如注意力、记忆力和视觉空间技能等执行功能。本研究旨在确定CDT在诊断PD患者认知障碍方面的敏感性。
我们回顾了2018年至2022年间被诊断为痴呆（30例患者）或轻度认知障碍（14例患者）的44例PD患者（16例女性，28例男性）的记录。将这些患者与106名神经科门诊就诊者进行比较，后者作为对照组。由一名独立研究人员评估患者的CDT分数，除年龄和教育水平外，对所有其他患者数据保密。
在44例PD患者中，2例轻度认知障碍患者被评定为正常，而所有PD痴呆病例均仅通过CDT得以识别。在健康对照组中，106人中有72人报告无认知问题，而有34人（32.1%）经盲法调查者评估报告有认知问题。CDT的阳性预测值为55.3%，阴性预测值为97.3%。敏感性计算为95.5%，特异性为67.9%。
研究结果表明，CDT在检测有认知缺陷的PD患者的认知障碍方面具有敏感性。虽然CDT是一种有效的快速筛查工具，高分表明无认知障碍，但仅凭低分不足以确诊痴呆。全面的神经学评估和详细的认知评估对于确诊痴呆仍然至关重要。
